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Cambodia’s antibiotic resistance high: study

A woman packs antibiotics in a Phnom Penh. Physicians have admitted to overprescribing antibiotics, a problem that a new study suggests may be leading to antibiotic resistance.
A woman packs antibiotics in a Phnom Penh. Physicians have admitted to overprescribing antibiotics, a problem that a new study suggests may be leading to antibiotic resistance. Pha Lina

Cambodia’s antibiotic resistance high: study

A new study by Cambodia’s Pasteur Institute reveals worryingly high, and increasing, levels of antibiotics resistance in the Kingdom, likely as a result of overprescribing medication.

“In Cambodia, the misuse of antibiotics is a known phenomenon, but there is little data on microbial resistance,” reads a Tuesday press release accompanying the study.

To rectify this data gap, the Institute conducted a four-year study to examine the frequency of “extended-spectrum beta-lactamase producing enterobacteria (ESBL)”, a type of bacteria resistant to many types of antibiotics.

“When I arrived in Cambodia in 2012 . . . I was surprised to see in the urine of Cambodian patients a lot of resistant bacteria, with a frequency much higher than that observed in France,” Dr Alexandra Kerleguer, from the Institute’s medical Biology Unit, said.

The Institute collected samples at Calmette and Choy Ray hospitals, including blood, stool, urine and more.

The results showed not only a high rate of ESBL in Cambodia, but that it is continually growing.

The total proportion of ESBLs increased from nearly 24 percent more than 38 percent from the start of 2012 until December 2015, with E. coli in particular seeing a marked increase, from nearly 29 percent to more than 48 percent.

The report by Kerleguer and others claimed the change was “a gradual and statistically significant increase”.

“The most commonly identified strains were E. coli and K. pneumoniae, present in 77% and 19% of positive isolates, respectively,” the report says.

The report notes that there was no significant statistical difference in data from Calmette, a national hospital, and Choy Ray, a community clinic. The authors said it was “especially . . . cause for serious local and international concern” that resistance levels were so high in the clinic, where patients should not have had as much exposure to medication as at a national referral hospital like Calmette.

“The indiscriminate use of fluoroquinolones has increased resistance to these molecules significantly,” the paper argues, referring to a particular type of antibiotic used or a variety of infections.

The paper advocated for a “dual strategy” in reducing the problem, calling for fewer antibiotics prescriptions and higher hygiene standards both within hospitals themselves, and in communities in general.

The prescription of certain antibiotics must “be strictly and continuously supervised to prevent the emergence of multi-resistant bacteria”.

The authors said the industry must focus both on less use, and “better use” by “prioritizing the use of molecules that exert the weakest selection pressure”.

“This is a considerable challenge in Cambodia, a country where even fluoroquinolones are available over the counter, dispensed for a day or two at a time, and where physicians and pharmacists are known to misuse or overuse these antibiotics which are considered ‘much more effective’,” the study

The paper concludes by saying the prevalence and spread of ESBLs is a “public health concern” and warning that there is a “very real risk of a therapeutic dead-end”, whereby these diseases can no longer be treated.

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