PHM-Exch> WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health

[Claudio Schuftan]

From: shila kaur <kaur_shila at yahoo.com> Coordinator
Health Action International Asia Pacific (HAIAP)
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 WHO’s first global report on antibiotic resistance reveals serious,
worldwide threat to public health New WHO report provides the most
comprehensive picture of antibiotic resistance to date, with data from 114
countries
News release
*30 April 2014 | Geneva -* A new report by WHO–its first to look at
antimicrobial resistance, including antibiotic resistance, globally–reveals
that this serious threat is no longer a prediction for the future, it is
happening right now in every region of the world and has the potential to
affect anyone, of any age, in any country. Antibiotic resistance–when
bacteria change so antibiotics no longer work in people who need them to
treat infections–is now a major threat to public health.
“Without urgent, coordinated action by many stakeholders, the world is
headed for a post-antibiotic era, in which common infections and minor
injuries which have been treatable for decades can once again kill.”
“Effective antibiotics have been one of the pillars allowing us to live
longer, live healthier, and benefit from modern medicine. 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.”
Key findings of the report
The report, "Antimicrobial resistance: global report on surveillance",
notes that resistance is occurring across many different infectious agents
but the report focuses on antibiotic resistance in seven different bacteria
responsible for common, serious diseases such as bloodstream infections
(sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea.
The results are cause for high concern, documenting resistance to
antibiotics, especially “last resort” antibiotics, in all regions of the
world.
Key findings from the report include:

   - Resistance to the treatment of last resort for life-threatening
   infections caused by a common intestinal bacteria,* Klebsiella
   pneumoniae*–carbapenem antibiotics–has spread to all regions of the
   world. *K. pneumoniae *is a major cause of hospital-acquired infections
   such as pneumonia, bloodstream infections, infections in newborns and
   intensive-care unit patients. In some countries, because of resistance,
   carbapenem antibiotics would not work in more than half of people treated
   for *K. pneumoniae* infections.
   - Resistance to one of the most widely used antibacterial medicines for
   the treatment of urinary tract infections caused by E.
   coli–fluoroquinolones–is very widespread. In the 1980s, when these drugs
   were first introduced, resistance was virtually zero. Today, there are
   countries in many parts of the world where this treatment is now
   ineffective in more than half of patients.
   - Treatment failure to the last resort of treatment for gonorrhoea–third
   generation cephalosporins–has been confirmed in Austria, Australia, Canada,
   France, Japan, Norway, Slovenia, South Africa, Sweden and the United
   Kingdom. More than 1 million people are infected with gonorrhoea around the
   world every day.
   - Antibiotic resistance causes people to be sick for longer and
   increases the risk of death. For example, people with MRSA
   (methicillin-resistant *Staphylococcus aureus*) are estimated to be 64%
   more likely to die than people with a non-resistant form of the infection.
   Resistance also increases the cost of health care with lengthier stays in
   hospital and more intensive care required.

Ways to fight antibiotic resistance
The report reveals that key tools to tackle antibiotic resistance–such as
basic systems to track and monitor the problem–show gaps or do not exist in
many countries. While some countries have taken important steps in
addressing the problem, every country and individual needs to do more.
Other important actions include preventing infections from happening in the
first place–through better hygiene, access to clean water, infection
control in health-care facilities, and vaccination–to reduce the need for
antibiotics. WHO is also calling attention to the need to develop new
diagnostics, antibiotics and other tools to allow healthcare professionals
to stay ahead of emerging resistance.
This report is kick-starting a global effort led by WHO to address drug
resistance. This 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.
How to tackle resistance
People can help tackle resistance by:

   - using antibiotics only when prescribed by a doctor;
   - completing the full prescription, even if they feel better;
   - never sharing antibiotics with others or using leftover prescriptions.

Health workers and pharmacists can help tackle resistance by:

   - enhancing infection prevention and control;
   - only prescribing and dispensing antibiotics when they are truly needed;
   - prescribing and dispensing the right antibiotic(s) to treat the
   illness.

Policymakers can help tackle resistance by:

   - strengthening resistance tracking and laboratory capacity;
   - regulating and promoting appropriate use of medicines.

Policymakers and industry can help tackle resistance by:

   - fostering innovation and research and development of new tools;
   - promoting cooperation and information sharing among all stakeholders.

The report–which also includes information on resistance to medicines for
treating other infections such as HIV, malaria, tuberculosis and
influenza–provides the most comprehensive picture of drug resistance to
date, incorporating data from 114 countries.
For more information contact:
Glenn Thomas
WHO, Geneva
Communications Officer
Telephone: +41 22 791 39 83
Mobile.: +41 79 509 06 77
Email:thomasg at who.int
Highlights of the report by WHO region WHO African Region
The report reveals major gaps in tracking of antibiotic resistance in the
WHO African Region, with data gathered in a limited number of countries.
While it is not possible to assess the true extent of the problem with the
data available, that which is available is worrying. Significant resistance
is reported for several bacteria that are spread in hospitals and
communities. This includes significant E. coli resistance to third
generation cephalosporins and fluoroquinolones–two important and commonly
used types of antibacterial medicine. In some parts of the region, as many
as 80% of of *Staphylococcus aureus* infections are reported to be
resistant to methicillin (MRSA), meaning treatment with standard
antibiotics does not work.
WHO Region of the Americas
The Pan American Health Organization, WHO’s Regional Office for the
Americas, coordinates the collection of data on antibiotic resistance from
hospitals and laboratories in 21 countries in the Region. The results show
high levels of *E. coli* resistance to third generation cephalosporins and
fluoroquinolones–two important and commonly used types of antibacterial
medicine–in the Americas. Resistance to third generation cephalosporins in *K.
pneumoniae* is also high and widespread. In some settings, as many as 90%
of *Staphylococcus aureus* infections are reported to be
methicillin-resistant (MRSA), meaning treatment with standard antibiotics
does not work.
WHO Eastern Mediterranean Region
Data in the report show extensive antibiotic resistance across the WHO
Eastern Mediterranean Region. In particular, there are high levels of *E.
coli* resistance to third generation cephalosporins and
fluoroquinolones–two important and commonly used types of antibacterial
medicine. Resistance to third generation cephalosporins in *K.
pneumoniae*is also high and widespread. In some parts of the Region,
more than half of *Staphylococcus
aureus* infections are reported to be methicillin-resistant (MRSA), meaning
that treatment with standard antibiotics does not work. The report reveals
major gaps in tracking of antibiotic resistance in the Region. WHO’s
Regional Office for the Eastern Mediterranean has identified strategic
actions to contain drug resistance and is supporting countries to develop
comprehensive national policies, strategies and plans.
WHO European Region
The report reveals high levels of resistance to third generation
cephalosporins in *K. pneumoniae* throughout the WHO European Region. In
some settings, as many as 60% of *Staphylococcus aureus* infections are
reported to be methicillin-resistant (MRSA), meaning that treatment with
standard antibiotics does not work. The report finds that although most
countries in the EU have well-established national and international
systems for tracking antibiotic resistance, countries in other parts of the
Region urgently need to strengthen or establish such systems. WHO’s
Regional Office for Europe and its partners are supporting these countries
through the newly-established Central Asian and Eastern European
Surveillance of Antimicrobial Resistance network (CAESAR). The aim of
CAESAR is to set up a network of national systems to monitor antibiotic
resistance in all countries of the WHO European Region for standardized
data collection so that information is comparable.
WHO South-East Asia Region
The available data reveal that antibiotic resistance is a burgeoning
problem in WHO’s South-East Asia Region, which is home to a quarter of the
world’s population. The report’s results show high levels of *E.
coli*resistance to third generation cephalosporins and
fluoroquinolones—two
important and commonly used types of antibacterial medicine–in the Region.
Resistance to third generation cephalosporins in *K. pneumoniae* is also
high and widespread. In some parts of the Region, more than one
quarter of *Staphylococcus
aureus* infections are reported to be methicillin-resistant (MRSA), meaning
that treatment with standard antibiotics does not work. In 2011, the health
ministers of the Region articulated their commitment to combat drug
resistance through the Jaipur Declaration. Since then, there has been
growing awareness of the need for appropriate tracking of drug resistance,
and all countries have agreed to contribute information to a regional
database. Dr Poonam Khetrapal Singh, WHO Regional Director for South-East
Asia, has identified drug resistance as a priority area of WHO’s work in
the Region.
WHO Western Pacific Region
Collaboration on tracking of antibiotic resistance between countries in the
WHO Western Pacific Region was established in the 1980s, but suffered
setbacks following a series of emergencies in the early 2000s. However,
many countries in the region have long-established national systems for
tracking resistance. Recently, WHO’s Regional Office for the Western
Pacific has taken steps to revive the regional collaboration. The report
reveals high levels of* E. coli* resistance to fluoroquinolones–an
important and commonly used type of antibacterial medicine–in the Region.
Resistance to third generation cephalosporins in *K. pneumoniae* is also
widespread. In some parts of the Region, as many as 80% of *Staphylococcus
aureus* infections are reported to be methicillin-resistant (MRSA), meaning
that treatment with standard antibiotics does not work.
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