Antibiotics are losing their power to fight infections in every country in the world, according to new data from the WHO, creating a situation that could have devastating consequences for public health by raising the possibility that once-beaten diseases will re-emerge as global killers.
Antibiotic resistance is a major threat to public health, the WHO says. It is no longer something to worry about in the future, but is happening now and could affect anybody, anywhere, of whatever age.
“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” said Keiji Fukuda, a physician and the WHO’s assistant director-general for health security. “Effective antibiotics have been one of the pillars allowing us to live longer, live healthier and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public-health goods and the implications will be devastating.”
Illustration: Yusha
The new report is the first to gather comprehensive data from the WHO on antibiotic resistance and has information from 114 countries. Although the data are more complete in some regions than in others, it is clear that drug-resistant strains of bacteria and viruses are common and that trying to preserve the efficacy of the antibiotics we have is a losing battle.
“We know that the pathogens are everywhere. They were here before humanity,” Carmem Pessoa Da Silva, team lead on antimicrobial resistance at the WHO, told reporters. “It is not a problem of a single country or single region. It is a problem that belongs to the entire planet. This is important. No single country even with the best possible policies in place can address this issue alone. We need all countries to get together and discuss and put in practice possible solutions.”
The report looks in detail at antibiotic resistance in seven bacteria that are responsible for common and potentially serious diseases, such as bloodstream infections or sepsis, diarrhea, pneumonia, urinary tract infections and gonorrhea. It finds there is resistance even to antibiotics that are used as a last resort when others fail.
Most troubling is that the data collected by the WHO show there is resistance all over the world to the “last resort” antibiotics used against life-threatening infections that are caused by a common intestinal bacterium, Klebsiella pneumoniae.
This bacterium is a major cause of infections acquired by some very vulnerable patients in hospital. It can cause pneumonia, bloodstream infections and infections in newborns and intensive-care unit patients. The antibiotics of last resort are called carbapenems — but the report says there is resistance to them in every region. In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K pneumoniae infections.
Very serious cases of bacteria resistant to carbapenems have been caused by an enzyme called NDM1.
“That is a particularly vicious one,” WHO Europe senior adviser on antimicrobial resistance Danilo Lo Fo Wong said. “One of the few antibiotics that we can use against it is an old one which was discarded because of its side effects.”
There have been no new classes of antibiotics in 25 years, he said.
Pharmaceutical companies cannot cover the costs of research and development because new antibiotics have to be used sparingly, for fear of resistance developing — and when that begins, they have a short lifespan.
“New antibiotics coming on to the market are not really new,” he said. “They are variations of those we already have.”
That means that bacteria are likely to develop resistance to them that much sooner.
“We see treatment failure and we see people die because they are not treated in time,” he said. “In some parts of the world, it is about availability.”
However in others, patients are treated with one antibiotic after another to try to find something that works, increasing the risk to them because they become more ill and also further driving resistance. Some countries in Europe do not automatically carry out tests to establish what the infection is, especially if there are additional costs to the hospital or patient.
The report also highlights widespread resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E coli. In the 1980s, when the fluoroquinolones were introduced, there was virtually no resistance, but now in many countries, they are ineffective in more than half of patients.
The UK is one of several countries where resistance has developed to the last-line antibiotics used to treat gonorrhea, known as the third-generation cephalosporins. The WHO also names Austria, Australia, Canada, France, Japan, Norway, South Africa, Slovenia and Sweden as countries where this is the case.
The WHO urges all countries to be more sparing in their use of antibiotics in humans and in animals and to improve hand hygiene, which has been credited with reducing the numbers of cases of the “superbug” MRSA — Staphylococcus aureus, which is resistant to the antibiotic methicillin — in the UK.
Medecins Sans Frontieres (MSF), the volunteer doctors who work in crisis settings around the world, said a global plan for the rational use of affordable antibiotics was urgently needed.
“We see horrendous rates of antibiotic resistance wherever we look in our field operations, including children admitted to nutritional centers in Niger and people in our surgical and trauma units in Jordan,” MSF Access Campaign medical director Jennifer Cohn said. “Countries need to improve their surveillance of antimicrobial resistance, as otherwise our actions are just a shot in the dark. Eithout this information, doctors don’t know the extent of the problem and can’t make the right clinical decisions needed.”
“Ultimately, WHO’s report should be a wake-up call to governments to introduce incentives for industry to develop new, affordable antibiotics that do not rely on patents and high prices and are adapted to the needs of developing countries,” she said.
British experts agreed on the urgency of the problem.
“The world needs to respond as it did to the AIDS crisis of the 1980s,” said Laura Piddock, professor of microbiology at the University of Birmingham and director of the campaigning group Antibiotic Action. “To do this, we need to be ambitious to succeed.” Mandatory and funded global surveillance and public education campaigns were important, “but these are just starting points. We still need a better understanding of all aspects of resistance as well as new discovery, research and development of new antibiotics,” she said. However, she added, UK government funding for antibiotic research had dwindled.
Martin Adams, president of the Society for Applied Microbiology, also called for more research into how resistance develops in human and animal antibiotic use.
“Even if there are new antimicrobial drugs brought to market, we will still face the specter of resistance unless we can learn how to minimize or slow its development,” he said.
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