Antimicrobial resistance situation and control measures in Hong Kong: from a One Health perspective

Multi-drug-resistant organisms pose a critical public health challenge globally, particularly in densely populated Hong Kong with a rapidly aging population, where over 90% of food is imported. This review examines the targeted surveillance and control efforts implemented under the One Health framework to combat antimicrobial resistance. Between 2010 and 2023, surveillance revealed the prevalence rates of extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli in tested pigs (51.5%) and chickens (86.3%). Alarmingly, carbapenemase-producing E. coli was increasingly detected in pigs (<5-19.2% from 2017 to 2023). For other food items, ESBL-producing Enterobacterales were found in sashimi (11.5%), sushi (4.8%), ready-to-eat (RTE) vegetables (26.9%), RTE cut fruits (5.6%), braised dishes (19.8%) and roast meat (2.4%). Mean antimicrobial consumption in food animals was 113.4 mg/kg target animal biomass for pigs from 2019 to 2022. Antimicrobial consumption in hospitals and the community, expressed as defined daily doses per 1000 inhabitants per day, declined from 20.4 to 13.8 during the coronavirus disease 2019 pandemic, and gradually rebounded to 17.1 in 2023. In residential care homes for the elderly (RCHEs), the prevalence of meticillin-resistant Staphylococcus aureus (MRSA) escalated rapidly from 2.8% to 48.7% between 2005 and 2021, triggering a pilot MRSA decolonization programme in 257 RCHEs, which led to a significant reduction in community-onset MRSA infections (from 3.526 to 2.632 per 1000 resident-days; P<0.005) and MRSA bacteraemia (from 0.322 to 0.197 per 1000 resident-days; P=0.025). These findings highlight the challenges in the control of ESBL and carbapenemase-producing E. coli in animals, compliance with food hygiene measures, and infection control in overcrowded and understaffed RCHEs or hospitals in perpetuating MRSA infections in healthcare settings.