High levels of antibiotic resistance in serious infections, says WHO

Surveillance data on antibiotic resistance released by the World Health Organisation (WHO) has found high levels of resistance in relation to several serious bacterial infections across a number of countries.

Kanaga Raja

IN a new report highlighting the first release of surveillance data from its Global Antimicrobial Resistance Surveillance System (GLASS), WHO said that it has found widespread occurrence of antibiotic resistance among 500,000 people with suspected bacterial infections across 22 countries.

According to a 29 January WHO press release, the most commonly reported resistant bacteria were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Streptococcus pneumoniae, followed by Salmonella spp.

The system does not include data on resistance of Mycobacterium tuberculosis, which causes tuberculosis, as WHO provides annual updates in a separate report on tuberculosis.

Among patients with suspected bloodstream infection, the proportion that had bacteria resistant to at least one of the most commonly used antibiotics ranged tremendously between different countries – from zero to 82%, said WHO.

Resistance to penicillin – the medicine used for decades worldwide to treat pneumonia – ranged from zero to 51% among reporting countries.

And 8%-65% of E. coli associated with urinary tract infections presented resistance to ciprofloxacin, an antibiotic commonly used to treat this condition, according to the WHO press release.

‘The report confirms the serious situation of antibiotic resistance worldwide,’ said Dr Marc Sprenger, director of WHO’s Antimicrobial Resistance Secretariat, in the press release. ‘Some of the world’s most common – and potentially most dangerous – infections are proving drug-resistant.

‘And most worrying of all, pathogens don’t respect national borders. That’s why WHO is encouraging all countries to set up good surveillance systems for detecting drug resistance that can provide data to this global system.’

‘The report is a vital first step towards improving our understanding of the extent of antimicrobial resistance. Surveillance is in its infancy, but it is vital to develop it if we are to anticipate and tackle one of the biggest threats to global public health,’ said Dr Carmem Pessoa-Silva, coordinator of the new surveillance system at WHO.

Launched by WHO in October 2015, GLASS is the first global collaborative effort to standardise antimicrobial resistance (AMR) surveillance. The system is helping to standardise the way that countries collect data and enable a more complete picture of AMR patterns and trends, said WHO.

In its early implementation phase (2015-19), GLASS aims to combine data on the status of enrolled countries’ AMR surveillance systems with AMR data for selected bacteria that cause infections in humans: Acinetobacter spp., E. coli, K. pneumoniae, Neisseria gonorrhoeae, Salmonella spp., Shigella spp., S. aureus and S. pneumoniae.

According to the WHO report, titled Global Antimicrobial Resistance Surveillance System (GLASS) Report: Early Implementation 2016-2017, these pathogens cause worldwide common hospital and community acquired infections.

Rates of antibiotic resistance are reported to be increasing, to the point that infections caused by these pathogens might need to be treated with last-resort drugs, which might be not only less effective and safe, but also more resource-consuming and not widely available, particularly in low-resource settings.

For this reason, said the report, AMR in these pathogens is now considered to rank among the most important threats to public health globally.

According to WHO, to date, 52 countries (25 high-income, 20 middle-income and 7 low-income countries) are enrolled in GLASS.

For the first report, 40 countries provided information about their national surveillance systems and 22 countries also provided data on levels of antibiotic resistance.

In this data call, countries provided AMR data primarily for pathogens isolated from blood specimens, followed by urine, stool, cervical and urethral ones.

According to the report, the total number of isolates with submitted antimicrobial susceptibility testing (AST) results varied considerably, from a minimum of 72 isolates per country to a maximum of 167,331 (for countries’ combined total of 507,746 isolates).

Only one country (Republic of Korea) submitted data on all selected pathogens.

According to the report, the most frequently reported were resistance patterns for E. coli, K. pneumoniae, S. aureus and S. pneumoniae (17 countries among the 22 countries reporting AMR rates), followed by resistance patterns for Salmonella spp. (15 countries).

AST results for N. gonorrhoeae and Shigella spp. were compiled by 11 and eight countries, respectively.

The GLASS report noted that antimicrobial-resistant organisms are found in people, food, animals, plants and the environment (in water, soil and air), and they can move between ecosystems.

AMR occurs naturally and over time when micro-organisms (such as bacteria, fungi, viruses and parasites) are exposed to antimicrobial substances. As a result, treatments become ineffective and infections persist in the body, increasing the risk of spread to others. Although the emergence of AMR is a natural phenomenon, the misuse and overuse of antimicrobials is accelerating this process, said the report.

‘Rigorous policy interventions to tackle AMR are paramount and global collaboration is necessary to improve the understanding of AMR dynamics and to inform containment and mitigation strategies to preserve human and animal health, and the environment,’ it underlined.

According to the WHO press release, the rollout of GLASS is already making a difference in many countries.

For example, Kenya has enhanced the development of its national AMR system, while Tunisia has started to aggregate data on AMR at national level. Korea completely revised its national surveillance system to align with the GLASS methodology, providing data of very high quality and completeness.

Countries such as Afghanistan or Cambodia that face major structural challenges have enrolled in the system and are using the GLASS framework as an opportunity for strengthening their AMR surveillance capacities, said WHO.                  


Kanaga Raja is Editor of the South-North Development Monitor (SUNS) published by the Third World Network. This article was first published in SUNS (No. 8612, 1 February 2018).

*Third World Resurgence No. 326/327, October/November 2017, pp 2-3