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Widespread MultiAntimicrobialResistant Shigella in Asia: What Does It Mean

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Title: Widespread MultiAntimicrobialResistant Shigella in Asia: What Does It Mean


1
Widespread 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

2
Background
  • 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.

Second International Conference on Improving Use
of Medicines
3
Objectives
  • 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.

Second International Conference on Improving Use
of Medicines
4
Methods (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

Second International Conference on Improving Use
of Medicines
5
Methods (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

Second International Conference on Improving Use
of Medicines
6
Overall trend of AMR
n 120
n 159
n 87
Second International Conference on Improving Use
of Medicines
7
Trend and level of AMR in 3 countries
n43
n26
n72
n7
n18
n38
n14
n17
n17
Second International Conference on Improving Use
of Medicines
8
Resistance by Antimicrobials in Indonesia

Second International Conference on Improving Use
of Medicines
9
Resistance by Antimicrobials Expenditure for
Antimicrobials for Human in Thailand
Million Bhats

FOM Resistant Strain
Second International Conference on Improving Use
of Medicines
10
Resistance 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).

Second International Conference on Improving Use
of Medicines
11
Lessons 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.

Second International Conference on Improving Use
of Medicines
12
Implications
  • 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.

Second International Conference on Improving Use
of Medicines
13
Research 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

Second International Conference on Improving Use
of Medicines
14
Conclusions
  • 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.

Second International Conference on Improving Use
of Medicines
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