May 6, 2014

World Health Organization Warns of Frightening, Growing Antimicrobial Resistance

For decades, we’ve heard the alarm: Microorganisms dangerous to human health become resistant to the drugs we create to kill them. The persistent, clever adaptations of these pathogens – managing to flourish in environments our space-age science aims to make as inhospitable for them as possible -- is surely an impressive example of Darwinian survival.

Just last month, the World Health Organization (WHO) released its assessment, "Antimicrobial resistance: global report on surveillance 2014." Its review of the growing worldwide threat posed by antimicrobial resistance (AMR) is scary. Here’s how the overview begins:
Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi… a problem so serious that it threatens the achievements of modern medicine. A post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century.

The WHO report is the most comprehensive ever, based on statistics from 114 member states and other partners. The issue is not just a Third World concern; AMR is a huge problem in the U.S., where over-prescribing and improper use are common. The alarm is global, and only countries in western Europe were acknowledged for their “well-established national and international systems for tracking antibiotic resistance.”

WHO warns that all countries must work harder to address the problem, and – since everyone on the planet faces the dire consequences of inaction -- that all countries must work more closely in concert.

While the report discusses many different infectious agents, it focuses on antibiotic resistance in seven different bacteria responsible for common, serious diseases -- like bloodstream infections (sepsis), diarrhea, pneumonia, urinary tract infections and gonorrhea. It also provides information about the growing AMR to medicines for treating other infections -- like HIV, malaria, tuberculosis, and influenza.

Perhaps most alarmingly, WHO documents the resistance which these pathogens have developed to “last resort” antibiotics all around the world.

Key findings include:
  • Resistance to the treatment of last resort -- carbapenem antibiotics -- for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumonia, 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 gonorrhea -- third generation cephalosporins -- has been confirmed in Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom. More than 1 million people are infected with gonorrhea 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.

WHO stresses the need to prevent infection in the first place – thus rendering antibiotic use unnecessary – through better hygiene, access to clean water, infection control in healthcare facilities, and vaccination programs. The report makes these recommendations for patients, healthcare workers, policymakers, and industry leaders.

People can help tackle resistance by:
  • using antibiotics only when prescribed by a doctor;
  • completing the full prescription, even if they feel better;
  • never sharing antibiotics with others or using leftover prescriptions.

Health workers and pharmacists can help tackle resistance by:
  • enhancing infection prevention and control;
  • only prescribing and dispensing antibiotics when they are truly needed;
  • prescribing and dispensing the right antibiotic(s) to treat the illness.

Policymakers can help tackle resistance by:
  • strengthening resistance tracking and laboratory capacity;
  • regulating and promoting appropriate use of medicines.

Policymakers and industry leaders can help tackle resistance by:
  • fostering innovation and research and development of new tools;
  • promoting cooperation and information sharing among all stakeholders.

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