Antibiotic resistance in the Western Pacific Region: a systematic review

Abstract

Purpose: There have been increasing reports of bacteria carrying antibiotic-resistant genes discovered in the Western Pacific Region (WPR) in recent years. However, the impact on human health of these resistant pathogens has not been well documented due to the lack of region-wide and national surveillance programs on antimicrobial resistance (AMR) in the region. The objective of this review is to systematically review published evidence on the prevalence of AMR in selected bacterial pathogens in the region over the past 15 years. Methods & Materials: A literature search for published data on AMR in eight selected pathogens (methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, Enterococcus faecalis, Haemophilus influenzae, Klebsiella pneumoniae, Neisseria gonorrhoeae, Pseudomonas aeruginosa, and Streptococcus pneumoniae) was conducted on bibliographic database PubMed for five pre-selected locations in the WPR, namely mainland China, Japan, Australia, the Republic of Korea and Hong Kong. Results: Our search identified 4,674 articles, 207 of which reported the prevalence of the eight selected pathogens in the five pre-selected locations. There were 43 studies on E. coli, 41 on MRSA, 25 on K. pneumoniae, 25 on N. gonorrhoeae, 24 on P. aeruginosa, 24 on S. pneumoniae, 15 on H. influenza, and 10 on E. faecalis. In the five selected locations, greatest levels of resistance were reported for E. coli (33.7% - 93.3% against ampicillin) and S. pneumoniae (4.1% - 97% against erythromycin). High prevalence of MRSA was recorded in the region over the past 15 years (up to 73% in Korea, 69% in Hong Kong, 64.8% in China, and 63.4% in Japan), with the exception of Australia (16% - 30.3%). Moderate to high levels of resistance against third-generation cephalosporins were reported in P. aeruginosa, and high levels of resistance against penicillin and fluoroquinolones were also reported in N. gonorrhoeae. Conclusion: Generally, high prevalences of antibiotic resistance were identified in the 5 selected locations in the WPR, particularly in E. coli, N. gonorrhoeae, P. aeruginosa, and S. pneumoniae. However, longitudinal trends of antibiotic resistance in any of the selected pathogens were difficult to determine as most published data were generated from cross-sectional studies and few were from systematic surveillance through national or region-wide networks.