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.
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.”
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.”
A recent article in the Journal of Infection looks retrospectively at 13 years’ worth of clinical samples to identify pulmonary diseases caused by non-tuberculosis mycobacteria and to estimate what proportion of them were resistant to commonly used antimicrobials. Image credit: Martha L. Warnock, University of California, San Francisco. This image depicts a bronchiole that is almost completely occluded by granulomatous inflammation. Two small lumens remain (arrows). This lesion is frequent in non-tuberculous mycobacterial infections in the non-immunocompromised, where it may be associated with bronchiectasis. (Image credit)