Multidrug-resistant Escherichia coli in Asia: epidemiology and management

Abstract

Escherichia coli has become multiresistant by way of production of a variety of β-lactamases. The prevalence of CTX-M–producing E. coli has reached 60–79% in certain parts of Asia. The acquisition of CTX-M plasmids by E. coli sequence type 131, a successful clone of E. coli, has caused further dissemination of CTX-M–producing E. coli. The prevalence of carbapenemase-producing E. coli, especially Klebsiella pneumoniae carbapenemase, and New Delhi metallo-β-lactamase (NDM)-producing E. coli has been increasing in Asia. K. pneumoniae carbapenemase and NDM have now been found in E. coli sequence type 131. The occurrence of NDM-producing E. coli is a major concern particularly in the Indian subcontinent, but now elsewhere in Asia as well. There are multiple reasons why antibiotic resistance in E. coli in Asia has reached such extreme levels. Approaches beyond antibiotic therapy, such as prevention of antibiotic resistance by antibiotic stewardship and protecting natural microbiome, are strategies to avoid further spread of antibiotic resistance.

Keywords:

• AmpC
• Asia
• carbapenemase
• ESBL
• management
• molecular epidemiology
• multidrug-resistant Escherichia coli

Financial & competing interests disclosure

DL Paterson has been on the advisory boards for AstraZeneca, Cubist, Pfizer and Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The prevalence of multidrug-resistant (MDR) Escherichia coli is humans and food-producing animals is increasing worldwide, including Asian countries.

• The prevalence of extended-spectrum β-lactamase–producing E. coli fecal carriage in healthy humans was 50% in east Asia and suspected as being higher in south Asia.

• CTX-M–producing E. coli in humans and food-producing animals are the predominant E. coli resistant to extended-spectrum cephalosporins.

• Carbapenemase-producing E. coli has emerged throughout Asia.

• CTX-M-15, Klebsiella pneumoniae carbapenemase, New Delhi metallo-β-lactamase and IMP-producing E. coli ST131 have been reported.

• Plasmids or extra-chromosomal DNA carrying β-lactamases usually carry resistance to other classes of antibiotics.

• Existing management of infections by MDR E. coli is generally antibiotic treatment.

• Multiple alternative approaches to prevent fecal carriage by MDR E. coli, such as by bacterial interference and protecting the microbiome of gastrointestinal and female genital tracts, have given promising results.

• Controlling antibiotic usage has direct impact in reducing further spread of antibiotic resistance.

Notes