Strategic measures for the control of surging antimicrobial resistance in Hong Kong and mainland of China

Cheng, Vincent CC; Wong, Sally CY; Ho, Pak-Leung; Yuen, Kwok-Yung

Control of antibiotic resistance in China VCC Cheng et al 2 the United States. 26 Patients with pneumococal bacteremia and meningitis due to a non-susceptible antibiotic strain have an increased risk of mortality 27, 28 Inadequate initial antimicrobial therapy was shown to be an independent risk factor for mortality in patients with ESBLproducing Enterobacteriaceae infections, as illustrated in two retrospective cohort studies involving almost 400 subjects in the United States and Italy. 29, 30 Mortality following bacteremia caused by ESBLproducing E. coli was significantly higher than non-ESBL-producing E. coli regardless of whether the infection was acquired in the community or in hospitals. 31 In hospital-acquired infections, patients with non-pneumonic MRSA infections had a higher 90-day mortality compared with patients with non-pneumonic methicillin sensitive Staphylococcus aureus infections, independent of the severity of the patients' underlying illnesses. 32 In addition, patients with nosocomial MRSA bacteremia had a crude mortality of 50%, according to a large cohort of 1148 patients over 15 years. 33 Even in critically ill patients, those with MRSA bacteremia had a significantly higher attributable 30-day mortality rate (53.2% vs. 18.4%) and in-hospital mortality rate (63.8% vs. 23.7%) than patients with methicillin sensitive Staphylococcus aureus bacteremia, after accurate adjustment for disease severity. 34 Carbapenem-resistant gram-negative organisms also carried significant mortality in hospitalized patients. The 30-day mortality in patients with CRAB in intensive care units was as high as 80%. 35 Similarly, the in-hospital mortality of patients associated with carbapenem-nonsusceptible Klebsiella pneumoniae and E. coli in intensive care units was found to be 50% in a nationwide multicenter study in Taiwan. 36 Nineteen (29%) of 66 isolates had genes encoding carbapenemases, including KPC-2 (n514), IMP-8 (n51), Verona integronencoded metallo-b-lactamase (VIM) (n53) and NDM-1.