Carbapenems are relatively expensive, second or third line antibiotics which are used in infections caused by antibiotic resistant bacteria. However, results from the Resistance Map project conducted by the Center for Disease Dynamics, Economics and Policy (CDDEP) has shown that the use of carbapenems is on the rise in India, mainly driven by rampant prescribing in healthcare settings accompanied by ready, over-the-counter availability without prescriptions or with invalid prescriptions. Given this rise in the consumption of carbapenems, it is logical to hypothesise that the number of carbapenem resistant bacterial infections should be on the rise. In fact, in the developed world, Carbapenem Resistant Enterobacteriaceae have become a major source of concern. In India, although the proportion of samples reported to bear Carbapenem Resistant Escherichia coli has remained relatively stable over the past decade or so, there has been a distressing rise in the proportion of Carbapenem Resistant Klebsiella. Given this scenario, an interesting study has come out in a recent issue of the CDC’s Emerging Infectious Diseases journal that talks about carbapenem resistance in a bacterial genus which has not been in the resistance discourse – Vibrio.
Bovine Tuberculosis (bTB) is generally viewed as a disease of cattle and domesticated bovines. However, there are cycles of spillover of the agent which function in certain niches, especially in peri-sylvatic ecosystems where interactions between domesticated bovines and wild cervids (deer) or other wild bovines (wildbeeste) may create vulnerabilities. Since it is especially difficult to monitor the disease in wild populations, such spillovers may be difficult to detect and have extensive impact before effective interventions are implemented. The identification of bTB in wild cervids in South Eastern Indiana in the United States thus serves as a reminder of this difficult issue.
From the State of the World’s Antibiotics 2015 report from the Center of Disease Dynamics, Economics and Policy:
“Antibiotics are amongst the most familiar medicines and are used liberally by people all over the world. The societal consequences of the loss of effectiveness is of little concern to the individual user or prescriber, since resistance affects the next patient. These characteristics combine to foster gross antibiotic overuse and accelerate antibiotic resistance.”
This figure shows the incidence of ehrlichicosis cases by state in 2010 per million persons. Ehrlichiosis was not notifiable in Alaska, Colorado, the District of Columbia, Hawaii, Idaho, Iowa, Nevada, New Mexico, North Dakota or Montana. The incidence rate was zero for Arizona, Connecticut, Indiana, Massachusetts, Oregon, South Dakota, Utah, Vermont, Washington, and Wyoming. Incidence ranged between 0.03 to 1 case per million persons for California, Florida, Louisiana, Michigan, Ohio, Pennsylvania, Rhode Island and Texas. Annual incidence ranged from 1 to 3.3 cases per million persons in Alabama, Georgia, Illinois, Kansas, Maine, Minnesota, Mississippi, Nebraska, New Hampshire, New York, South Carolina and West Virginia. The highest incidence rates, ranging from 3.3 to 26 cases per million persons were found in Arkansas, Delaware, Kentucky, Maryland, Missouri, New Jersey, North Carolina, Oklahoma, Tennessee, Virginia, and Wisconsin.
Image and text credit: The US Centers for Disease Control and Prevention webpage on Statistics and Epidemiology of Ehrlichiosis. Link
Ehrlichiosis is caused by three species of bacteria belonging to the genus Ehrlichia: E. chaffeensis, E. ewingii and the provisionally named E. muris like (EML). A recent article in the CDC’s EID indicates that the proportion of cases attributable to E. ewingii may be higher than what we initially knew it to be.
An article published in The Lancet today has highlighted the possibility of establishing a World Serology Bank to better understand the dynamics of infectious disease dynamics, especially in an era where vaccinations against infectious diseases is becoming more and more prevalent. With rapid advance in diagnostic technologies, there has been impressive progress in what used to be tedious and time consuming tests. Now, using multiplex technology, a number of samples can be tested at one go, often for a number of pathogens, therefore, cutting the time requirement exponentially! However, it essentially remains a developed world solution for a problem that largely affects low and middle income countries. Image Credits: MedPage Today
Glenn Tillotson, commenting on the Jim O’Neill report (1) in a short article in the Lancet Infectious Diseases has proposed additional frameworks to contain antimicrobial resistance. (2) The O’Neill report, titled “Review on antimicrobial resistance. Securing new drugs for future generations: the pipeline for antibiotics.” is one of the most intensively researched documents into the emerging problem. Tillotson acknowledged the importance of the O’Neill report, stating:
“The latest report1 by Jim O’Neill and colleagues regarding the parlous state of antibiotic resistance and its effects—both financial and societal—has grabbed the bull by the horns and clearly stated the obvious, but essential, points of the economic reality of antibiotic development.”