Global Resistance Hot Spots - Role of low and middle income countries

Bacterial resistance is undoubtedly recognised as a major medical challenge in most healthcare systems. Resistance-determining genes, mostly in combination, and extensively drug-resistant (XDR) pathogens are spreading with unprecedented speed. Low- and middle-income countries with limited economic resources, high disparity in standard of living, weak national drug regulatory authorities, inefficient antibiotic policies, and erratic access to antibiotics are important high-impact resistance regions which contribute significantly to the global pool of resistance genes and difficult-to-treat-infections. Emerging markets, such as China, India and Brazil will face a growing resistance selection pressure while antibiotics become commodities in insufficiently regulated markets. The escalating resistance crisis will have a great impact on all civil societies worldwide. In high-income countries, empirically used ineffective antibiotics in the case of XDR or pandrug-resistant infections in critically ill patients will result in high mortality. In low- and middle-income countries, multidrug resistance leads to untreatable resistant infections much earlier in the escalating chain of resistant events as they do not have a broad enough selection of second-line drugs, and novel antibiotics may not be available or affordable. Moreover, the weak political will to face this problem and take concerted action in many resistance hot spots of the world accelerates the resistance spiral and puts all other countries, especially those with low resistance rates, at risk for increased imported resistance. This gloomy scenario of resistance with limited or no treatment option is already seen in some parts of the world and will influence the life expectancy as it threatens the advances of modern medicine.

Abstract licence: CC BY-NC-ND

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