Epidemiology and burden of multidrug-resistant bacterial infection in a developing country

摘要

Antimicrobial resistance is a global problem. Each year, an estimated 23,000 deaths in the United States and 25,000 deaths in the European Union are extra deaths caused by bacteria resistant to antibiotics. People in low- and middle-income countries are also using more antibiotics, in part because of rising incomes, lower costs of antibiotics, and a lack of control of antimicrobial usage in the hospitals and over-the-counter sales of the drugs. These factors are thought to be driving the development and spread of bacteria that are resistant to multiple antibiotics in countries such as China, India, Indonesia and Thailand. However, a lack of information makes it difficult to estimate the size of the problem and, then, to track how antimicrobial resistance and multi-drug resistance is changing over time in these and other low- and middle-income countries. Now, by integrating routinely collected data from a range of databases, Lim, Takahashi et al. estimate that around an extra 19,000 deaths are caused by multi-drug resistant bacteria in Thailand each year. Thailand has a population of about 70 million, and so, per capita, this estimate is about 3 to 5 times larger than those for the United States and European Union (which have a populations of about 300 million and 500 million, respectively). Lim, Takahashi et al. also show that more of the bacteria collected from patients are resistant to multiple antimicrobial drugs and that the burden of antimicrobial resistance in Thailand is worsening over time. These findings suggest that more studies with a systematic approach need to be done in other low- and middle-income countries, especially in countries where microbiological laboratories are readily available and routinely used. Further work is also needed to identify where resources and attentions are most needed to effectively fight against antimicrobial resistance in low- and middle-income countries.