For the first time, the World Health Organization has examined antimicrobial resistance globally, and the grim findings won’t be surprising to anyone who’s been following this issue. (Last year, the US CDC and UK’s Chief Medical Officer issued reports with similarly alarming warnings.) The WHO authors write in the report summary:
Antimicrobial resistance (AMR) is an increasingly serious threat to global public health. AMR develops when a microorganism (bacteria, fungus, virus or parasite) no longer responds to a drug to which it was originally sensitive. This means that standard treatments no longer work; infections are harder or impossible to control; the risk of the spread of infection to others is increased; illness and hospital stays are prolonged, with added economic and social costs; and the risk of death is greater—in some cases, twice that of patients who have infections caused by non-resistant bacteria.
The problem is so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—is a very real possibility for the 21st century.
The report, which analyzes data from 129 member states’ resistance-surveillance programs, identifies very high rates of resistance among bacteria causing pneumonia, urinary-tract infections, and other common infections. Specifically, many countries reported high rates of resistance to third-generation cephalosporins and to fluoroquinolones among Escherichia coli bacteria that cause urinary-tract and bloodstream infections; resistance to third-generation cephalosporins and carbapenems among Klebsiella pneumoniae bacteria causing pneumonia and bloodstream infections; and methicillin resistance among Staphylococcus aureus bacteria responsible for wound and bloodstream infections (the dreaded MRSA).
In addition, the report describes concerns about multi-drug-resisant tuberculosis, particularly in Eastern Europe and Central Asia; artemisinin-resistant malaria (suspected or confirmed in Cambodia, Myanmar, Thailand, and Vietnam); anti-HIV drug resistance in low- and middle-income countries; and adamantanes resistance in some flu viruses.
“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,” said Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security, in an accompanying news release. The report stresses the importance of surveillance, and the news release explains that the report “is kick-starting a global effort led by WHO to address drug resistance” that will involve “the development of tools and standards and improved collaboration around the world to track drug resistance, measure its health and economic impacts, and design targeted solutions.”
Surveillance is an important first step toward a global response to this public-health threat, but slowing the evolution of antibiotic resistance will require governments to crack down on problematic uses of antibiotics. In the US, we seem to have an especially hard time stopping the routine use of antibiotics in healthy livestock (that’s where around 70% of US antibiotics go), a practice that allows animals to grow quickly in cramped conditions, but also one that researchers have linked to antibiotic-resistant infections in humans. Cheaper meat is not nearly as important as effective antibiotics. I’d much rather pay more for chicken cutlets in exchange for knowing that the average case of pneumonia, wound infection, or urinary-tract infection is likely to respond to antibiotics. A post-antibiotic future, as the WHO report reminds us, is a grim one.