Abstract
As in many other developing countries, conditions that may foster antibiotic resistance in Mexico differ from developed countries, and so resistance prevalence. Fecal pollution and other traits of overcrowded, poor cities, might create ideal settings for selecting, exchanging and maintaining resistance traits. Medical abuse of antibiotics, along with low-quality drugs, are also present as in many developing countries. Self-prescription, a common yet unmeasured practice among Mexican population, may also contribute to increased resistance rates. Pneumococcal resistance towards penicillin and macrolides are the highest in Latin American countries, as is resistance of Salmonella and uropathogenic Escherichia coli towards ampicillin and sulfamethoxazole-trimethoprim; about one tenth of isolates of these gram-negative pathogens seem to produce extended-spectrum beta-lactamases (ESBL). High rates of multiple-drug resistant Mycobacterium tuberculosis are also found in Mexico, although there is no report of extensively drug-resistant strains. As to hospital-acquired pathogens, about a third of E. coli and Klebsiella isolates are ESBL-producers, and half of Staphylococcus aureus isolates are resistant to oxacillin (MRSA). Around 40% Pseudomonas aeruginosa isolates are resistant to ceftazidime, imipenem or levofloxacin. Although community-acquired MRSA, vancomycin-resistant enterococci, and other resistance problems found in developed countries, are not as common in Mexico, local issues are no small concern, and are disturbingly moving towards outpatients.
Highlights
Many articles on antibiotic resistance start with a statement about the threat it poses towards public health
The kind of organisms in which resistance is dangerously growing is different: while rich countries are concerned with hospital-acquired pathogens such as the ESKAPE group including Enterococcus, Staphylococcus, Klebsiella, Acinetobacter, Pseudomonas, Enterobacter, poor countries are challenged with multi-resistant pathogens in the community, such as Mycobacterium tuberculosis, pneumococci, uropathogenic Escherichia coli (UPEC) or Salmonella
A surprising 12% of Salmonella isolates were resistant to ceftriaxone; perhaps the worrisome presence of extendedspectrum beta-lactamases (ESBLs) in communityacquired pathogens, mostly reported in enteropathogens in Latin America [21], are already in Mexico
Summary
Many articles on antibiotic resistance start with a statement about the threat it poses towards public health. All these have been very recently reviewed [1], with regard to bacteria, and to other microbial pathogens that are gaining resistance and that pose particular threats to the public health in developing countries. Real or apparent, on the biology of the emergence and spread of resistance genes that will be discussed shortly, there is no reason to believe that there is a significant disparity on the molecular basis of antibiotic resistance between Mexico (or the whole of Latin America) and richer countries.
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