WHO Global antibiotic resistance report - experts respond
1 May 2014
Overnight, the World Health Organization (WHO) has released its first global report on antimicrobial resistance, including resistance to antibiotic drugs.
The report, which also includes information on resistance to medicines for treating other infections such as HIV, malaria, tuberculosis and influenza, provides the most comprehensive picture of drug resistance to date, incorporating data from 114 countries.
The report reveals that antibiotic resistance is no longer a prediction for the future -- it is happening right now in every region of the world, and has the potential to affect anyone, of any age, in any country.
Without urgent, coordinated action by many stakeholders, the world is heading for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.
findings from the report:
• Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumoniae -- carbapenem antibiotics -- has spread to all regions of the world. K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients. In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections
• Resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E. coli -- fluoroquinolones -- is very widespread. In the 1980s, when these drugs were first introduced, resistance was virtually zero. Today, there are countries in many parts of the world where this treatment is now ineffective in more than half of patients.
• Treatment failure to the last resort of treatment for gonorrhoea -- third generation cephalosporins -- has been confirmed in Austria, Australia, Canada, France, Japan, Norway, South Africa, Slovenia, Sweden and the United Kingdom. More than 1 million people are infected with gonorrhoea around the world every day.
• Antibiotic resistance causes people to be sick for longer and increases the risk of death. For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection. Resistance also increases the cost of health care with lengthier stays in hospital and more intensive care required.
The Science Media Centre rounded up the following expert comments:
Dr Siouxsie Wiles, microbiologist, University of Auckland comments:
"Alongside vaccines, antibiotics are arguably one of the most important discoveries in medical history. In antibiotics, humans are exploiting the weapons produced as part of an arms race that has existed between microbes for millennia. The first antibiotic was used to treat people in 1937 and not long after that we became aware of the other side of the microbial arms race - that microbes can become resistant to these wonder drugs. Resistance to penicillin was known before the antibiotic even came into use. Latest estimates put the number of potential antibiotic resistance genes that exist at more than 20,000. But it doesn't end there, microbes have crafty ways in which they can share resistance genes between themselves, and this has exacerbated the problem.
"The fact that antibiotics have been is use for over 80 years, and it is only now that the WHO have produce their first global report on the state of antibiotic resistance, just shows how we underestimated the impact antibiotic resistance would have. Their report highlights what microbiologists have been shouting for a while now, that a world without antibiotics is a scary place, and we are likely to be living in that world in as little as ten years.
"It is clear that we need novel ways to tackle infectious microbes and the WHO placed 'fostering research and developing new tools' as a way that policymakers and industry can help. It is a worry that infectious diseases were specifically excluded from the three health-related National Science Challenges announced by the government last year. In a country with increasing rates of infectious diseases, if tackling these aren't a national challenge, then I don't know what is."
Dr Mark Thomas, Associate Professor in Infectious Diseases, Faculty of Medical and Health Sciences, University of Auckland, comments:
"Excessive antimicrobial use in New Zealand makes a significant contribution to the spread of antibiotic resistant bacteria in our community. The level of antibiotic use within New Zealand is relatively high compared with many other developed countries, and has been rising steadily in recent years. Antibiotic resistance in bacteria that commonly cause disease in people has increased in New Zealand in recent years and is a steadily increasing problem for the treatment of infection in many patients. Furthermore, while infections due to bacteria that are resistant to all available antibiotics are presently very rare in New Zealand, occasionally such cases do occur. We need to take effective steps to reduce the level of consumption antimicrobials in New Zealand, and maintain the effectiveness of these medicines for the future."
Professor Kurt Krause, Director of Webster Centre for Infectious Diseases, University of Otago, comments:
"It's clear that the development and worldwide spread of multi-drug resistant bacterial pathogens is becoming the most urgent crisis in infectious diseases. It threatens to move us into the post-antibiotic era and to change the way we practice medicine. While NZ has been fortunate to avoid the high levels of resistance seen in the most affected areas, it is important that ongoing surveillance continues for these organisms and that clear infection control policies and plans are in place. After all, even the most resistant of organisms are potentially only a plane trip away.
It's now a very important time to keep the following action points in mind:
1. We must
husband our remaining antibiotics by using them
2. We must work to eliminate any unneeded environmental exposure to antibiotics as in, for example, animal feed.
3. We need close monitoring for resistant organisms in our clinics and hospitals coupled with modern methods of infection control.
4. We need to incentivise research into the development of new antibiotics as is being carried out in North America and the European Union.
"Together we can overcome this issue, but the time for ignoring it, is long past."
Dr Deborah Williamson, clinical microbiologist at ESR, comments:
"Antimicrobial resistance is arguably one of the biggest man-made public health threats of modern times, and similar to other settings, New Zealand must confront this challenge. Noteworthy contemporary issues in New Zealand include methicillin-resistant resistant S. aureus(MRSA), the circulation of resistant gram negative bacteria the community setting, and the alarming global reservoir and importation of drug-resistant TB.
"New Zealand is fortunate to have a coordinated programme of antimicrobial resistance surveillance that is based at the Institute of Environmental Science and Research, Wellington, and recently, this programme has been greatly expanded to strengthen the national response to AMR. It is imperative that, in the face of the threats and realities of antimicrobial resistance, New Zealand builds on existing linkages and infrastructure, and adopts a cohesive, pro-active and multi-regional approach that combines expertise from across the medical, academic, and veterinary sectors."
Professor John Fraser, Dean, Faculty of Medical and Health Sciences, University of Auckland, comments:
"The WHO report reveals the antibiotic resistance as a truly global issue. We are fortunate in New Zealand to benefit from a high quality surveillance system but in reality this only slows rather than protects us from the emerging antibiotic resistance. Indeed there is clear evidence that certain practices is this country have rapidly led to our own NZ specific resistant strains, so we are part of the problem and should as much as possible take steps to increase vigilance and to reduce those practices that promote antibiotic selection."
Associate Professor Dr Anthony Poole, Lecturer in Genetics, University of Canterbury comments:
"The major kinds of antibiotics have been identified from a handful of microbial sources. Our global focus on pathogens means we have heavily studied these microbes, but we tend to neglect the enormous diversity of microbial life - stuff that's not an immediate threat to our health or food supply. An untapped source of novel antibiotics almost certainly resides in the genomes of poorly-studied species, so to build up our armory of antibiotics, and our capacity to keep pathogens at bay, we need to embrace the study of the other 99% of microbial diversity. We still know very little about microbial diversity in NZ, and this report should thus be a wake-up call for us as a nation to think more broadly about investing in basic research to understand our hidden microbial treasures."
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