A team from the Ineos Oxford Institute for antimicrobial research (IOI) and University of Agriculture Faisalabad (UAF) has found evidence that the prevalence of carbapenem-resistant bacteria is increasing in Pakistan. Carbapenems are an advanced class of antibiotics.
Researchers conducted a systematic review and meta-analysis of studies reporting carbapenem resistance and their genetic determinants in different bacterial species. They determined the pooled prevalence (PPr) of carbapenem resistance by combining prevalence data reported by various studies from Pakistan.
Analysing 88 studies which reported data on carbapenem resistance from bacterial isolates collected between the years 1990 and 2019, researchers found an increase in PPr carbapenem resistance from 0% in studies published during 2009 - 2010 compared to 36% in 2019 - 2020 studies.
The global spread of carbapenem resistance threatens the effectiveness of carbapenems, which are considered ‘last resort’ antibiotics used to treat multi-drug resistant bacterial infections.
In 2018 Pakistan established the Pakistan Antimicrobial Resistance Surveillance System (PASS) in alignment with the WHO Global Antimicrobial Resistance Surveillance System. PASS published its first surveillance report for the years 2017-18 in which an increased resistance was reported for different carbapenem antimicrobials i.e., ertapenem (23%–29%), imipenem (10%–15%), and meropenem (19%–20%).
This evidence reflects a similar increasing trend of carbapenem resistance reported by CHINET, an AMR surveillance programme in China.
Researchers also suggested possible treatment options for bacterial isolates resistant to carbapenems, including other antibiotics like polymyxin B, colistin, tigecycline, and fosfomycin.
In the studies analysed we have found evidence of carbapenem resistance from human, animal, and environment sources, demonstrating the crucial need to approach this challenge from a One Health perspective.
Unfortunately, the suggested treatment options in this paper for carbapenem-resistant bacteria are already being used in the agricultural sector for food-producing animals in Pakistan. So, it very likely that bacteria will soon become resistant to these remaining treatments for carbapenem-resistant infections in humans.
Rising levels of AMR in clinical bacterial isolates is alarming. Pakistan urgently needs a national AMR surveillance strategy to monitor the growing rates of AMR and to take holistic actions to stop the spread of drug-resistant bacterial infections in clinical and non-clinical settings.