PHM-Exch> High antibiotic resistance worldwide: New WHO Report

[Claudio Schuftan]

From: South Centre <south at southcentre.int>

A new report by the World Health Organization has revealed new data
confirming the “serious situation of antibiotic resistance worldwide”.
Information from some countries show a high incidence of resistance, up to
82% for bloodstream infection, 51% for penicillin and 65% for E. coli
associated with urinary tract infections.

“The report confirms the serious situation of antibiotic resistance
worldwide,” says Dr Marc Sprenger, director of WHO’s Antimicrobial
Resistance Secretariat.  “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.”

The new report, released on 29 January 2018, contains surveillance data on
antibiotic resistance obtained from WHO’s Global Antimicrobial Surveillance
System (GLASS).  It reveals widespread occurrence of antibiotic resistance
among 500 000 people with suspected bacterial infections across 22
countries.

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
tuberculosis (TB), which is reported separately in WHO’s annual TB report.

According to a WHO press release:

   - 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%.
   - Resistance to penicillin – the medicine used for decades worldwide to
   treat pneumonia – ranged from zero to 51% among reporting countries.
   - Between 8% to 65% of E. coli associated with urinary tract infections
   presented resistance to ciprofloxacin, an antibiotic commonly used to treat
   this condition.


The Report represents a first attempt by WHO to report official national
AMR data for key pathogens to a global system using standardised
surveillance methodology.

According to a Summary of the 160-page report:

GLASS supports the development of three essential core components for
national AMR surveillance: a National Coordination Centre (NCC), a National
Reference Laboratory (NRL), and sentinel surveillance sites where both
diagnostic results and epidemiological data are collected.

The core components are linked together by a constant flow of data and
information exchange, and work together to building an effective network
for detection and monitoring AMR in clinical samples. Almost all countries
that have enrolled in GLASS have in place, or are working to establish, a
system that includes these three core components.

National AMR surveillance plans have been introduced in most of the
countries enrolled in GLASS, and surveillance National Focal Points (NFPs)
have been identified in all countries, working closely with the GLASS
Secretariat alongside WHO Regional Offices, Country Offices, and regional
networks.

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 full WHO report can be downloaded by following the links starting with
the one below:

http://www.who.int/mediacentre/news/releases/2018/antibiotic-resistance-
found/en/
<https://southcentre.us5.list-manage.com/track/click?u=fa9cf38799136b5660f367ba6&id=e3b21da4e0&e=4fac633f11>

Below is the WHO press release of 29 January 2018.



*WHO Press Release:   **High levels of antibiotic resistance found
worldwide, new data shows*

http://www.who.int/mediacentre/news/releases/2018/antibiotic-resistance-
found/en/
<https://southcentre.us5.list-manage.com/track/click?u=fa9cf38799136b5660f367ba6&id=e770bd3745&e=4fac633f11>

*29 JANUARY 2018 | BANGKOK* - WHO’s first release of surveillance data on
antibiotic resistance reveals high levels of resistance to a number of
serious bacterial infections in both high- and low-income countries.

WHO’s new Global Antimicrobial Surveillance System (GLASS) reveals
widespread occurrence of antibiotic resistance among 500 000 people with
suspected bacterial infections across 22 countries.

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 (TB), as WHO has
been tracking it since 1994 and providing annual updates in the Global
tuberculosis report.

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%. Resistance to penicillin – the medicine used for decades worldwide to
treat pneumonia – ranged from zero to 51% among reporting countries. And
between 8% to 65% of E. coli associated with urinary tract infections
presented resistance to ciprofloxacin, an antibiotic commonly used to treat
this condition.

“The report confirms the serious situation of antibiotic resistance
worldwide,” says Dr Marc Sprenger, director of WHO’s Antimicrobial
Resistance Secretariat.

“Some of the world’s most common – and potentially most dangerous –
infections are proving drug-resistant,” adds Sprenger. “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.”

To date, 52 countries (25 high-income, 20 middle-income and 7 low-income
countries) are enrolled in WHO’s Global Antimicrobial Surveillance System.
For the first report, 40 countries provided information about their
national surveillance systems and 22 countries also provided data on levels
of antibiotic resistance.

“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,” says Dr Carmem Pessoa-Silva, who
coordinates the new surveillance system at WHO.

Data presented in this first GLASS report vary widely in quality and
completeness. Some countries face major challenges in building their
national surveillance systems, including a lack of personnel, funds and
infrastructure.

However, WHO is supporting more countries to set up national antimicrobial
resistance surveillance systems that can produce reliable, meaningful data.
GLASS is helping to standardize the way that countries collect data and
enable a more complete picture about antimicrobial resistance patterns and
trends.

Solid drug resistance surveillance programmes in TB, HIV and malaria have
been functioning for many years and have helped estimate disease burden,
plan diagnostic and treatment services, monitor the effectiveness of
control interventions, and design effective treatment regimens to address
and prevent future resistance. GLASS is expected to perform a similar
function for common bacterial pathogens.

The rollout of GLASS is already making a difference in many countries. For
example, Kenya has enhanced the development of its national antimicrobial
resistance system; Tunisia started to aggregate data on antimicrobial
resistance at national level; the Republic of Korea completely revised its
national surveillance system to align with the GLASS methodology, providing
data of very high quality and completeness; and 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. In general, national
participation in GLASS is seen as a sign of growing political commitment to
support global efforts to control antimicrobial resistance.

The need for a global surveillance system was highlighted by WHO in 2014 in
the Antimicrobial resistance global report on surveillance.

In October 2015, WHO launched the Global Antimicrobial Surveillance System
(GLASS) working closely with WHO Collaborating Centres and existing
antimicrobial resistance surveillance networks and based on the experience
of other WHO surveillance programmes. For example, TB drug resistance
surveillance has been implemented in 188 countries over the past 24 years.
HIV drug resistance surveillance started in 2005 and by 2017, over 50
countries had reported data on pretreatment and acquired resistance using
standardized survey methods.

Any country, at any stage of the development of its national antimicrobial
resistance surveillance system, can enrol in GLASS. Countries are
encouraged to implement the surveillance standards and indicators
gradually, based on their national priorities and available resources.

GLASS will eventually incorporate information from other surveillance
systems related to antimicrobial resistance in humans, such as in the food
chain, monitoring of antimicrobial consumption, targeted surveillance
projects, and other related data.

All data produced by GLASS is available free online and will be updated
regularly.

Dr Tedros Adhanom Ghebreyesus, WHO’s Director-General, has underscored his
aim to make antimicrobial resistance one of WHO’s top priorities by
bringing together experts working on this issue under a newly created
strategic initiatives cluster.
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