Our findings confirmed that MRSA infections in the community have been increasing in Asian countries. Data also suggest that various MRSA clones have spread between the community and hospitals as well as between countries.

Isolates from Hong Kong showed the highest rate of ciprofloxacin resistance (11.8%), followed by isolates from Sri Lanka (9.5%), the Philippines (9.1%), and Korea (6.5%). Multilocus sequence typing showed that the spread of the Taiwan 19F clone and the Spain 23F clone could be one of the major reasons for the rapid increases in antimicrobial resistance among S. pneumoniae isolates in Asia. Data from the multinational surveillance study clearly documented distinctive increases in the prevalence rates and the levels of antimicrobial resistance among S. pneumoniae isolates in many Asian countries, which are among the highest in the world published to date.The global emergence of in vitro antimicrobial resistance in Streptococcus pneumoniae has become a serious clinical concern since the 1980s (1). During the past two decades, the rates of resistance to penicillin, other beta-lactams, and non-betalactam agents have been increasing rapidly in many parts of the world. In particular, data on rates of pneumococcal resistance from Asian countries at the end of the 1990s were alarming.

Antimicrobial resistance in

Acinetobacter spp., P. aeruginosa, S. aureus, and K. pneumoniae are the most frequent isolates from adults with HAP or VAP in Asian countries. These isolates are highly resistant to major antimicrobial agents, which could limit the therapeutic options in the clinical practice. Discordant initial empirical antimicrobial therapy significantly increases the likelihood of pneumonia-related mortality.

Appropriate antimicrobial treatment of community-acquired pneumonia (CAP) should be based on the distribution of aetiological pathogens, antimicrobial resistance of major pathogens, clinical characteristics and outcomes. We performed a prospective observational study of 955 cases of adult CAP in 14 hospitals in eight Asian countries. Microbiological evaluation to determine etiological pathogens as well as clinical evaluation was performed. Bronchopulmonary disease (29.9%) was the most frequent underlying disease, followed by cardiovascular diseases (19.9%), malignancy (11.7%) and neurological disorder (8.2%). Streptococcus pneumoniae (29.2%) was the most common isolate, followed by Klebsiella pneumoniae (15.4%) and Haemophilus influenzae (15.1%). Serological tests were positive for Mycoplasma pneumoniae (11.0%) and Chlamydia pneumoniae (13.4%). Only 1.1% was positive for Legionella pneumophila by urinary antigen test. Of the pneumococcal isolates, 56.1% were resistant to erythromycin and 52.6% were not susceptible to penicillin. Seventeen percent of CAP had mixed infection, especially S. pneumoniae with C. pneumoniae. The overall mortality rate was 7.3%, and nursing home residence, mechanical ventilation, malignancy, cardiovascular diseases, respiratory rate>30/min and hyponatraemia were significant independent risk factors for mortality by multivariate analysis (P<0.05). The current data provide relevant information about pathogen distribution and antimicrobial resistance of major pathogens of CAP as well as clinical outcomes of illness in Asian countries.

To investigate the nasal carriage of antibiotic-resistant pneumococci by children, anterior nasal swabs were done for 4963 children <5 years old in 11 countries in Asia and the Middle East. In total, 1105 pneumococci isolates (carriage rate, 22.3%) were collected, 35.8% of which were found to be nonsusceptible to penicillin. Prevalence of penicillin nonsusceptibility was highest in Taiwan (91.3%), followed by Korea (85.8%), Sri Lanka (76.5%), and Vietnam (70.4%). Penicillin resistance was related to residence in urban areas, enrollment in day care, and a history of otitis media. The most common serogroups were 6 (21.5%), 23 (16.5%), and 19 (15.7%). The most common clone, as assessed by pulsed-field gel electrophoresis, was identical to the Spanish 23F clone and to strains of invasive isolates from adult patients. Data in this study documented the high rate of penicillin or multidrug resistance among isolates of pneumococci carried nasally in children in Asia and the Middle East and showed that this is due to the spread of a few predominant clones in the region.

This multinational study from Asia revealed that reduced susceptibility to ciprofloxacin (MIC, 0.125 to 1 g/ml) in nontyphoid Salmonella isolates was common in Taiwan (48.1%) and Thailand (46.2%) and in S. enterica serotype Choleraesuis (68.8%) and S. Virchow (75.0%) from all countries. Reduced susceptibility to ceftriaxone (MIC, 2 to 8 g/ml) remained uncommon in Asia, except in Taiwan (38.0%) or in S. Typhimurium (25.0%) from all countries.Nontyphoid Salmonella bacteria, with more than 2,500 serotypes, usually cause diarrheal diseases in humans that may be complicated by extraintestinal infections, such as bacteremia, meningitis, and osteomyelitis (11). Resistance to antimicrobial agents, including fluoroquinolones and expanded-spectrum cephalosporins, has been a serious problem worldwide. Nontyphoid salmonellosis has been rampant in Asia (7); however, data on the antimicrobial susceptibilities, as well as the prevalence, of various serotypes in many Asian countries after 2000 have been lacking.During 2003 to 2005, 400 clinical isolates of nontyphoid Salmonella bacteria were randomly collected from 11 medical centers in seven Asian countries (Table 1) and transported to the central laboratory in Samsung Medical Center, Seoul, Korea, for serogrouping and serotyping using O and H antisera, respectively (Difco Laboratories, Detroit, MI). Susceptibilities to ciprofloxacin, tetracycline, ceftriaxone, ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole were determined by a broth microdilution method, and the results were interpreted according to the breakpoints for MICs suggested by the NCCLS (10). For statistical analysis, isolates in the "intermediate" category were deemed "resistant" in this study. Concomitant resistance to at least three of the six antibiotics tested was defined as multidrug resistance (MDR). Isolates with ciprofloxacin MICs of 0.125 to 1 g/ml were defined as having "reduced susceptibility" to ciprofloxacin (9). Similarly, "reduced susceptibility" to ceftriaxone was defined as isolates showing ceftriaxone MICs of 2 to 8 g/ml (14). These definitions were proposed in previous reports to reflect the clinical therapeutic responses (9, 14). The 2 test and Student's t test were used to determine the significance of differences, and a P value of Ͻ0.05 was considered statistically significant.A total of nine serogroups (B, C1, C2, D, E, G, I, K, and M) and 82 serotypes were identified among the isolates tested. Serogroups B (34.8%) and D (25.0%) were the two leading serogroups in all areas except Philippines, where serogroup E (25 isolates, 53.2%) was most prevalent. The distribution of major serotypes among the countries is shown in Table 1. Overall, S. enterica serotype Enteritidis and S. Typhimurium were the two most-prevalent serotypes except in Philippines, Singapore, and Thailand, where S. Weltevreden was either the most-or second-most-prevalent serotype. In Sri Lanka and Thailand, the most-prevalent serotypes were S. Agona and S. Stanley, respectively. S. Choleraesuis was relatively mor...

National networks of laboratory-based surveillance of antimicrobial resistance (AMR) monitor resistance trends and disseminate these data to AMR stakeholders. Whole-genome sequencing (WGS) can support surveillance by pinpointing resistance mechanisms and uncovering transmission patterns. However, genomic surveillance is rare in low-and middleincome countries. Here, we implement WGS within the established Antimicrobial Resistance Surveillance Program of the Philippines via a binational collaboration. In parallel, we characterize bacterial populations of key bug-drug combinations via a retrospective sequencing survey. By linking the resistance phenotypes to genomic data, we reveal the interplay of genetic lineages (strains), AMR mechanisms, and AMR vehicles underlying the expansion of specific resistance phenotypes that coincide with the growing carbapenem resistance rates observed since 2010. Our results enhance our understanding of the drivers of carbapenem resistance in the Philippines, while also serving as the genetic background to contextualize ongoing local prospective surveillance.