The antimicrobial crisis in Latin America
Prof Cesar A. Arias is Professor of Infectious Diseases and Director of the Centre for Antimicrobial Resistance and Microbial Genomics (CARMiG) at the University of Texas Health Science Centre (UTHealth) in Houston. He is also a professor at Universidad El Bosque in Bogota, Colombia. Dr Jose M. Munita is Associate Professor of Infectious Diseases and Director of the Genomics and Resistant Microbes Group in the Clinica Alemana, Universidad del Desarrollo, in Chile. He is also Adjunct Assistant Professor at UTHealth and Director of International Research at CARMiG.
We’re in a hospital in Houston and are called to see a patient in the intensive care unit who has been transferred from a hospital in Latin America. The patient has a long and complicated history of abdominal problems secondary to an episode of pancreatitis and has multiple infected collections in the abdomen. He has received multiple courses of antimicrobials and currently is not responding to therapy. The reason is that the infection is caused by a strain of Escherichia coli that is now resistant to all antibiotics. In desperation, I call several of my infectious diseases colleagues in Latin America and they seem to be very used to these kinds of organisms. It is difficult to believe that the lack of effective antimicrobial therapies is now becoming the “norm” in certain parts of the world.
The AMR case in Latin America
Recognition of antimicrobial resistance as a top priority has led many governments and funding agencies to make important efforts to increase the budget allocated to fund high quality research in this topic. The Longitude Prize in the UK and the Bill and Melinda Gates Foundation’s Grand Challenge to find Novel Approaches to Characterizing and Tracking the Global Burden of Antimicrobial Resistance are prime examples of this commitment. Furthermore, the Obama administration’s FY 2016 budget nearly doubled the amount of federal funding to combat antimicrobial resistance, to more than $1.2 billion, and similar efforts have been put in place by the UK and the European Union.
The problem of antimicrobial resistance is as important in Latin America as it is in the rest of the world and advancing our understanding of the crisis at a regional level is crucial. Multidrug-resistant organisms are a major cause of hospital-associated infections in Latin American countries, causing more than 50% of such infections in countries like Brazil, Bolivia and Peru. Moreover, infections with these organisms have been estimated to produce a gross domestic product loss of up to 1.6%, which poses yet another challenge for countries with economies fighting their way into the developed world.
As with many other regions of the world, the challenges regarding resistant organisms and the drivers underlying the problem among Latin American countries are distinct from other world regions and have the potential of having an important impact in the spread of resistance worldwide. Prime examples are the dissemination of carbapenemase-resistant Enterobacteriaceae in several Latin American countries. Likewise, a recent report from Brazil showed the emergence of resistance to vancomycin in a community-associated MRSA strain whose genomic background has been shown to exhibit an immense potential of dissemination, both in the community and in the hospital environment.
A surveillance gap
Specific data on antibiotic consumption in humans and animals in Latin American countries are not known and there are no robust surveillance programs to track the spread of organisms and mechanisms of resistance. Antibiotic prescribing patterns among physicians across the region is very heterogeneous and access to over the counter antibiotics is still common practice in some countries.
To highlight the problem of antimicrobial resistance and in line with most other regions in the world, in October 2015 the World Health Organization regional committee for the Americas released a plan of action to combat antimicrobial resistance in Latin America. We need to follow on this mandate and governments should launch robust initiatives that focus on surveillance and identification of multidrug-resistant organisms in humans and in animal husbandry.
Back in Houston, our patient infected with resistant E. coli was a very complicated case, and he died. To prevent further deaths from drug-resistant infections, an aggressive and multidisciplinary approach would be the only strategy to really improve our knowledge of the scale of the problem and design effective measures to counteract the tide in the region, resulting in better ways to inform policy and concentrate limited resources. We need to act now!
Learn more about the Center of Antimicrobial Resistance and Microbial Genomics (CARMiG) at the McGovern Medical School, part of The University of Texas Health Science Center at Houston (UTHealth)