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Widespread Multi-Antimicrobial- Resistant Shigella in Asia: What Does It Mean? Okumura J 1), Osaka K 2), Okabe N 2) 1)University of Tokyo 2)National Institute.

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Presentation on theme: "Widespread Multi-Antimicrobial- Resistant Shigella in Asia: What Does It Mean? Okumura J 1), Osaka K 2), Okabe N 2) 1)University of Tokyo 2)National Institute."— Presentation transcript:

1 Widespread Multi-Antimicrobial- Resistant Shigella in Asia: What Does It Mean? Okumura J 1), Osaka K 2), Okabe N 2) 1)University of Tokyo 2)National Institute of Infectious Diseases, Japan Second International Conference on Improving Use of Medicines

2 Okumura J, Osaka K, Okabe N Abstract Background: Despite immense efforts to contain AMR, its development has been accelerated. Shigella sonnei, spread by travelers, illustrates the problems caused by resistant microbes and urgency of improving therapeutic drug use to stop its transmission. Methods: Altogether 366 samples of S. sonnei, isolated at quarantine stations in Japan from 1997 through 1999. Sensitivity of the samples were checked. The tested antimicrobials were: ABPC, CP, CTX, FOM, LVFX, NFLX, ST, and TC. Results: 90% had resistance to at least one antimicrobial and 80% had more than two. In Indonesia (n=69), Thailand (n=42), and India (n=141), most of resistant strains were multiple ones. Resistance to FOM and NFLX appeared in Indonesia and Thailand in 1999. Conclusions: The study results imply the necessity of reciprocal monitoring and information sharing systems for sensitivity of antimicrobials, its consumption and usage. A sense of urgency of each stakeholder is needed for the success of the system establishment.

3 Okumura J, Osaka K, Okabe N Background Despite immense efforts to contain antimicrobial resistance (AMR), development of resistant microbes has been accelerated. For Example, Shigella sonnei, spread by travelers, illustrates the problems caused by resistant microbes and the urgency of its containment.

4 Okumura J, Osaka K, Okabe N Objectives To understand the trend of development and distribution of resistant S. sonnei in Asia. To identify factors by which the world has been failing to contain AMR, in spite of holding a number of expert meetings and a mountain of documents on the agenda. To seek effective and practical measures to halt the spread of AMR before it reaches at critical level.

5 Okumura J, Osaka K, Okabe N Methods (1) Design: Retrospective, time series Samples: Imported S. sonnei which were isolated from travelers at quarantine stations in Japan 120, 87 and 159 samples each year during the period of 1997 – 1999

6 Okumura J, Osaka K, Okabe N Methods (2) Checked AMR of the isolated S. sonnei by measuring Minimum Inhibitory Concentration (MIC): By using E-test ® (AB Biodisk) on agar media Antimicrobials are: Ampicillin (ABPC), Chloramphenicol (CP), Cefotaxime (CTX), Fosfomycin (FOM), Levofloxacin (LVFX), Norfloxacin (NFLX), Tetracycline (TC), Sulfamethoxazole-Trimethoprim (ST) Referred the National Committee for Clinical Laboratory Standards E-test ®

7 Okumura J, Osaka K, Okabe N Overall trend of AMR n = 120n = 159n = 87

8 Okumura J, Osaka K, Okabe N Trend and level of AMR in 3 countries n=43n=26n=72n=7n=18n=38n=14n=17

9 Okumura J, Osaka K, Okabe N Resistance by Antimicrobials in Indonesia %

10 Okumura J, Osaka K, Okabe N Resistance by Antimicrobials & Expenditure for Antimicrobials for Human in Thailand Million Bhats FOM Resistant Strain %

11 Okumura J, Osaka K, Okabe N Resistance to 2 nd or 3 rd line antimicrobials: All the S. sonnei developed resistance to NFLX also attained resistance to more than three antimicrobials (P<0.001). FOM Total ResistantSensitive Resistance to: 4 or more133548 3 or less11307318 Multiple Resistance and Susceptibility to FOM (Unit: Strain) Odds Ratio: 10.4 (95% CI: 4.0 – 27.2) P<0.001

12 Okumura J, Osaka K, Okabe N Lessons learned In spite of immense efforts to contain AMR during the last century, the problem has been unsolved and AMR strains become easily transmitted in the current highly mobile world. e.g.1, The World Health Assembly (WHA) Resolution of 1988 urged member states to take actions to contain AMR. e.g.2, The current efficacy of Antimicrobial Resistance Information Bank (A-R Info Bank) is questionable. The velocity of AMR development has been accelerated hence no effective antimicrobials may exist in the near future. There might be accumulated data on AMR in each country, which are however least likely used for the purpose of AMR containment.

13 Okumura J, Osaka K, Okabe N Implications Establishment of monitoring and information sharing systems is urgently needed, which cover sensitivity of antimicrobials, its consumption and usage. The system should be reciprocal one, which can be accessed by Internet. If Internet access is difficult, at least quarterly reports should be distributed. Strong political commitment and a sense of urgency of each stakeholder, are needed to establish and maintain the reciprocal system, such as smallpox eradication programme.


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