LAUSR

Carbapenem resistant Enterobacteriaceae (CRE) infections have spread globally, leaving polymyxins, including colistin, as 'treatments of last resort'. Emerging colistin resistance raises the specter of untreatable infections. Despite this threat, data remain limited for much of the world, including Southeast Asia where only 3 of 11 nations submitted data on carbapenem and colistin resistance for recent World Health Organization reports. To improve understanding of the challenge, we utilized broad strategies to search for and analyze data on carbapenem and colistin resistance among Escherichia coli and Klebsiella in Southeast Asia. We found 258 studies containing 526 unique reports and document carbapenem resistant E. coli and Klebsiella in 8 of 11 and 9 of 11 nations, respectively. We estimated carbapenem resistance proportions through meta-analysis of extracted data for nations with ≥100 representative isolates. Estimated resistance among Klebsiella was high (>5%) in four nations (Indonesia, Philippines, Thailand, and Vietnam), moderate (1-5%) in two (Malaysia and Singapore) and low (<1%) in two (Cambodia and Brunei). For E. coli, resistance was generally lower but high in two of seven nations with ≥100 isolates (Indonesia and Myanmar). The most common carbapenemases were NDM metallo-β-lactamases and OXA. Despite sparse data, polymyxin resistance was documented in 8 of 11 nations, with mcr-1 the predominant genotype. The widespread presence of carbapenem and polymyxin resistance, including their overlap in 8 nations, represents a continuing risk and increases the threat of infections resistant to both. These findings, and remaining data gaps, highlight the urgent need for sufficiently resourced robust antimicrobial resistance surveillance.