title: Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia.
abstract: Carbapenem-resistant Gram-negative bacteria, in particular the Acinetobacter baumannii-calcoaceticus complex and Enterobacteriaceae, are escalating global public health threats. We review the epidemiology and prevalence of these carbapenem-resistant Gram-negative bacteria among countries in South and Southeast Asia, where the rates of resistance are some of the highest in the world. These countries house more than a third of the world's population, and several are also major medical tourism destinations. There are significant data gaps, and the almost universal lack of comprehensive surveillance programs that include molecular epidemiologic testing has made it difficult to understand the origins and extent of the problem in depth. A complex combination of factors such as inappropriate prescription of antibiotics, overstretched health systems, and international travel (including the phenomenon of medical tourism) probably led to the rapid rise and spread of these bacteria in hospitals in South and Southeast Asia. In India, Pakistan, and Vietnam, carbapenem-resistant Enterobacteriaceae have also been found in the environment and community, likely as a consequence of poor environmental hygiene and sanitation. Considerable political will and effort, including from countries outside these regions, are vital in order to reduce the prevalence of such bacteria in South and Southeast Asia and prevent their global spread.
authors: Saw Swee Hock School of Public Health, National University of Singapore, Singapore liyang_hsu@yahoo.com paul_anantharajah_tambyah@nuhs.edu.sg.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore.|Tan Tock Seng Hospital, Singapore.
authors: Li-Yang
authors: 0000-0002-0396-066X
authors: LY
authors: Hsu
authors: Thammasat University Hospital, Pathum Thani, Thailand.
authors: Anucha
authors: A
authors: Apisarnthanarak
authors: Aga Khan University, Karachi, Pakistan.
authors: Erum
authors: E
authors: Khan
authors: Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.
authors: Nuntra
authors: 0000-0002-9356-2592
authors: N
authors: Suwantarat
authors: Apollo Hospital, Chennai, India.
authors: Abdul
authors: A
authors: Ghafur
authors: Yong Loo Lin School of Medicine, National University of Singapore, Singapore liyang_hsu@yahoo.com paul_anantharajah_tambyah@nuhs.edu.sg.
authors: Paul Anantharajah
authors: PA
authors: Tambyah
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology*; D040981:Acinetobacter baumannii / Q000187:drug effects; D001210:Asia, Southeastern / Q000453:epidemiology; D001211:Asia, Western / Q000453:epidemiology; D015780:Carbapenems; D004755:Enterobacteriaceae / Q000187:drug effects; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology*; D062665:Epidemiological Monitoring; D006801:Humans; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D018440:beta-Lactam Resistance
chemical_list: D015780:Carbapenems
keywords: Acinetobacter; Enterobacteriaceae; Gram-negative bacteria; South Asia; Southeast Asia; carbapenem resistance; carbapenems; mcr-1