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Hassan B, et. al Nature Microbiology. 2021;6(10):1259-70

A role for arthropods as vectors of multidrug-resistant Enterobacterales in surgical site infections from South Asia

Professor Tim Walsh and his team at the Ineos Oxford Institute (IOI), in partnership with other UK colleagues and collaborators in Peshawar, northern Pakistan, have published findings in Nature Microbiology showing compelling evidence that Ants, spiders, flies, and cockroaches play a role in the transmission of drug-resistant infections in hospitals.

Overview of new findings

  • The study indicates that arthropods such as ants, spiders, flies, and cockroaches are carriers for multidrug-resistant bacteria, enabling the transmission of drug resistant infections in hospitals.
  • The researchers found links between the bacteria found in these arthropods and those found at surgical site infections on patients, and on hospital surfaces.
  • Approximately 20% of the arthropods studied were carrying bacteria resistant to a “last-resort” antibiotic, carbapenem – a drug reserved for life-threatening infections.
  • 70-80% were carrying enzymes that confer resistance to many common antibiotics, including penicillins, cephalosporin, and the monobactam aztreonam.

Global implications

  • While the research was carried out in South Asia, its findings have global implications.
  • As we’ve seen from COVID, pathogens do not respect national borders. Antimicrobial resistance which arises in one part of the world will spread across the globe.
  • The worldwide insect population is expected to double if temperatures rise by 1.5˚C. As a result of this climate-change fuelled population growth, the researchers estimate that by 2080 there could be approx. 50,000 trillion flies carrying carbapenem resistance.
  • With these insects acting as vectors (a spreader of infection) to transmit drug-resistant infection to humans, the risk to human health is clear.

Need for Action

  • This research demonstrates the importance of improving health infrastructure and hygiene/infection control/waste management measures, especially in lower middle income countries.
  • By showing that these arthropods are a vector for drug resistance, the need to eradicate/reduce their presence in healthcare settings is clear. Addressing this issue in South Asia will have benefits across the globe.
  • It also shows the need to take a One Health approach to addressing drug resistance, with integrated actions across human, animal and environmental health sectors.

Ineos Oxford Institute (IOI)

  • This new research in the transmission of drug-resistant infections in South Asian hospitals demonstrates the need to tackle drug-resistant infections in a global, collaborative way. Antimicrobial resistance can spread between species and across national borders, so mitigating the spread of this resistance via arthropods in Asia can have health benefits for all of us.
  • The research is the result of close collaboration between scientists from the Ineos Oxford Institute, other UK colleagues and collaborators in Peshawar, northern Pakistan. By bringing top scientists together and supporting them to carry out crucial research such as this, we can identify tangible, impactful, evidence-based ways to address the problem of drug-resistant infections globally.

Similar to our experience over the last eighteen months with the pandemic, a problem currently seen from afar will quickly come into focus much closer to home. The clinical burden of AMR is most felt in low-middle income countries, but the increase in global temperatures, due to climate change, will result in a significant increase in flies and many other insects and a subsequent increase in the global velocity of antibiotic resistance.