jason gale
TRANSCRIPT
Jason GaleEditor-at-large – Global Health
Bloomberg News/Sydney
Tel. +61-2-9777-8660E-mail: [email protected]
Twitter: @jwgale
PROSTATE BIOPSIESTransrectal ultrasound-guided
• Prostate needle biopsy patients = sentinels for ciprofloxacin-resistant (?MDR) in gut commensals?
• Small BUT growing riskNam, Loeb, Williamson, Patel et al
• Travelers, health-care workers (and their household members), veterinarians, repeat Bx patients, recent antibiotic-users among those at highest risk
• New approaches to mitigating risk needed
Source: Michael Liss, University of California, San Diego
Japan 0%North America 30%
India/Nepal/Sri Lanka 79%
Middle East/Africa 75%
South America/ Mexico 60%
Europe 24%
Southeast Asia/Pacific 52%
China, Hong Kong, Taiwan, Korea 69%
Source: Kennedy et al, European Journal of Clinical Microbiology & Infectious Diseases, 2010
SOUVENIRSmicrobial
• Travelers return with MDR gut commensals• Cipro resistance 3.9% pre-travel 33% post-travel• ESBL+ve 2% pre-travel 22% post-travel
SEXmicrobial
The Superbug, Biopsy, Sepsis
• Global problem• Getting worse• Challenging clinical practice• Affecting outcomes
• E. coli strains are shared among household members, including the family dogJohnson et al, Journal of Clinical Microbiology December 2008
• Multidrug-resistant E. coli may colonize the GI tract for 1 year or more Nordmann et al, Journal of Antimicrobial Chemotherapy, 2011
Colonizationgut
Extended Spectrum Beta Lactamase
• Enzymes that open the beta-lactam ring, inactivating the antibiotic
• Confer resistance to most beta-lactam antibiotics, including penicillins, cephalosporins, and the monobactam aztreonam
• First plasmid-mediated beta lactamase in Gram-negative bacteria was discovered in Greece in the 1960s
• Now worldwide• CTX-M-15, probably from India• CTX-M-14, probably from China
• First line options for UTIs are lost:Trimethoprim • Trimethoprim/sulfamethoxazole • Gentamicin • Ceftriaxone • Ticarcillin/clavulanate • Piperacillin/tazobactam •
Ciprofloxacin
Why?• Nature of Gram-negative bacteria
• accumulate resistance mechanisms• gut colonization• combining with virulence mechanisms
• Antibiotic use • in people• in animals
• Global travel• global trotting grandpas• medical tourism
% Fluoroquinolone Resistance in E. coli / K. pneumoniae Isolates*
• Greece – 24 / 71
• Bulgaria – 33 / 52
• Cyprus – 43 / 39
• Hungary – 37 / 43
• Italy – 39 / 39
• Czech Republic – 23 / 55
• Latvia – 14 / 52
• Poland – 26 / 33
• Portugal – 27 / 31
• Malta – 34 / 16
• Spain – 33 / 14
* Bacteraemias in (mostly) elderly and not necessarily reflective of gut carriage
resistance
RESERVOIRS? • ESBL genes in 80% of raw chicken meat sold at retail
• Predominant ESBL genes in chicken meat and human rectal swab specimens were identical
Source: Overdevest et al, Emerging Infectious Diseases, July 2011
Jason GaleEditor-at-large – Global Health
Bloomberg News/Sydney
Tel. +61-2-9777-8660E-mail: [email protected]
Twitter: @jwgale