WHO: United effort key to battling bleak drug resistance scenario



In its most complete report yet on the global threat of antimicrobial resistance, especially that involving antibiotics, the World Health Organization (WHO) today painted a bleak picture, showing that doctors around the globe are running out of options for some of their most vulnerable patients.

The agency also spelled out steps needed to control the problem, including standards for surveillance, improved collaboration, and targeted solutions.

Today's report is a global inventory of antimicrobial resistance data, including information from 129 countries in all six of the WHO's regions. The 256-page report focuses on antibiotic resistance in bacteria that cause serious diseases such as bloodstream infections, diarrhea, pneumonia, urinary tract infections (UTIs), and gonorrhea. It also provides a snapshot of how countries are tracking antimicrobial resistance.

Capacity to treat serious infections dropping

At a media telebriefing today, Keiji Fukuda,MD, the WHO's assistant director-general for health security, said the WHO is highlighting the problem now, because global leadership is needed to focus attention and resources on the bigger issue, given that much of the work on resistance has zeroed in on individual organisms and diseases. He also told reporters that the timing is good, because awareness is rising outside of medical circles.

Fukuda said antimicrobial resistance is far from an abstract threat. He said doctors all over the globe are grappling with the impact, with all countries being affected and developing nations shouldering the greatest burden.

For example, he said for gonorrhea, a sexually transmitted disease contracted by 1 million people each day, 10 countries have reported untreatable cases of the disease. Fukuda added that, for some common UTIs and diarrheal illnesses, doctors are running out of medicines that can be taken by mouth, which can increase medical costs when injected or intravenous drugs are used instead.

He said antimicrobial drugs, especially antibiotics, are a pillar of modern medicine that doctors also rely on to protect some of their most vulnerable patients, such as those undergoing cancer treatment, premature babies, patients undergoing surgery, malnourished children, and those with underlying conditions such as diabetes and renal disease.

"While the numbers vary from region to region, the picture is consistent: the capacity to treat serious infections is becoming less in all parts of the world," Fukuda said.

Incomplete but clear data

In collecting all the data, the WHO found many gaps in information on some of the most important pathogens from a public health perspective. It also found a lack of methodology standards, data, sharing, and coordination.

Despite the lack of solid surveillance for antimicrobial resistance in every country, however, the group said it's clear that the problem has reached alarming levels in many parts of the world.

Researchers asked countries for their most recent information on resistance surveillance and data for nine of the most important bacteria–antibacterial drug combinations. (For example, Escherichia coli and third-generation cephalosporins or fluoroquinolones.) From 129 countries, 114 provided data on at least one of the combinations, and 22 countries provided data on all nine.

Sobering findings

The report identified several key findings. When WHO investigators looked at the Klebsiella pneumoniae, a common intestinal bacterium that is a major driver of hospital-acquired infections, they found that in some countries, carbepenem antibiotics—the last resort for life-threatening infections—won't work in more than half of the people because of resistance.

Similarly, countries in many parts of the world now report that fluoroquinolones are ineffective for half of patients with UTIs due to resistant E coli.

Members of the WHO team also looked at outcomes of people sickened with resistant organisms, finding that antibiotic resistance can increase the length of an illness and make it more deadly. For example, they estimated that patients infected with methicillin-resistant Staphylococcus aureus (MRSA) are 64% more likely to die than people with nonresistant S aureus.

Action needed at all levels

The WHO said the report galvanizes a global effort to battle drug resistance, which will require several steps: tools and standards for surveillance, improved collaboration, measurements for health and economic impact, and targeted solutions.

It also outlined steps for how everyone can battle resistance, from individual patients to policy makers. For example, the WHO urged patients to use antibiotics only when prescribed by a doctor and to take the full course, even if they feel better.

They urged health workers to boost infection prevention and control and prescribe the right antibiotics, and only when needed.

The authors of the report said policymakers and the pharmaceutical industry can support the development of new drugs and diagnostic tools and promote the sharing of information among all stakeholders.

See also:

Apr 30 WHO global report on antibiotic resistance

Apr 30 WHO press release on the report

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