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Polymyxin resistance in Enterobacterales: overview and epidemiology in the Americas

J Rodríguez-Santiago1, P Cornejo-Juárez2, J Silva-Sánchez3

  • 1Instituto Nacional de Salud Pública (INSP), Centro de Investigación sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Cuernavaca, Morelos, México; Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México.

International Journal of Antimicrobial Agents
|August 22, 2021
PubMed

Insights

Carbapenem- and polymyxin-resistant Enterobacterales are a global threat. This study highlights limited data in the Americas, suggesting urgent surveillance and regulatory measures for antimicrobial use in veterinary medicine.

Area of Science:

  • Microbiology
  • Public Health
  • Infectious Diseases

Background:

  • The global rise of carbapenem- and polymyxin-resistant Enterobacterales (CPRE) poses a significant public health challenge.
  • Limited data exists on CPRE epidemiology in the Americas, with Latin America suspected as a reservoir for plasmid-mediated polymyxin resistance.
  • Polymyxins are critical last-resort antibiotics, making resistance a growing concern.

Purpose of the Study:

  • To provide an updated overview of polymyxin use, availability, and resistance.
  • To review the current epidemiology of polymyxin resistance in Enterobacterales across the Americas.
  • To identify gaps in surveillance and propose regulatory measures.

Main Methods:

  • Literature review of English and Spanish publications on polymyxin resistance in Enterobacterales in the Americas.
  • Analysis of data on carbapenemase-producing and colistin-resistant Klebsiella pneumoniae and Escherichia coli.
  • Examination of plasmid-mediated resistance mechanisms, including mcr-1.

Main Results:

  • Widespread carbapenemase-producing and colistin-resistant Klebsiella pneumoniae (ST258 clone, mgrB mutations) identified in the Americas.
  • Prevalence of IncI2 and IncX4 plasmids carrying mcr-1 in Escherichia coli, primarily from human sources.
  • Underreporting of plasmid-mediated colistin resistance in the veterinary sector across the Americas.

Conclusions:

  • Urgent need for enhanced surveillance of polymyxin resistance in Enterobacterales in the Americas.
  • Implementation of regulatory measures for antimicrobial use in veterinary medicine is crucial.
  • Addressing resistance requires a One Health approach, considering human, animal, and environmental sectors.
Keywords:
AmericasAntimicrobial resistanceEnterobacteralesEpidemiologyPolymyxins

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