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Clin Infect Dis. 2013 May;56(9):1310-8. doi: 10.1093/cid/cit020. Epub 2013 Jan 18.

The global spread of healthcare-associated multidrug-resistant bacteria: a perspective from Asia.

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Division of Infectious Diseases, National University Health System, Level 10, Department of Medicine, 1E Kent Ridge Road, Singapore 119228.


Since antibiotics were first used, each new introduced class has been followed by a global wave of emergent resistance, largely originating in Europe and North America where they were first used. Methicillin-resistant Staphylococcus aureus spread from the United Kingdom and North America across Europe and then Asia over more than a decade. Vancomycin-resistant enterococci and Klebsiella pneumoniae carbapenemase-producing K. pneumoniae followed a similar path some 20 years later. Recently however, metallo-β-lactamases have originated in Asia. New Delhi metallo-β-lactamase-1 was found in almost every continent within a year of its emergence in India. Metallo-β-lactamase enzymes are encoded on highly transmissible plasmids that spread rapidly between bacteria, rather than relying on clonal proliferation. Global air travel may have helped facilitate rapid dissemination. As the antibiotic pipeline offers little in the short term, our most important tools against the spread of antibiotic resistant organisms are intensified infection control, surveillance, and antimicrobial stewardship.

[Indexed for MEDLINE]

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