AUTHOR=Osei Sekyere John 

TITLE=Current State of Resistance to Antibiotics of Last-Resort in South Africa: A Review from a Public Health Perspective

JOURNAL=Frontiers in Public Health

VOLUME=4

YEAR=2016

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2016.00209

DOI=10.3389/fpubh.2016.00209

ISSN=2296-2565

ABSTRACT=<p>A review of the literature was undertaken to delineate the current level and mechanisms of resistance to carbapenems, colistin, and tigecycline in South Africa. Thirty-two English publications and 32 National Institute of Communicable Diseases communiqués identified between early January 2000 and 20 May, 2016 showed substantial reports of NDM (<italic>n</italic> = 860), OXA-48 (<italic>n</italic> = 584), VIM (<italic>n</italic> = 131), and IMP (<italic>n</italic> = 45) carbapenemases within this period, mainly in <italic>Klebsiella pneumoniae</italic> (<italic>n</italic> = 1138), <italic>Acinetobacter baumannii</italic> (<italic>n</italic> = 332), <italic>Enterobacter cloacae</italic> (<italic>n</italic> = 201), and <italic>Serratia marcescens</italic> (<italic>n</italic> = 108). Colistin and tigecycline resistance was prevalent among <italic>K. pneumoniae, A. baumannii, S. marcescens</italic>, and <italic>E. cloacae</italic>. The first <italic>mcr-1</italic> colistin resistance gene to be detected in South Africa was reported in <italic>Escherichia coli</italic> from livestock as well as from hospitalized and outpatients. There are increasing reports of NDM and OXA-48 carbapenemases among Enterobacteriaceae and <italic>A. baumannii</italic> in South Africa. <italic>Mcr-1</italic> is now present in South African patients and livestock. Resistance to carbapenems, colistin, and tigecycline restricts infection management options for clinicians.</p>