Title: Widespread MultiAntimicrobialResistant Shigella in Asia: What Does It Mean
1Widespread Multi-Antimicrobial-Resistant Shigella
in Asia What Does It Mean?
Chiang Mai, Thailand March 30 April 2, 2004
Second International Conference on Improving Use
of Medicines
- Okumura J1), Osaka K2), Okabe N2)
- University of Tokyo
- National Institute of Infectious Diseases, Japan
2Background
- Despite immense efforts to contain antimicrobial
resistance (AMR), development of resistant
microbes has been accelerated. - For example, Shigella sonnei, spread by
travelers, illustrates the problems caused by
resistant microbes and the urgency of its
containment.
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3Objectives
- To understand the trend of development and
distribution of resistant S. sonnei in Asia. - To identify factors by which the world has been
failing to contain AMR, in spite of holding a
number of expert meetings and a mountain of
documents on the agenda. - To seek effective and practical measures to halt
the spread of AMR before it reaches at critical
level.
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4Methods (1)
- Design Retrospective, time series
- Samples
- Imported S. sonnei which were isolated from
travelers at quarantine stations in Japan - 120, 87 and 159 samples each year during the
period of 1997 1999
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5Methods (2)
- Checked AMR of the isolated S. sonnei by
measuring Minimum Inhibitory Concentration (MIC) - By using E-test (AB Biodisk) on agar media
- Antimicrobials are Ampicillin (ABPC),
- Chloramphenicol (CP), Cefotaxime (CTX),
- Fosfomycin (FOM), Levofloxacin (LVFX),
- Norfloxacin (NFLX), Tetracycline (TC),
Sulfamethoxazole-Trimethoprim (ST) - Referred the National Committee for
- Clinical Laboratory Standards
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6Overall trend of AMR
n 120
n 159
n 87
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7Trend and level of AMR in 3 countries
n43
n26
n72
n7
n18
n38
n14
n17
n17
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8Resistance by Antimicrobials in Indonesia
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9Resistance by Antimicrobials Expenditure for
Antimicrobials for Human in Thailand
Million Bhats
FOM Resistant Strain
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10Resistance to 2nd or 3rd line antimicrobials
Multiple Resistance and Susceptibility to FOM
(Unit Strain)
Odds Ratio 10.4 (95 CI 4.0 27.2) Plt0.001
- All the S. sonnei developed resistance to NFLX
also attained resistance to more than three
antimicrobials (Plt0.001).
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11Lessons learned
- In spite of immense efforts to contain AMR during
the last century, the problem has been unsolved
and AMR strains become easily transmitted in the
current highly mobile world. - e.g.1, The World Health Assembly (WHA) Resolution
of 1988 urged member states to take actions to
contain AMR. - e.g.2, The current efficacy of Antimicrobial
Resistance Information Bank (A-R Info Bank) is
questionable. - The velocity of AMR development has been
accelerated hence no effective antimicrobials may
exist in the near future. - There might be accumulated data on AMR in each
country, which are however least likely used for
the purpose of AMR containment.
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12Implications
- Establishment of monitoring and information
sharing systems is urgently needed, which cover
sensitivity of antimicrobials, its consumption
and usage. - The system should be reciprocal one, which can be
accessed by Internet. If Internet access is
difficult, at least quarterly reports should be
distributed. - Strong political commitment and a sense of
urgency of each stakeholder, are needed to
establish and maintain the reciprocal system,
such as smallpox eradication programme.
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13Research Agenda
- For the monitoring system, key microbes should be
determined with considering test cost, required
skill, severity of problems. Also, targeted
antimicrobials should be determined. - The efficacy of the reciprocal monitoring system
should be carefully monitored and evaluated - Baseline data analysis
- Regular submission and utilization of relevant
data - Changes in antimicrobial consumption and AMR
development among key microbes
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14Conclusions
- Before establishing the system, a certain period
is needed for the preparation. However, by
utilizing the existing platform (e.g., national
data on AMR and Antimicrobial consumption in
several countries), it can be initiated shortly
in some regions. - Each country should be responsible for their
antimicrobial use and understand we live in
highly mobile world.
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