New chapter in tackling antimicrobial resistance in Thailand

Sumpradit, Nithima; Wongkongkathep, Suriya; Poonpolsup, Sitanan; Janejai, Noppavan; Paveenkittiporn, Wantana; Boonyarit, Phairam; Jaroenpoj, Sasi; Kiatying-Angsulee, Niyada; Kalpravidh, Wantanee; Sommanustweechai, Angkana; Tangcharoensathien, Viroj

doi:10.1136/bmj.j2423

Cited by 49 publications

(45 citation statements)

References 2 publications

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“…It is recognised that AMR can develop and spread rapidly in regions where antibiotics are inappropriately sold/used and freely available, and that hospital settings provide excellent opportunities for the dissemination of resistance. In Thailand, carbapenem-resistant P. aeruginosa is an increasing problem, especially in the context of hospital-acquired infections (8,9) . Previous studies have sought to characterise the genetic basis underlying carbapenem resistance amongst P. aeruginosa clinical isolates in Thailand (10) , and globally (11) , but the role of plasmids is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

A megaplasmid family responsible for dissemination of multidrug resistance inPseudomonas

Cazares

Moore

Grimes

et al. 2019

Preprint

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Multidrug resistance (MDR) represents a global threat to health. Although plasmids can play an important role in the dissemination of MDR, they have not been commonly linked to the emergence of antimicrobial resistance in the pathogen Pseudomonas aeruginosa . We used whole genome sequencing to characterize a collection of P. aeruginosa clinical isolates from a hospital in Thailand. Using long-read sequence data we obtained complete sequences of two closely related megaplasmids (>420 kb) carrying large arrays of antibiotic resistance genes located in discrete, complex and dynamic resistance regions, and revealing evidence of extensive duplication and recombination events. A comprehensive pangenomic and phylogenomic analysis indicated that 1) these large plasmids comprise a family present in different members of the Pseudomonas genus and associated with multiple sources (geographical, clinical or environmental); 2) the megaplasmids encode diverse niche-adaptive accessory traits, including multidrug resistance; 3) the pangenome of the megaplasmid family is highly flexible and diverse, comprising a substantial core genome (average of 48% of plasmid genes), but with individual members carrying large numbers of unique genes. The history of the megaplasmid family, inferred from our analysis of the available database, suggests that members carrying multiple resistance genes date back to at least the 1970s.

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Section: Introductionmentioning

confidence: 99%

A megaplasmid family responsible for dissemination of multidrug resistance inPseudomonas

Cazares

Moore

Grimes

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…It is recognised that AMR can develop and spread rapidly in regions where antibiotics are inappropriately sold/used and freely available and that hospital settings provide excellent opportunities for the dissemination of resistance. In Thailand, carbapenem-resistant P. aeruginosa is an increasing problem, especially in the context of hospital-acquired infections 8 . Previous studies have sought to characterise the genetic basis underlying carbapenem resistance among P. aeruginosa clinical isolates in Thailand 9 , and globally 10 , but the role of plasmids is poorly understood.…”

mentioning

confidence: 99%

A megaplasmid family driving dissemination of multidrug resistance in Pseudomonas

et al. 2020

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Multidrug resistance (MDR) represents a global threat to health. Here, we used whole genome sequencing to characterise Pseudomonas aeruginosa MDR clinical isolates from a hospital in Thailand. Using long-read sequence data we obtained complete sequences of two closely related megaplasmids (>420 kb) carrying large arrays of antibiotic resistance genes located in discrete, complex and dynamic resistance regions, and revealing evidence of extensive duplication and recombination events. A comprehensive pangenomic and phylogenomic analysis indicates that: 1) these large plasmids comprise an emerging family present in different members of the Pseudomonas genus, and associated with multiple sources (geographical, clinical or environmental); 2) the megaplasmids encode diverse niche-adaptive accessory traits, including multidrug resistance; 3) the accessory genome of the megaplasmid family is highly flexible and diverse. The history of the megaplasmid family, inferred from our analysis of the available database, suggests that members carrying multiple resistance genes date back to at least the 1970s.

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“…Despite the fact that most URTIs have viral aetiology, therefore antibiotics are not usually indicated and when used they have neither cured (reduced the symptoms/prevented complications) nor shorten the duration of URTIs [20]. We found that considerable number of patients still received antibiotics for URTIs at ETU.…”

Section: Discussionmentioning

confidence: 72%

Antibiotics Utilization Patterns and Direct Cost in an Emergency Treatment Unit in Sri Lanka

Aberathna

Morrissey

Ball

et al. 2019

Int J Curr Pharm Sci

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Objective: Anecdotal evidence suggested that antibiotics are frequently used in the Emergency Treatment Units in Sri Lanka, mostly for the respiratory tract, soft tissue or urinary tract infections. This study aimed to describe the utilization patterns of antibiotics in terms of most common type, indication and associated direct cost in ETU at the Teaching Hospital Karapitiya, Sri Lanka. Methods: In this study, utilization patterns and the direct cost of antibiotics in an emergency treatment unit was evaluated by checking the bed-head tickets of all patients admitted to the unit from 1/5/16 to 15/5/16. Out of the 414 bed-head tickets checked 156 patients were receiving antibiotic treatment. Socio-demographic characteristics were analyzed. The prices of antibiotics in SriLankan government hospitals were taken from the hospital medical supply division price list. Data were analyzed by Microsoft Excel™. Results: In this study, 45.5% (out of 156 patients) were aged between 61-80years. The most used antibiotic was amoxicillin/clavulanic acid (18.1%) and clarithromycin (15.5%). Generic antibiotics were used for most patients (95.58%). Fixed-dose combinations were used in 18.5% of cases, including amoxicillin/clavulanic acid and piperacillin/tazobactam. The common indications for prescribing antibiotics were respiratory tract infections (31.2%) and soft tissues injuries (12.1%). Conclusion: This study revealed that there is apparent overuse of antibiotics and reveals that antibiotic stewardship programme could reduce antibiotic use, antibiotic resistance, and cost. Improved understanding of the rationale for antibiotic use would contribute optimising their use. Further studies are needed to establish the extent of sub-optimal prescribing of antibiotics in Sri Lankan hospitals.

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New chapter in tackling antimicrobial resistance in Thailand

Abstract: Nithima Sumpradit and colleagues describe the experience of Thailand in developing its national strategic plan on antimicrobial resistance and highlight the need for sustained political commitment and multisectoral collaboration

Cited by 49 publications

References 2 publications

A megaplasmid family responsible for dissemination of multidrug resistance inPseudomonas

A megaplasmid family responsible for dissemination of multidrug resistance inPseudomonas

A megaplasmid family driving dissemination of multidrug resistance in Pseudomonas

Antibiotics Utilization Patterns and Direct Cost in an Emergency Treatment Unit in Sri Lanka

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