Deadly antibiotic-resistant bacteria island-hops around the Pacific

Dunedin North, NEW ZEALAND — A drug-resistant infection is "a ticking time bomb" in the Pacific, according to new Otago University research.

A landmark study, just published in The Lancet Regional Health- Western Pacific journal, has found strains of carbapenem-resistant Acinetobacter baumannii (known as CRAb) are spreading between India, Fiji, Samoa, Australia and New Zealand.

Radio New Zealand is reporting that lead author Sakiusa Baleivanualala, from Otago's Department of Microbiology and Immunology and the College of Medicine Nursing and Health Science at the Fiji National University, said little was known about CRAb transmission in the region.

The team identified previously unrecognized outbreaks of CRab in Fiji and Samoa that linked to strains in other parts of Oceania and South Asia, which indicated "the potential for high mobility and dissemination."

"CRAb can cause infections of the blood, urinary tract, and lungs and, because it is resistant to medicine, infections are hard to treat, with an increased risk of disease spread, severe illness and death," he told RNZ.

The researchers analyzed CRAb detected in hospitals in Fiji and Samoa, and compared the strains to those from hospitals in New Zealand, Australia and India.

Their findings included:

• •            A significant presence of CRAb in Fiji and Samoa.
• •            Evidence of CRAb transmission within hospitals in Fiji and Samoa.
• •            Ineffectiveness of some common hospital disinfectants against the strains.
• •            Trans-national movement of CRAb strains, especially between India, Australia, New Zealand, Fiji and Samoa.

Researchers are calling for the re-evaluation of infection control strategies and public health measures, as well as a collaborative, funded approach to surveillance of antibiotic-resistant bacteria across the region.

"Knowledge empowers communities to advocate for better healthcare policies and practices," Baleivanualala said.

"This should serve as a call to action for better infection control practices and antimicrobial stewardship around the world."

Meanwhile, The Samoa Observer is reporting that according to Baleivanualala, “In the Tupua Tamasese Mea’ole Hospital in Samoa, there were at least 59 CRAb isolated in 2019, with 60 per cent of Acinetobacter baumannii isolates resistant to carbapenems, when tested."

Out of the cases that the research group sequenced, he said two major outbreaks could be identified in Fiji with one “genetically linked” to published sequences in India, which suggested a possible source.

“The other outbreak strain was not only found in Fiji (including a historical outbreak from 2016/2017), but also in Samoa, and cases in New Zealand and Australia, suggesting dissemination around the Pacific.

“The vast majority of cases were likely to have been acquired in hospital. CRAb is adept at surviving in hospital environments and is relatively resistant to disinfectants commonly found in cleaning agents.

“Indeed, swabs taken from various locations within the Tupua Tamasese Mea’ole Hospital environment isolated CRAb that were genetically linked to CRAb isolated from patients, suggesting a possible source of contamination. 

When asked about the research group’s source of data in Samoa, Baleivanualala said their data and CRAb were collected from the microbiology laboratory in Samoa’s national hospital, with the appropriate ethics approval given by Samoa’s Ministry of Health (MOH).

Expanding on the "source" of the pathogen, when questioned further by The Observer, he said their research was not able to "definitively identify" a source of CRAb within the Samoan and Fijian hospitals but their data "suggests that the hospital environment (including equipment used), and infected patients could serve as possible source of infection."

Professor James Ussher, of Otago's Department of Microbiology and Immunology, said there was a "pressing need for immediate action."

"The increasing prevalence of CRAb in healthcare settings in Fiji and Samoa is a ticking time bomb that could have catastrophic consequences if not addressed promptly."

Actions could include the establishment of programs:

¥  to guide the appropriate use of antibiotics;

¥  strengthen antimicrobial resistance surveillance;

¥  introduce or upgrade rigorous infection control practices within healthcare settings;

¥  initiate public awareness campaigns about antimicrobials and antimicrobial resistance; and,

¥ encourage a multifaceted approach to combating antimicrobial resistance.