Abstract
A review of the literature was undertaken to delineate the current level and mechanisms of resistance to carbapenems, colistin, and tigecycline in South Africa. Thirty-two English publications and 32 National Institute of Communicable Diseases communiqués identified between early January 2000 and 20 May, 2016 showed substantial reports of NDM (n = 860), OXA-48 (n = 584), VIM (n = 131), and IMP (n = 45) carbapenemases within this period, mainly in Klebsiella pneumoniae (n = 1138), Acinetobacter baumannii (n = 332), Enterobacter cloacae (n = 201), and Serratia marcescens (n = 108). Colistin and tigecycline resistance was prevalent among K. pneumoniae, A. baumannii, S. marcescens, and E. cloacae. The first mcr-1 colistin resistance gene to be detected in South Africa was reported in Escherichia coli from livestock as well as from hospitalized and outpatients. There are increasing reports of NDM and OXA-48 carbapenemases among Enterobacteriaceae and A. baumannii in South Africa. Mcr-1 is now present in South African patients and livestock. Resistance to carbapenems, colistin, and tigecycline restricts infection management options for clinicians.
Highlights
The inexorable adaptations of bacteria to the therapeutic effects of antibiotics, with its grave implications, are dawning upon the world. This is witnessed in the increasing awareness being created by the WHO and EU about antibiotic resistance, through the formers’ global/regional antibiotic surveillance reports (1, 2)
Resistance to Last-Resort Antibiotics in South Africa instituted by both organizations (3), while efforts to engage policy makers and governments (4), clinicians, and patients in antibiotic stewardship have increased concomitantly (1, 2)
The effect of antibiotic use in livestock production on clinical medicine was a subject of debate (5)
Summary
The inexorable adaptations of bacteria to the therapeutic effects of antibiotics, with its grave implications, are dawning upon the world. This is witnessed in the increasing awareness being created by the WHO and EU about antibiotic resistance, through the formers’ global/regional antibiotic surveillance reports (1, 2). The effect of antibiotic use in livestock production on clinical medicine was a subject of debate (5). The detection of mcr-1 colistin resistance gene in swine, pork, imported chicken (in Denmark), and hospitalized patients has helped settle the argument that antibiotics use in veterinary medicine, as growth promoters, can be a source of resistance genes in human pathogenic bacteria (6, 7). The concept of “One Health” that triangulates clinical, environmental, and veterinary antibiotic resistance surveillance and molecular epidemiological studies as a means to containing resistance is gaining grounds (8)
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