Research shows that antibiotic-resistant strains of bacteria that are widespread in Norway, Great Britain and the United Stated have not taken a hold in Pakistan in spite of the extensive use of antibiotics in this region.
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Professor Jukka Corander leads a team of researchers from the University of Oslo, the Wellcome Sanger Institute in England, the University of Helsinki and the University of the Punjab. They have found remarkable and unexpected differences in the distribution of E.coli between Punjab in Pakistan, Europe and the United States. Photo: Mona Mehus, UiO
A new research study now shows that the situation is not such a cause for concern in the Pakistani province of Punjab, in spite of the fact that antibiotics are widely used in this area. Strains of antibiotic-resistant E. coli that we struggle to contain in the West have fortunately not taken a hold in Pakistan even though the country's extensive use of antibiotics is making bacteria more resistant to medicines there too.
The worst bacteria are kept under control
A research team from the University of Oslo, the Wellcome Sanger Institute in England, the University of Helsinki, the University of Punjab and others points to "remarkable and unexpected differences" in the distribution of E.coli in the Punjab in Pakistan compared to that in Europe and the USA.
In a new study, the research team collected 1,411 samples from 494 outpatients and 423 people in the local community. In some cases, samples were collected before, during and after the patient took antibiotics. The aim was to see what effect this had.
The new study, which was published in the journal Nature Communications on 18th June this year, also showed that the E.coli strains that cause many urinary tract infections in the West and which are common in Norway, do not exist in the Punjab region.
Substantial differences
The distribution of bacterial strains found in this project are simply very
different from those in studies previously carried out in Europe and the USA in that strains that are often found in western countries are not prevalent in Pakistan. The E.coli strains that typically cause urinary tract infections in the West are by contrast extremely rare in the Punjab region of Pakistan.
The researchers also found that apart from the most common bacterial strains that occur both in Pakistan and Europe, the most common E.coli strains in Pakistan are rare in Europe.
Furthermore, the Pakistani variants are a natural part of the bacteria flora in the digestive system and are not linked to infections and disease.
The bacterial strains were outcompeted
This study is the first time that the effect of the use of antibiotics on the prevalence of bacteria resistant to treatment has been studied in Pakistan. The research team discovered that although the use of antibiotics increased the prevalence of certain resistant strains of bacteria by over 200%, these were nevertheless generally outcompeted by other E.coli strains.
This would indicate that the use of antibiotics created an environment in which antibiotic-resistant E.coli had the upper hand, but that these resistant strains could no longer outcompete other strains of bacteria when the patient stopped taking antibiotics. In this way, the bacteria had less benefit from being resistant to antibiotics: the selection pressure disappeared.
The scientists believe that most probably, this happens because of the selection pressure in the environment resulting from a lower level of sanitation and differences in food hygiene.
Recommend better surveillance
If we can find out more about the factors that prevent antibiotic-resistant bacterial strains from gaining a foothold in the Punjab region, this can help us to discover new ways of reducing the spread of harmful strains of bacteria in other parts of the world, including Norway.
In order to maintain an overview of the situation and implement measures to combat antibiotic resistance (AMR), it is therefore important to carry out international research projects that chart the spread of the various variants of bacteria in different parts of the world.
Monitoring the bacteria and their genomic data can then help us to predict the outbreak of infections, track down the dangerous bacteria variants and stop the outbreak of infections both in the Punjab and the rest of the world.
Contact information
https://www.med.uio.no/imb/english/people/aca/jukkac/index.html
Press release from the Wellcome Sanger Institute
https://www.sanger.ac.uk/news_item/western-superbugs-do-not-dominate-in-pakistan/
Scientific reference
T. Khawaja, T. Mäklin, T. Kallonen, et al. (2024) Deep sequencing of Escherichia coli displays marked colonisation diversity and impact of antibiotic use in Punjab, Pakistan. Nature Communications. DOI: 10.1038/s41467-024-49591-5
Funding
The study was funded by the Trond Mohn Research Foundation, the University of Helsinki, the Sigrid Jusélius Foundation, the Wellcome Sanger Trust and the Research Council of Finland.
