title: Strategic measures for the control of surging antimicrobial resistance in Hong Kong and mainland of China.
abstract: Antimicrobial-resistant bacteria are either highly prevalent or increasing rapidly in Hong Kong and China. Treatment options for these bacteria are generally limited, less effective and more expensive. The emergence and dynamics of antimicrobial resistance genes in bacteria circulating between animals, the environment and humans are not entirely known. Nonetheless, selective pressure by antibiotics on the microbiomes of animal and human, and their associated environments (especially farms and healthcare institutions), sewage systems and soil are likely to confer survival advantages upon bacteria with antimicrobial-resistance genes, which may be further disseminated through plasmids or transposons with integrons. Therefore, antibiotic use must be tightly regulated to eliminate such selective pressure, including the illegalization of antibiotics as growth promoters in animal feed and regulation of antibiotic use in veterinary practice and human medicine. Heightened awareness of infection control measures to reduce the risk of acquiring resistant bacteria is essential, especially during antimicrobial use or institutionalization in healthcare facilities. The transmission cycle must be interrupted by proper hand hygiene, environmental cleaning, avoidance of undercooked or raw food and compliance with infection control measures by healthcare workers, visitors and patients, especially during treatment with antibiotics. In addition to these routine measures, proactive microbiological screening of hospitalized patients with risk factors for carrying resistant bacteria, including history of travel to endemic countries, transfer from other hospitals, and prolonged hospitalization; directly observed hand hygiene before oral intake of drugs, food and drinks; and targeted disinfection of high-touch or mutual-touch items, such as bed rails and bed curtains, are important. Transparency of surveillance data from each institute for public scrutiny provides an incentive for controlling antimicrobial resistance in healthcare settings at an administrative level.
authors.affiliation: Department of Microbiology, Queen Mary Hospital , Hong Kong, China ; Infection Control Team, Queen Mary Hospital , Hong Kong, China.
authors.forename: Vincent C C
authors.initials: VC
authors.lastname: Cheng
authors.affiliation: Department of Microbiology, Queen Mary Hospital , Hong Kong, China.
authors.forename: Sally C Y
authors.initials: SC
authors.lastname: Wong
authors.affiliation: Department of Microbiology, Queen Mary Hospital , Hong Kong, China.
authors.forename: Pak-Leung
authors.initials: PL
authors.lastname: Ho
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong, China ; Department of Clinical Microbiology and Infection Control, Hong Kong University-Shenzhen Hospital , Shenzhen 518053, Guangdong province, China.
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D000383:Agriculture / Q000379:methods; D000818:Animals; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology / Q000401:mortality; D002681:China / Q000453:epidemiology; D004350:Drug Residues; D024881:Drug Resistance, Bacterial / Q000235:genetics; D017048:Health Care Costs; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D017053:Infection Control; D008460:Meat / Q000032:analysis / Q000382:microbiology; D015995:Prevalence; D012722:Sewage / Q000032:analysis
chemical_list: D000890:Anti-Infective Agents; D012722:Sewage
keywords: animal; antimicrobial consumption; antimicrobial resistance; directly observed hand hygiene; food; infection control; proactive surveillance; sewage