Emergence and Spread of Antimicrobial-Resistant Pathogens in an Era of Globalization

In recent years, we have witnessed an increased emergence of antimicrobial-resistant (AMR) pathogens. In this era of globalization, international travel has been implicated as a significant risk factor for the acquisition of infections with multidrug-resistant bacteria, including Acinetobacter spp., methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, hypervirulent Clostridium difficile, and Extended-Spectrum-Beta-Lactamase- (ESBL-) producing Enterobacteriaceae [1–4]. The plasmid encoded cefotaximase enzymes CTX-M and the New Delhi metallo-beta-lactamase-1 (NDM-1) represent two excellent examples of the ESBL and carbapenemase that have been rapidly and globally disseminated. In this special issue, M. Elouennass et al. report on high rates of ESBL-producing Enterobacteriaceae and the emergence of carbapenemase-producing isolates in Morocco. The boom in medical tourism has seen patients from developed nations taking up low-cost private medical care in developing countries. This inevitably provides ample opportunity for clinically important AMR pathogens to be acquired and disseminated across geographical borders. A recent example is NDM-1 which was first described in an isolate from a Swedish patient who had previously been hospitalized in New Delhi, India [5]. NDM-1-producing isolates have subsequently been reported across several continents often detected in patients with history of recent medical care in the Indian subcontinent [6]. Preventive measures against nosocomial transmission of AMR pathogens include hand hygiene, environmental decontamination as well as screening and cohorting of patients. Data from the study by J. C. Catano et al., presented in this issue, identifies the diversity of areas of bacterial contamination in a tertiary healthcare setting in a developing country. As stated by the authors “these bacterial reservoirs are a plausible source of infections for patients” and it indicates the need for further research to evaluate strategies for minimizing risk of transmission to patients.