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Control of multiply resistant cocci: do international comparisons help?
S Harbarth1, W Albrich, D A Goldmann
1Children's Hospital, and Harvard Medical School, Boston, USA. stephan.harbarth@hcuge.ch
Abstract:
Antibiotic resistance has become a worldwide problem. However, the reasons for the uneven geographic distribution of antibiotic-resistant microorganisms are not fully understood. For instance, there are striking differences in the epidemiology of multiresistant gram-positive cocci between the USA and Germany. According to recent reports, the prevalence of high-level penicillin-resistant pneumococci (PRP), meticillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) in clinically relevant isolates of hospitalised patients in the USA and Germany are: PRP, 14% versus less than 1%; MRSA, 36% versus 15%; and VRE, 15% versus 1%. These disparities may be explained by several determinants: (1) diagnostic practice and laboratory recognition (all three pathogens); (2) clonal differences and pathogen transmissibility (VRE); (3) antibiotic prescribing practices (all three pathogens); (4) population characteristics, including extensive daycare exposure in the USA (PRP); (5) cultural factors (all three pathogens); (6) factors related to the health-care and legal system (all three pathogens); and (7) infection-control practices (MRSA and VRE). Understanding these determinants is important for preventing further spread of multiresistant cocci within the USA. A rational approach to national surveillance is urgently needed in Germany to preserve the favourable situation and decrease MRSA transmission. Finally, we suggest that a macro-level perspective on antibiotic resistance can broaden the understanding of this worldwide calamity, and help prevent further dissemination of multiply resistant microorganisms.
Insights
Antibiotic resistance varies significantly between the USA and Germany due to factors like prescribing practices and healthcare systems. Understanding these differences is key to controlling the spread of resistant bacteria globally.
Area of Science:
- Microbiology
- Epidemiology
- Public Health
Background:
- Antibiotic resistance is a global health crisis.
- Geographic variations in antibiotic-resistant microorganisms are not fully understood.
- Significant differences exist in the prevalence of multiresistant gram-positive cocci between the USA and Germany.
Purpose of the Study:
- To investigate the reasons behind the uneven geographic distribution of antibiotic resistance.
- To compare the epidemiology of specific multiresistant pathogens in the USA and Germany.
- To identify determinants influencing antibiotic resistance patterns.
Main Methods:
- Comparative analysis of epidemiological data from the USA and Germany.
- Review of factors including diagnostic practices, antibiotic prescribing, population characteristics, cultural factors, healthcare systems, and infection control.
- Literature review and synthesis of existing reports on antibiotic resistance.
Main Results:
- Prevalence rates for penicillin-resistant pneumococci (PRP), meticillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) are substantially higher in the USA compared to Germany.
- Key disparities include differences in diagnostic practices, antibiotic prescribing habits, population demographics (e.g., daycare exposure in the USA), and healthcare system factors.
- Specific pathogens like VRE show differences in clonal spread and transmissibility.
Conclusions:
- Multiple determinants contribute to the geographic variation in antibiotic resistance.
- Understanding these factors is crucial for developing targeted interventions to curb the spread of resistant bacteria.
- A macro-level perspective and rational surveillance strategies are needed globally to combat antibiotic resistance.