The Brave New World of Infectious Diseases

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Coming back from ECCMID, one gets the impression that we are moving towards an era in which we can diagnose everything but treat nothing. A late breaker session on colistin resistance provided much detail data on the situation in the EU.

As we know, colistin resistance conferred by the mcr-1 gene has been found on all continents, on plasmids and on chromosomes, in humans, in livestock and in the environment. It has been around for a few years already, but we just did not know it.

In western European countries, the prevalence of colistin resistance in livestock (mainly pigs) was 3.5% in E. coli and 9.9% for Salmonella based on 10-yr surveillance data (2004-2014) presented at the conference. Over 19% of the colistin-resistant E. coli carried the mcr-1 gene. There was no evidence of increasing resistance over the years. Several standard antibiotics are still quite effective. The message from the veterinary perspective: not to worry.

The Netherlands, always on the forefront of antibiotic stewardship in Europe, seems to have things under reasonable control. The Dutch have been monitoring the situation and significantly reduced the use of polymyxins in animal feed. While they may be an island of tranquility,other countries have much higher mcr-1 resistance rates, as shown below in Table 1.

mcr-1 prevalence
Table 1: mrc-1 resistance (presentation by Liz Terveer, Leiden, ECCMID 2016)

In Italy, approximately 1/2 of K. pneumoniae were carbapenemase producers and approx. 1/3 of K. pneumoniae were colistin-resistant in 2015.  Both rates were considerably lower just 1 year earlier, in 2014.

Further data were presented documenting the progression of colistin resistance in various enteric pathogens isolated from human sources.

Camilla Rodrigues
Camilla Rodrigues, MD – Convenor

Repeatedly the recommendation was made by speakers that more data was needed. Good point, thanks for stating the obvious. Such tepid advice has become the norm; however, it has hardly been a recipe to deal with the core issue. It seems that most ID folks have an excellent analytical mind, but only few put the data pieces together in a synthetic integrative manner.

So, we were actually surprised to hear Dr. Camilla Rodrigues (Mumbai, India – faculty/convenor) state in her session summary that it was time to stop the veterinary use of colistin. Thank you, Dr. Rodrigues, you said what others were not courageous enough to say. You provided the over-arching holistic perspective and showed civil courage so rarely seen at these sessions. You saved the day.

 

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