In recent years, we have witnessed an increased emergence of antimicrobial-resistant (AMR) pathogens. In this era of globalization, international travel has been implicated as a significant risk factor for the acquisition of infections with multidrug-resistant bacteria, including Acine-tobacter spp., methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, hypervirulent Clostridium difficile, and Extended-Spectrum-Beta-Lactamase- (ESBL-) producing Enterobacteriaceae. The plasmid encoded cefotaximase enzymes CTX-M and the New Delhi metallo-beta-lactamase-1 (NDM-1) represent two excellent examples of the ESBL and carbapenemase that have been rapidly and globally disseminated. In this special issue, M. Elouennass et al. report on high rates of ESBL-producing Enterobacteriaceae and the emergence of carbapenemase-producing isolates in Morocco. The boom in medical tourism has seen patients from developed nations taking up low-cost private medical care in developing countries. This inevitably provides ample opportunity for clinically important AMR pathogens to be acquired and disseminated across geographical borders. A recent example is NDM-1 which was first described in an isolate from a Swedish patient who had previously been hospitalized in New Delhi, India [5]. NDM-1-producing isolates have subsequently been reported across several continents often detected in patients with history of recent medical care in the Indian subcontinent [6]. Preventive measures against nosocomial transmission of AMR pathogens include hand hygiene, environmental decontamination as well as screening and cohorting of patients. Data from the study by J. C. Catano et al., presented in this issue, identifies the diversity of areas of bacterial contamination in a tertiary healthcare setting in a developing country. As stated by the authors "these bacterial reservoirs are a plausible source of infections for patients" and it indicates the need for further research to evaluate strategies for minimizing risk of transmission to patients.
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机译：近年来，我们目睹了抗药性（AMR）病原体的出现。在这个全球化时代，国际旅行已成为获得多重耐药细菌感染的重要危险因素，包括不动杆菌属细菌，耐甲氧西林金黄色葡萄球菌，耐万古霉素肠球菌，高毒性艰难梭菌和产肠杆菌科细菌的广谱β-内酰胺酶（ESBL）。编码头孢噻肟酶CTX-M和新德里金属β-内酰胺酶-1（NDM-1）的质粒代表了ESBL和碳青霉烯酶的两个极好的例子，它们已经在全球范围内迅速传播。在本期特刊中，M。Elouennass等人。报道了在摩洛哥高产ESBL的肠杆菌科和产碳青霉烯酶的菌株的出现。医疗旅游业的蓬勃发展已经使发达国家的患者在发展中国家接受低成本的私人医疗服务。这不可避免地为临床上重要的AMR病原体的采集和跨地理边界的传播提供了充足的机会。最近的一个例子是NDM-1，它首先是从一名瑞典患者的分离物中描述的，该患者先前曾在印度新德里住院[5]。随后，在印度次大陆，有近来医疗史的患者中经常在几大洲发现生产NDM-1的分离株[6]。预防AMR病原体在医院内传播的预防措施包括手卫生，环境净化以及患者的筛查和队列研究。 J. C. Catano等人在本期中发表的研究数据确定了发展中国家三级医疗机构中细菌污染区域的多样性。如作者所述，“这些细菌库是患者感染的合理来源”，这表明需要进行进一步研究，以评估将传播给患者的风险降至最低的策略。
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