Hospital infections by antimicrobial-resistant organisms in developing countries

Antimicrobial resistance is a global public health concern. Hospitals in developing countries are fighting a progressively uphill battle against not only high burden of infectious diseases but also an ever-increasing proportion of multidrug-resistant pathogens. As many as 56% of Staphylococcus aureus isolates from hospital-acquired infections in South Asia have now become methicillin resistant. Vancomycin-resistant enterococci (VRE), with a reported prevalence of 6-12% in Asian hospital-based studies account for 10% of nosocomial urinary tract infections and a 31% mortality rate with VRE bacteremias. Third-generation cephalosporin-resistant Escherichia coli and Klebsiella account for case fatality rates between 12 and 52% in neonatal inpatients. Pan-resistance has been reported in 14-35.8% isolates of Acinetobacter spp. from developing country hospital inpatients over the last decade. Pseudomonas spp., an important neonatal killer in the Indo-Pak subcontinent, is ceftazidime resistant in 34-55% isolates and aminoglycoside resistant in 23-69% isolates. Alarmingly, these figures show a rising temporal trend and highlight antimicrobial-resistant organisms as major, untreatable threats in many resource-constrained countries. Antimicrobial resistance does not only mean increasing expense of treatment and poor clinical outcomes but also has a major impact on the way health systems are perceived and therefore accessed. There is an urgent need to devise comprehensive strategies and programs for improving hospital infection control and containing antimicrobial resistance in developing countries.