WHO report points to rise in antibiotic resistance

A new report from the World Health Organization (WHO) reveals high levels of resistance in bacteria, causing life-threatening bloodstream infections, as well as growing resistance to treatment in several bacteria causing common infections in the community based on data reported by 87 countries in 2020.

For the first time, the Report of the Global Antimicrobial Resistance and Use Surveillance System (GLASS) provides analytics for antimicrobial resistance (AMR) in the context of national testing coverage, AMR trends since 2017, and human antimicrobial consumption data from 27 countries. In six years, GLASS has obtained the participation of 127 countries representing 72% of the world’s population. The report includes an innovative interactive numeric format for easy retrieval of data and graphics.

The report shows that high levels (over 50%) of resistance have been reported in bacteria that commonly cause bloodstream infections in hospitals, such as Klebsiella pneumoniae and Acinetobacter spp. These life-threatening infections require treatment with antibiotics of last resort, such as carbapenems. However, 8% of bloodstream infections caused by Klebsiella pneumoniae have been reported to be resistant to carbapenems, increasing the risk of death from unmanageable infections.

Common bacterial infections are becoming increasingly resistant to treatment. Over 60% of isolates of Neisseria gonorrhea, a common sexually transmitted disease, showed resistance to one of the most widely used oral antibacterials, ciprofloxacin. More than 20% of isolates of E. coli, the most common pathogen urinary tract infections— were resistant to both first-line drugs (ampicillin and co-trimoxazole) and second-line treatments (fluoroquinolones).

“Antimicrobial resistance compromises modern medicine and puts millions of lives at risk,” said Dr Tedros Adhanom Ghebreyesus, Director General of WHO. -guaranteed data in all countries, not just the richest.”

Although most resistance trends have remained stable over the past 4 years, bacteremia due to Escherichia coli and Salmonella spp. and resistant gonorrhea infections have increased by at least 15% compared to 2017 rates. Further research is needed to identify the reasons for the observed increase in AMR and to what extent it is related to the increase in hospitalizations and increased antibiotic treatment during the COVID-19 pandemic. The pandemic has also prevented several countries from reporting data for 2020.

New analyzes show that countries with lower testing coverage, mostly low and middle-income country (PFR-PRI), are more likely to report significantly higher AMR levels for most “insect-drug” combinations. This may (partly) be due to the fact that in many LRICs a limited number of referral hospitals fall under GLASS. These hospitals often treat the sickest patients who may have already received antibiotic treatment.

For example, the global median levels of antimicrobial resistance were 42% (E. Coli) and 35% (methicilin resistant Staphylococcus aureus – MRSA) – both indicators of the Sustainable Development Goals related to antimicrobial resistance. But when only countries with high testing coverage were considered, those levels were significantly lower at 11% and 6.8%, respectively.

With respect to human antimicrobial consumption, 65% of 27 reporting countries have met the WHO target of ensuring that at least 60% of antimicrobials consumed belong to the “ACCESS” group of antibiotics “, i.e. antibiotics which, according to the WHO AWaRE classification, are effective. in a wide range of common infections and have a relatively low risk of creating resistance.

AMR rates remain difficult to interpret due to insufficient testing coverage and low laboratory capacity, especially in low- and middle-income countries. To fill this critical gap, WHO will follow a two-pronged approach aimed at generating short-term evidence through surveys and building long-term capacity for routine surveillance. This will involve the introduction of nationally representative AMR prevalence surveys to generate baseline and trend AMR data for policy development and monitoring of interventions, as well as an increase in the number of laboratories quality assured reporting representative AMR data at all levels of the health system.

Responding to antimicrobial resistance trends requires high-level commitment from countries to build surveillance capacity and provide quality-assured data and action by all people and communities. By strengthening the collection of standardized quality data on AMR and AMR, the next phase of GLASS will support effective data-driven action to stop the emergence and spread of AMR and protect the use of antimicrobial drugs for people. future generations.

Provided by the World Health Organization