A rare antibiotic-resistant bacterial infection has been
found in a Laramie County resident receiving care at Cheyenne Regional Medical
Center (CRMC), according to a statement earlier this year by the Wyoming
Department of Health (WDH) . Recent testing showed the organism infecting the
patient, an enterobacteriaceae, also included a rare antibiotic-resistant gene
known as MCR-1. It does not appear the infection was acquired at the hospital.
The mcr-1 gene makes bacteria resistant to colistin,
which is used for multidrug-resistant Pseudomonas aeruginosa, Klebsiella
pneumoniae, and Acinetobacter including NDM-1 metallo-β-lactamase
multidrug-resistant Enterobacteriaceae.
Colistin has been categorized as one of the few “Reserve
Group Antibiotics” by the WHO in its “Model List of Essential Medicines Amended
August 2017”. According to the WHO, Reserve Group antibiotics should be treated
as “last resort” options that should be accessible, but whose use should be
tailored to highly specific patients and settings, when all alternatives have
failed (e.g., serious, life-threatening infections due to multi-drug resistant
bacteria).
Besides colistin (polymyxin), other last-resort
antibiotics included in the WHO list are: Aztreonam, 4th generation
cephalosporins (cefepime), 5th generation cephalosporins
(ceftaroline), oxazolidinones (linezolid), tigecycline and daptomycin.
Emergence of the first mcr-1 gene, which confers
polymyxin resistance, was reported from China in 2015 (The Lancet Infectious
Diseases, Published Nov. 18, 2015). As of November 2, the mcr-1 gene has been
identified in human isolates in 19 states and in animal isolates in two states
in the US, according to the CDC.
These reported cases highlight the dissemination of
extensively drug-resistant and pan-drug-resistant Gram-negative bacteria, which
have become a significant danger to public health.
This means that colistin resistance is spreading
globally.
With no new antibiotics on the horizon, the situation may
revert to a ‘pre-antibiotic era’ as the WHO has also warned, unless steps are
taken urgently to check this public health danger.
The WHO says that “These medicines (reserve group
antibiotics) could be protected and prioritized as key targets of national and
international stewardship programs involving monitoring and utilization
reporting, to preserve their effectiveness.”
Colistin is misused in the meat and poultry industry in
India for its growth-promoting effect.
Reportedly, government agencies including the department
of animal husbandry, dairying and fisheries, Food Safety and Standards
Authority of India, ministry of agriculture and farmers’ welfare, ministry of
health and family welfare and the drug controller general of India have
examined the issue and recommended that colistin cannot be used (Live
Mint, Dec. 4, 2018). This needs to be implemented with immediate effect. A
colistin use policy needs to be formulated to promote its rational use and
prevent emergence of antimicrobial resistance to this “last-resort” antibiotic.
It is only through a concerted and coordinated global
action that this imminent public health danger can be thwarted.
Prescribing the right antibiotic, at the right dose, for
the right duration and at the right time helps optimize patient care and fight
antibiotic resistance.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical
Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA
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