About – Background

The discovery and use of antibiotics in the second half of the 20th century considerably decreased the death rates associated with infectious diseases. Nevertheless, the emergence of resistance to antibiotics quickly followed the massive use of these new drugs. The situation became particularly critical in recent years where multiple and extended resistant bacteria have become more prevalent whereas the discovery of antibiotics has significantly slowed down. Antimicroresistance (AMR) is now an increasing Public Health concern and threatens decades of infectious disease control efforts. The World Health Organization (WHO) fears for several years the start of a “postantibiotic” era in which “common infections and minor injuries can kill” (WHO, 2014). The WHO stated that the threat posed by antibiotic resistance is a real-time bomb and in the near future, its medical and economic consequences will largely surpass those of all the current chronic diseases, if not managed properly. The development of AMR control and monitoring strategies has become a priority in Low-Medium Income Countries (LMICs), particularly in South East Asia where very high levels of AMR prevalence were reported.

Emergence and spread of AMR are mostly attributed to the overuse of antibiotics, whether to humans, animals, or in the environment. Their unregulated or uncontrolled use in both human populations and farms is the main cause of resistance emergence and spread. Moreover, industrial and domestic waste also largely contributes to increase the resistance levels of microorganisms in the environment that act as both reservoirs and vectors of resistance between hospitals, communities and farms. Since drug resistance circulates in and between animals, humans and environments, efforts by just one sector cannot prevent or eliminate the problem. Thus, to overcome these challenges and prevent the further impact of drug-resistant infections caused by bacteria, bold and comprehensive actions are urgently required, employing a One Health approach that tackles antimicrobial resistance in the context of human, animal and plant health, as well as in food production and the environment. This kind of integrated and interdisciplinary programs will help set up effective surveillance systems, identify the source of drug resistance emergence and transmission and implement efficient control measures.

Southeast Asia is a world epicenter of infectious disease emergence. Almost 35% of the emerging infectious diseases identified in Asia between 1940 and 2004 correspond to the emergence of a new pattern of antimicrobial drug resistance (Horby et al. 2013). Nevertheless, the data on drug resistance in this region are still fragmented, often extremely localized and completely absent from some countries. Cambodia cumulates all the issues favoring the emergence and spread of more and more drug resistant bacteria. Despite the crucial issues in humans and animals, a few fragmented data are available and today no study has yet developed a One Health approach in this country. The few available data are extremely worrying. Indeed, in Carron et al. (2018), ESBL was detected in 42.7% of the E. coli strains and 33.7% of all K. pneumoniae isolated. The proportion of ESBL-producing E. coli increased significantly from 28.9% in 2012 to 48.2% in 2015. They also showed that the proportion of ESBL-E increased gradually over time from 23.8% to 38.4% during the study period. Multidrug resistance was high in this study, with some strains displaying resistance to all antibiotics available in the country.