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

The increasing trend of antibiotic consumption in animal husbandry was associated with the spread of antimicrobial resistance. 43 In an earlier study, the intestinal flora of the farm personnel has changed after the use of tetracycline-supplemented feed on a chicken farm. As expected, the intestinal flora of the chicken consisted almost entirely of tetracycline-resistant organisms within one week of starting tetracycline-supplemented feed. Furthermore, 31.3% of the weekly fecal samples from farm dwellers converted to an intestinal flora consisting of greater than 80% of tetracycline-resistant bacteria within 5 to 6 months. Selective pressure by tetracycline-supplemented feed in chickens appeared to extend to human in contact with chickens and the feed, resulting in a change to a predominant tetracycline-resistant intestinal flora. 44 The occurrence of acquired resistance to antimicrobials used for growth promotion among bacteria isolated from swine, cattle and poultry was demonstrated in Denmark during October 1995 to September 1996. 45 In fact, there was a clear and significant increase in the amount of resistance genes in the fecal metagenomes from Spanish, Danish, and American subjects for antibiotics approved for animal use by the Food and Drug Administration of the United States and for other antibiotics that have historically been used in the market. 46 According to a survey in 2007, China produced and consumed the largest quantity of antimicrobials by country. 47 The estimated annual antimicrobial production in China was 210 million kg, and 46% of these were used in the livestock industry. In a recent analysis of antimicrobial consumption in the United States, the estimated annual antibiotic use in livestock was 13.54 million kg, followed by humans (3.29 million kg), aquaculture (0.15 million kg), pets (0.15 million kg) and crops (0.07 million kg), with approximately 80% of antibiotics being consumed in agriculture and aquaculture. 48 The use of antibiotics in human also correlated with increasing isolation of multidrug resistant organisms (MDROs). The association of CRAB infection with hospital antimicrobial usage between 2003 and 2011 was assessed in a tertiary care hospital in northeast China. It was found that the rates of CRAB increased significantly from 11.3% to 59.1%. The quarterly use of carbapenems, but not other classes of antibiotics, was correlated strongly with the increase of quarterly isolation of CRAB (b51.661; P,0.001). 49 Similarly, a significant increase in the usage of carbapenems was strongly correlated with the isolation of imipenem-and meropenem-resistant P. aeruginosa (P,0.001). 50 Such high incidences of MDROs are likely to be related to the inappropriate use of antimicrobial agents in mainland China. A study conducted in mainland China-the first of its kind-examined 230 800 prescriptions written between 2007 and 2009 at 784 community health institutions in 28 cities across China and revealed substantial overprescribing, including twice as many prescriptions for antibiotics as recommended by the WHO. 51 Another observational study conducted in the Sichuan province, an agricultural and economically developing province in western China, collected and analyzed a total of 3059 prescriptions from 30 township health centers. Approximately 85% of the prescriptions contained antibiotics, of which 25% contained Control of antibiotic resistance in China VCC Cheng et al 3 two or more types of antibiotics. Such irra