World Health Day 2011–Antimicrobial Resistance: No Action Today, No Cure Tomorrow

Abstract

The World Health Organization (WHO) has recently announced that the global phenomenon of antimicrobial resistance will be the theme of World Health Day 2011.1 The campaign, which aims to safeguard medicines for future generations, will call on governments around the world to implement policies to prevent the emergence of highly resistant “superbugs”.1,2 Asia remains the epicenter of resistant superbugs.3,4 In Taiwan, there is an alarmingly high prevalence of penicillin-resistant Streptococcus pneumoniae, community-acquired and hospitalacquired methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae, multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii, as well as penicillinand fluoroquinolone-resistant Neisseria gonorrhoeae. Fluoroquinolone-resistant E coli and Salmonella species, particularly S enterica serotype Choleraesuis, are found not only in humans but also in animals. Azole-resistant Candida species, especially C glabrata, are prevalent in hospitals throughout Taiwan.3,4 In addition, the persistence of multidrug-resistant and the emergence of extensively drug-resistant Mycobacterium tuberculosis pose great challenges to public health.3 Community-acquired MRSA clones including ST59-MRSA-SCCmec type IV-spa type t437, ST30MRSA-SCCmec type IV-spa type t019, and ST72MRSA-SCCmec type IV-spa type t324 predominate in Asian countries. Previously established hospitalacquired MRSA strains including sequence type (ST)239 and ST5 clones have been found among community-acquired MRSA isolates from patients without any risk factors for hospital-acquired MRSA infection. Community-acquired MRSA clones such as ST59, ST30, and ST72 have also been isolated from patients with hospital-acquired infections.5 Various MRSA clones have spread between the community and hospitals as well as between countries.5 A few extensively drug-resistant A baumannii clones have disseminated throughout most hospital settings in Asia.3,4 Even more alarming is the recent emergence in Taiwan of carbapenemresistant Enterobacteriaceae, including those possessing New Delhi metallo-β-lactamase-1 and K pneumoniae carbapenemase.6 Antimicrobial resistance has struck at the core of infectious disease control worldwide.1,2 Although antimicrobial-resistant pathogens can be found throughout the world, antimicrobial resistance is of particular concern in countries where prescription of antimicrobial agents is unregulated and where antibiotics are widely available over the counter. The increased use of antibiotics in the