Global report on antimicrobial resistance

In 2014, the World Health Organization announced the results of its first global report on antimicrobial resistance, including antibiotic resistance. They say that antibiotic resistance is happening right now in every region of the world.

One day soon, common infections and minor injuries that have been treatable for decades may be able to kill again – as they did before the discovery of antibiotics.

In early May 2014, the World Health Organization (WHO) announced the results of its first global report on antimicrobial resistance, including antibiotic resistance. They say that antibiotic resistance is happening right now in every region of the world and has the potential to affect anyone of any age in any country.

Examples of bacterial resistance

The extensive report incorporated data from 114 countries and looked at resistance to treatment for a range of illness-causing bacteria. Among the key findings were that resistance to carbapenem antibiotics, the treatment for life-threatening infections caused by the common intestinal bacterium Klebsiella pneumoniae, has spread to all regions of the world.

K. pneumoniae causes hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients. According to the report, carbapenem antibiotics would no longer work in more than half of people treated for K. pneumoniae infections in some countries.

Resistance to fluoroquinolones, for the treatment of urinary tract infections caused by Escherichia coli, is also widespread. When fluoroquinolones were introduced in the 1980s, resistance was virtually zero. However, there are now countries where treatment is ineffective in more than half of patients.

In the early 1990s, ciprofloxacin (a fluoroquinolone) and cephalosporins were the usual treatments for the sexually transmitted disease (STD) gonorrhea, caused by infection with the Neisseria gonorrhoeae bacterium. By then, the bacterium had already developed resistance to penicillin and tetracyclines. Alarmingly, by the late 1990s, the bacteria were developing increasing ciprofloxacin resistance around the world, and by the mid to late 2000s, cephalosporins were the only remaining recommended treatments in most countries.

Now, worryingly, the WHO has reported treatment failures to third-generation cephalosporins in Austria, Australia, Canada, France, Japan, Norway, South Africa, Slovenia, Sweden and the United Kingdom. The latest available statistics from WHO for infection rates estimated that there were 106 million new cases of gonorrhea worldwide in 2008 – unless new treatments are developed, it may soon be untreatable.

“A world without antibiotics is a scary place”

Microbiologist Dr Siouxsie Wiles at the University of Auckland says that the 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.”

Dr Wiles says the WHO 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 10 years … It is clear that we need novel ways to tackle infectious microbes.”

A need for more research to develop new approaches

Professor Nigel Brown, President of the Society for General Microbiology in the UK, says that, while the WHO report is right to raise the importance of good surveillance data, if we are to understand the extent of antimicrobial resistance, scientific research, rather than more data, is the solution to the problem.

“It is vital that microbiologists and other researchers work together to develop new approaches to tackle antimicrobial resistance. These approaches will include new antibiotics but should also include studies to develop new rapid-diagnostic devices, fundamental research to understand how microbes become resistant to drugs and how human behaviour influences the spread of resistance.”

Household products may be part of the problem

In terms of ongoing human behaviour, Dr Sally Gaw, the Director of Environmental Science at the University of Canterbury, commented that the use of household products containing antimicrobial agents such as triclosan and triclorban may also contribute to the development of antibiotic-resistant bacteria. “These antimicrobial agents can be found in soaps, deodorants, toothpaste, kitchenware, sportswear and children’s toys. These chemicals are released into the environment via discharges from sewage treatment plants. There is growing evidence that widespread domestic use of antimicrobial compounds is contributing to the development of antibiotic resistance in bacteria in the environment. Soaps containing triclosan have been shown to be no more effective at controlling illness in people’s homes than ordinary soap. The domestic use of antimicrobial agents needs to be reassessed to ensure that these products do not reduce the effectiveness of medical treatment. Our obsession with killing germs may actually be putting people’s lives at risk.”

In general, people with antibiotic-resistant strains of infections of any bacteria tend to be sick for longer, often require hospitalisation and are at increased risk of death. For example, people with MRSA (methicillin-resistant Staphylococcus aureus), which is an increasing issue in New Zealand, are reported to be 64% more likely to die than people with a non-resistant form of the infection.

The report also includes information on resistance to medicines for treating other infections such as HIV, malaria, tuberculosis and influenza.