Antimicrobial resistance is now widespread, warns WHO

Widespread resistance to antimicrobial drugs is not a future threat—it is happening now in hospitals and in the community, a report from the World Health Organization warns.1

The report looked at data from 114 countries and found that antimicrobial resistance was occurring in every region of all the countries.

Keiji Fukuda, WHO’s assistant director general for health security, said that though this was a global threat it affected developing countries disproportionately.

He added, “Antimicrobial drugs are one of the foundations of modern healthcare. There are certain infections for which we have maintained targeted health efforts to control—infections like HIV, malaria, and tuberculosis. Much of our ability to address these infections is going to become eroded.”

The report found high rates of resistance among common bacteria such as Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus that cause common diseases such as urinary tract infections, bloodborne infections, diarrhoea, and wound infections. And 10 countries, including Australia, Canada, France, and the United Kingdom, have reported untreatable gonorrhoea infections.

The report also looked at antimicrobial resistance in specific diseases. It said that, worldwide, 3.2% of new cases of tuberculosis and 20.2% of existing cases were estimated to be multidrug resistant, with the highest rates in eastern Europe and central Asia. Some 84 000 cases of multidrug resistant tuberculosis were reported to WHO in 2012, thought to be a fifth of the total number of cases.

The report also warned that important recent gains in malaria control could be undermined by the spread of strains resistant to artemisinin, the best drug to treat the disease. And data indicate that 10-17% of patients infected with HIV who have not previously used antiretrovirals are infected with a virus resistant to at least one antiretroviral.

The report also warned that resistance to the established antifungal drug fluconazole and the newer class of agents, the echinocandins, was also emerging but that the global burden was unknown.

Fukuda said that the people most at risk from antimicrobial resistance included immunocompromised patients, premature babies, and patients recovering from surgery. He said that the report painted a “grim picture, but I want to point out it’s not a hopeless picture,” adding that countries that tried to tackle the problem would see results, although it would take time.

Fukuda said that new antimicrobial agents and technologies had to be developed, which were seen not in commercial terms but as “global public health goods.” He also said that the non-health uses of antibiotics had to be reduced, such as in the food chain or as growth promoters.

Fukuda acknowledged that it seemed strange that WHO was only just publishing its first ever global report on antimicrobial resistance.

He said, “In the past the approach to antimicrobial resistance focused on a lot of technical aspects, looking at it pathogen by pathogen, looking at resistance patterns in one group of viruses. This is not something that can be dealt with by tackling some pathogens; it needs a broad, sustained effort.”

WHO acknowledged that major gaps existed in disease surveillance. The report said that reliable data were the “essential basis of sound global strategies and public health actions to contain antimicrobial resistance.”

Martin Adams, president of the Society for Applied Microbiology, said it was worrying that many countries were unable to provide data.

He added, “There must also be a global effort on prevention and control of infections involving drug resistant microbes in humans and animals. This will require development and implementation of new products, policies, and practices—and fundamental research to unpick the mechanisms by which resistance develops and can be passed between micro-organisms and from environment to environment.”