Concise Notes on Gram(-) MDR Market Sizing Study
Overview of Antimicrobial Resistance (AMR)
Overuse of antibiotics has led to increased AMR, rendering antibiotics ineffective against infections.
Gram-negative bacteria like K. pneumoniae, E. coli, and P. aeruginosa are major drug-resistant pathogens.
The spread of AMR is fueled by human and animal populations, water contamination, and international travel.
A UK government study in 2016 estimated 700,000 deaths annually are attributed to AMR.
Without action, AMR may cause 10 million deaths by 2050.
Carbapenem Resistance
Development of carbapenem resistance in Enterobacteriaceae is a significant concern due to limited antibiotic options.
Carbapenem resistance is mediated by ESBLs and carbapenemases.
CRE infections are mainly reported in healthcare facilities of developed countries, but are also found in low-to-mid income countries
Executive Summaries by Country
United Kingdom
Gram-negative bloodstream infections increased steadily from 2013-2018 but decreased by 1% in 2018.
E. coli, P. aeruginosa, and Klebsiella spp. cause ~75% of gram-negative BSIs.
The susceptible population is growing at ~5-10%, while the resistant population is increasing at ~15-17%.
20-year vision and 5-year action plan to contribute to reduce the number of drug-resistant infections by 10% (5,000 infections) by 2050.
China
The ratio of gram-negative to gram-positive bacteria is 7:3.
Gram-negative bacteria account for 70.3% of isolates with a 5% growth rate.
E. coli, K. pneumoniae, P. aeruginosa, and A. baumannii are leading causes of healthcare-associated infections.
P. aeruginosa has the highest carbapenem resistance rate among gram-negative bacteria at 20.7% in 2017.
ESBL prevalence was 55.8% in E. coli and 29.9% in Klebsiella spp.
NDM producing bacteria were identified as E. coli 31.1%, Klebsiella pneumoniae 26.7%, Acinetobacter calcoacelicus 20%.
Philippines
~41.3% of the population has positive bacterial isolates, with >50% being gram-negative bacteria.
Leading causes of healthcare-associated bloodstream infections include E. coli, Klebsiella spp., A. baumannii, and Pseudomonas spp.
Carbapenem resistance rate in K. pneumoniae rose from under 6% (until 2013) to 11.9% in 2017.
According to a study, 36.8% of the total isolates tested (Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca and Proteus mirabilis) were positive for ESBL production in the Philippines and have reported increase in resistance.
NDM is the most common type of MBL in Philippines with a prevalence of 58.5%, followed by IMP with 7.3% and VIM with 4.8%.
France
In 2017, 68,581 patients were hospitalized, with P. aeruginosa (15.0%) being the most frequently isolated microorganism.
Gram-negative BSIs are predominant: 39% hospital-acquired, 45% community-acquired, and 16% other health care-associated.
Carbapenemase-producing E. coli isolates multiplied fivefold between 2012-2014.
5,543 deaths occurred due to multi-drug resistant bacterial infection
Mexico
Hospital infection frequency ranges from 2.1% to 15.8% of admitted patients.
Gram-negative bacilli caused 51.2% of NBSIs, with K. pneumoniae (30.4%) and E. coli (18.9%) being most common.
Highest MDR phenotype frequency was observed for A. baumannii (74%), followed by E. coli (40%) and P. aeruginosa (34%).
1/10th of E. coli isolates produce ESBL.
Greece
Greece is a highly endemic area for multidrug-resistant pathogens, mainly carbapenem-resistant gram-negative bacteria.
E. coli is the most prevalent pathogen in community and hospital settings, with ~4% growth between 2013-2018.
The percentage distribution of key pathogens in 2018 is E. coli (39%), Klebsiella spp. (24%), P. aeruginosa (18%), Acinetobacter (13%), and Enterobacter spp. (6%).
Patients with Carbapenem-resistant increased over the last five years in Greece
India
Gram-negative infections account for 68% of all bacterial infections.
E. coli, Acinetobacter spp., P. aeruginosa, and Klebsiella spp. contribute to 82% of gram-negative BSIs.
In 2017, 77% of A. baumannii, 59% of K. pneumoniae, 30% of P. aeruginosa, and 18% of E. coli were carbapenem-resistant.
ESBL production was confirmed in 87% of all gram negative bacteria.
Amongst isolates in the five genera (Pseudomonas* spp., Acinetobacter spp., Klebsiella spp., E. coli & Enterobacter) which were resistant to carbapenems, MBL production was confirmed in 52%
Kuwait
Hospitalized patient infection rate was 11%.
E. coli is the predominant pathogen in both CA-UTI and HA-UTI cases.
Prevalence of antibiotic resistance was highest in E. coli (77%) followed by K. pneumoniae (36.2%), Acinetobacter (16.7%), and P. aeruginosa (2.6%).
*Most common ESBL producing isolates are 81% *E. coli* and 44% Klebsiella pneumoniae.
Italy
Gram negative bacteria accounts for more than 50% infections in Italy, E. coli (40%) being the most prevalent among gram negative bacteria
Anticrobial consumption is among the highest of all EU/EEA Member States in Italy
A. baumannii had the highest carbapenem resistance rate at 80%, followed by K. pneumoniae at 32%, P. aeruginosa at 24% and E. coli at 0.1%
molecular analysis revealed three types of MBL genes circulating in Italy namely, , , and
Spain
In Spain, total infections* increased at a rate of ~2-3% during 2013-17, decreased by ~2% in 2018
Number of patients with nosocomial infection and community based infections increased during 2013-17 while a decline was observed in 2018 by 9% & 5% resp.
*total ESBL resistance for E. coli was 77.51% followed by K. pneumoniae (20.71%), ~91% of which belong to OXA-48 type
*Majority of deaths in patients with MDR bacteria infections are due to Carbapenem-resistant to E. coli, K. pneumoniae and P. aeruginosa
Russia
*Hospital acquired infections (HAI) were found to be more prevalent and accounted for ~66% on an average during 2013-16
*Rates of Carbapenem resistance in Acinetobacter increased to 94% in 2017 from 61% in 2015 while E. coli showed least resistant rates
*High level of CR pattern observed in Acinetobacter from 2015-17 towards Imipenem, Doripenem & Meropenem