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

Survey of antibiotic producing bacteria for antibiotic resistance genes showed the existence of a vast environmental pool of resistance genes with the potential to be captured and amplified in human flora if given the correct circumstances. 3 No wonder that the battle between human use of antimicrobials and development of resistance in microbes started soon after the discovery of sulphonamide and penicillin. Penicillin resistance rapidly emerged in Staphylococcus aureus in the 1940s when penicillin was widely used in humans. 4 While communityacquired penicillin-resistant Streptococcus pneumoniae 5 and extendedspectrum b-lactamase (ESBL)-producing Enterobacteriaceae 6 have been increasingly reported in the last two decades, methicillin-resistant Staphylococcus aureus (MRSA) 7 and vancomycin-resistant Enterococcus (VRE) 8 have now become endemic in many hospitals. Recently, the emergence of carbapenem-resistant Acinetobacter baumannii (CRAB), multidrug-resistant Acinetobacter baumannii 9 and carbapenemase-producing Enterobacteriaceae (CPE) 10, 11 have been reported in many parts of the world. The increasing or persistent trends of MRSA, ESBL-producing Escherichia coli, CRAB and carbapenem-resistant Pseudomonas aeruginosa in a teaching hospital in Hong Kong between 1998 and 2012 are illustrated in Figure 1 .