Carbapenem-Resistant Enterobacteriaceae in the Asia Pacific and Beyond

Enterobacteriaceae are the cause of both community-acquired and hospital-acquired infections. These infections can range from minor to life-threatening disorders, especially among vulnerable populations, including infants, elderly persons and patients with immunodeficiency. β-lactam drugs are often the primary therapeutic option for serious Enterobacteriaceae infections, and the carbapenems are usually considered as the last resort antibiotics against complicated infections. Unfortunately, carbapenem-resistant Enterobacteriaceae (CRE) has now emerged worldwide as an urgent antibiotic resistance threat. Asia-Pacific countries are regarded as high CRE prevalent regions, and the rate of CRE detection has been continuously increasing. Unlike some other regions in the world, e.g. the United States, where single class KPC carbapenemase is predominant, different classes of carbapenemase (e.g. KPC, NDM, IMP and OXA181) are frequently identified in regions within Asia-Pacific. CRE are particularly concerning, as the resistance is encoded by plasmid-borne genes, and can disseminate clonally or horizontally. A number of plasmid-mediated or clonal CRE outbreaks have been documented in several Asia-Pacific countries, such as China. In addition, the plasmid-mediated colistin resistance gene, mcr-1, which was originally identified in China, has been found in CRE clinical isolates, posing another significant threat to global health. Moreover, hypervirulent K. pneumoniae strains, associated with life-threatening community-acquired infections in young and healthy hosts, have been frequently identified in Asia-Pacific region. More recently, hypervirulence has emerged in carbapenem-resistant K. pneumoniae strains in China, representing a “triple threat” (hypervirulent, multidrug resistant, and highly transmissible) to global public health. CRE studies on resistance mechanisms, epidemiology, diagnosis and treatment in the Asia-Pacific region are making significant progress, and now is the time to arrange a Research Topic to present and highlight these novel findings.

The present Research Topic of Frontiers in Microbiology will feature authoritative articles on etiology, pathogenesis, virulence, resistance, diagnosis, treatment and control of CRE in the Asia-Pacific region. CRE-related topics on other emerging and existing antibiotic resistance beyond the region will also be covered. Potential authors would be researchers in academic institutes, Centers for Disease Control and Prevention, and hospitals, and would work in fields including environmental, veterinary, molecular medical and clinical microbiology. Leading researchers in these fields will be welcome to present original research articles, review and mini-review articles as well as perspectives on this topic.