Jason Gale

1. Jason Gale
Editor-at-large – Global Health
Bloomberg News/Sydney
Tel. +61-2-9777-8660
E-mail: j.gale@bloomberg.net
Twitter: @jwgale

2. Transrectal ultrasound-guided
PROSTATE BIOPSIES
• Prostate needle biopsy
patients = sentinels for
ciprofloxacin-resistant (?MDR)
in gut commensals?
• Small BUT growing risk
Nam, Loeb, Williamson, Patel et al
• Travelers, health-care workers
(and their household members),
veterinarians, repeat Bx
patients, recent antibiotic-users
among those at highest risk
• New approaches to mitigating
risk needed
Source: Michael Liss, University of California, San Diego

3. Japan 0%
microbial
SOUVENIRS
• Travelers return with MDR gut commensals
• Cipro resistance 3.9% pre-travel 33% post-travel
• ESBL+ve 2% pre-travel 22% post-travel
North America 30%
China, Hong Kong,
Taiwan, Korea 69%
India/Nepal/
Sri Lanka 79%
Middle East/Africa 75%
South
America/
Mexico 60%
Europe 24%
Southeast Asia/Pacific 52%
Source: Kennedy et al, European Journal of Clinical Microbiology & Infectious Diseases, 2010

4. microbial
SEX

5. The Superbug, Biopsy, Sepsis
• Global problem
• Getting worse
• Challenging clinical practice
• Affecting outcomes

9. gut
Colonization
• E. coli strains are shared among
household members, including the
family dog
Johnson et al, Journal of Clinical Microbiology December 2008
• Multidrug-resistant E. coli may
colonize the GI tract for 1 year or
more
Nordmann et al, Journal of Antimicrobial Chemotherapy, 2011

11. Extended Spectrum Beta Lactamase
• Enzymes that open the beta-lactam ring, inactivating the
antibiotic
• Confer resistance to most beta-lactam antibiotics, including
penicillins, cephalosporins, and the monobactam aztreonam
• First plasmid-mediated beta lactamase in Gram-negative bacteria
was discovered in Greece in the 1960s
• Now worldwide
• CTX-M-15, probably from India
• CTX-M-14, probably from China
• First line options for UTIs are lost:
Trimethoprim • Trimethoprim/sulfamethoxazole • Gentamicin •
Ceftriaxone • Ticarcillin/clavulanate • Piperacillin/tazobactam •
Ciprofloxacin

12. Why?
• Nature of Gram-negative bacteria
• accumulate resistance mechanisms
• gut colonization
• combining with virulence mechanisms
• Antibiotic use
• in people
• in animals
• Global travel
• global trotting grandpas
• medical tourism

13. % Fluoroquinolone Resistance
in E. coli / K. pneumoniae Isolates*
• Greece – 24 / 71
• Bulgaria – 33 / 52
• Cyprus – 43 / 39
• Hungary – 37 / 43
• Italy – 39 / 39
• Czech Republic – 23 / 55
• Latvia – 14 / 52
• Poland – 26 / 33
• Portugal – 27 / 31
• Malta – 34 / 16
• Spain – 33 / 14
* Bacteraemias in (mostly) elderly and not necessarily reflective of gut carriage

16. resistance
RESERVOIRS? • ESBL genes in
80% of raw
chicken meat
sold at retail
• Predominant
ESBL genes in
chicken meat
and human
rectal swab
specimens were
identical
Source: Overdevest et al, Emerging
Infectious Diseases, July 2011

17. Jason Gale
Editor-at-large – Global Health
Bloomberg News/Sydney
Tel. +61-2-9777-8660
E-mail: j.gale@bloomberg.net
Twitter: @jwgale