Circulation of Multidrug Resistant Pathogens between Developed and Developing Countries: A New Frontier of Biodefense. Implication for Policy Makers

Giancarlo Ceccarelli^1,2*, Carla Ceccarelli³ and Laura Elena Pacifici²

¹Department of Public Heath and Infectious Diseases, University of Rome “Sapienza”, Via del Policlinico 155, 00161, Rome, Italy

²Department of Emergency Services and Office for International Health Cooperation and Development, Italian Red Cross, Rome, Italy

³Department of Emergency Medicine, Calvary Mater Hospital, Newcastle, NSW, Australia

*Corresponding Author:

Giancarlo Ceccarelli
Department of Public Health and Infectious Diseases
University of Rome “Sapienza”, and
Department of Emergency Services-Office for
International Health Cooperation-Italian Red Cross, Rome, Italy
E-mail: Giancarlo.Ceccarelli@uniroma1.it

Received Date: December 04, 2012; Accepted Date: December 06, 2012; Published Date: December 08, 2012

Citation: Ceccarelli G, Ceccarelli C, Pacifici LE (2013) Circulation of Multidrug Resistant Pathogens between Developed and Developing Countries: A New Frontier of Biodefense. Implication for Policy Makers. J Bioterr Biodef 4:e109 doi: 10.4172/2157-2526.1000e109

Copyright: © 2013 Ceccarelli G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Severe infections caused by multidrug resistant pathogens are becoming a significant problem worldwide. The increasing incidences of infections related to these pathogens are associated with higher cost of care, longer durations of hospitalization, and increased mortality. In fact, multiple mechanisms of resistance have substantially reduced the current arsenal of antimicrobials. Furthermore, the emergence of strains resistant also to the remaining active antibiotics has further complicated the possibility of treating infections caused by these microbes and has exhausted the arsenal of available antibiotics [1].

These concepts that arise in the context of infections due to Gram-positive and especially Gram-negative bacteria can be extended also to other types of infections. In fact the emergence and spread of resistant organisms are growing problems in infections that account for most of developing countries disease burden, including malaria, tuberculosis, and HIV infection. For example, if globally about 3% of all newly diagnosed patients have multidrug resistant-tuberculosis, this proportion is higher in developing countries reflecting the failure of structures and programmes designed to ensure complete cure of tuberculosis. Indeed poorly managed TB-control programs, unenforced hospital infection control programs, suboptimal antibiotic regimens, and poor adherence to treatment have been associated with high rate of multidrug resistant-tuberculosis [2-4]. In the same way, in HIV infection, population levels of resistance are profoundly affected by multiple factors that include the availability of first-line and salvage therapies, the risk behaviours of HIV-infected individuals, and the level of available infrastructure [5,6]. In fact poor infrastructure may affect many of these factors, with unforeseeable effects on the population’s level of resistance.

World Health Organization indentified “poverty” as one of major force driving the development of antimicrobial resistance. In this sense in developing countries, factors such as unregulated manufacture and dispensing of antimicrobials, inadequate access to effective drugs, inadequate treatment regimens, low adherence to treatment, and poorly managed control programs are contributing to the development of multidrug-resistant organisms [7,8]. In fact inappropriate and irrational use of antimicrobial medicines provides favorable conditions for resistant microorganisms to emerge, spread and persist.

Anyway, if poverty and inadequate access to drugs continue to be a major force in the development of resistance, the ongoing circulation of pathogens between Europe, Asia, Africa, the Caribbean, and North and South America is just one of the factors that accounts for the problem of the multi/pan-drug resistant infections in developed countries.

In fact, the policies aimed at the control of infections in developed countries are still largely insufficient to control this biological emergency and are therefore subject to criticism and revisions. An interesting example of this problem is the management of screening of tuberculosis in migrants: in the recent years, different tuberculosis screening strategies among foreign-born individuals were published sparking debate among the scientific community. Screening for tuberculosis is primary performed with the aim of detecting the active disease. Anyway tuberculosis screening also provides an opportunity to offer preventive therapy for latent tuberculosis infection (LTBI). Because 5 to 10 percent of persons with LTBI are at risk of progressing to active disease, identification and treatment of LTBI are essential for the elimination of tuberculosis. Today, in many of developed countries, tuberculosis screening policies for immigrants request screening strategy, which uses tuberculin skin test or chest radiograph as the first step of screening. Anyway the results of these screening algorithms showed some limitations regarding the target of identifying LTBI. Therefore, screening for LTBI in populations immigrating to low-incidence countries remains a challenge. Moreover, the lack of screening methods is added to the lack of monitoring systems of diseases. In fact the prevalence of many tropical diseases has been largely underestimated by European Surveillance Systems [9]. Finally, we should not forget the misuse of anti-infective drugs in developed countries. It should be stressed that the rate of emergence of resistance is high even in Europe and North America, and the risk of circulation of resistance from developed countries to developing countries is also high.

Infections by multidrug and pan-resistant germs represent a new challenge for the medicine and a stern test for the health services of the industrialized countries and of the developing world. In fact in the future, the gradual spread of germs resistant to all types of antibiotics available will force to seek new strategies for individual and collective protection able to safeguard civil society [10]. In this sense, the multidrug-resistant infections represent a sort of biological attack where the enemy is the mismanagement of the antibiotic therapy. Although, there is a pressing need to establish a global task force to enforce the antibiotic stewardship and the implementation of measures to curb antibiotic resistance, the necessity to identify new policies able to control the diffusion of the multidrug-resistant pathogens is even more urgent at this time.

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