DRUG-RESISTANT ENTERIC PATHOGENS

Abstract

In 2010, WHO declared that AMR is one of the top 10 global public health threats facing humanity. Without adequate intervention, global death rates attributable to AMR are projected to surpass that of cancer and reach 10 million deaths per year by 2050. The transmission and spread of multi-drug resistant organisms (MDROs) are facilitated by the increase in travel and trade across the globe over the last few decades. Antimicrobial resistance imposes a drastic burden in terms of healthcare costs, morbidity and mortality. The human gastrointestinal (GI) tract has the potential to transmit MDROs, with the gut microbiome containing an estimated 1014 microorganisms. The gut is a key conduit for the genesis and spread of antimicrobial resistance in enteric bacterial pathogens. Invasive enteropathogens, that exist as bacterial commensals can inflict dysbiosis and disease when exposed to selection pressure of unnecessary antibiotics facilitating AMR development and spread. Common invasive enteropathogens include Campylobacter, Shigella, Salmonella enterica, Vibrio cholerae, Clostridioides difficile, Enterococcus spp and E.coli. In the Low middle income country (LMIC) especially the WHO SEARO region, there is an enormous burden of resistant gram negative organisms like E.coli and Klebsiella altering clinically important outcomes due to the limited treatment options. Salmonella typhi is already known to be resistant to the commonly prescribed antibiotics in this region and has led to outbreaks in South Asia Pakistan region. Nosocomial outbreaks due to multidrug-resistant strains of enteric bacteria such as Salmonella, Acinetobacter, and Pseudomonas have occurred in the WHO SEARO region leading to enormous cost implications due to the requirements of high-end antibiotics. Increased surveillance using Next-generation sequencing (NGS) based methods and AMR profile characterization, along with exploration of bacterial vaccines and phage therapies with ensuring access to newer antibiotics is the need of the hour.