Generated Summary
This document is the “Antimicrobial Resistance: Global Report on Surveillance 2014” produced by the World Health Organization (WHO) in collaboration with Member States and external partners. It is the first attempt by WHO to obtain an accurate picture of the magnitude of Antimicrobial Resistance (AMR) and the current state of surveillance globally, focusing on antibacterial resistance (ABR). The report highlights the critical need for strengthened and coordinated collaboration to address gaps in surveillance, sharing of data, and methodology harmonization. The report’s findings are based on data collected from 129 Member States regarding resistance surveillance and data for a selected set of nine bacteria-antibacterial drug combinations of public health importance. The report aims to provide a foundation for global strategies and public health actions to contain AMR, identifying key findings, surveillance challenges, and the health and economic burden associated with antimicrobial resistance.
Key Findings & Statistics
- Very high rates of resistance have been observed in all WHO regions in common bacteria that cause common health-care associated and community-acquired infections.
- Gaps exist in information on pathogens of major public health importance.
- There are significant gaps in surveillance, and a lack of standards for methodology, data sharing, and coordination.
- Overall, surveillance of ABR is neither coordinated nor harmonized.
- For Escherichia coli, 86 Member States provided data, and 5/6 WHO regions reported 50% resistance or more to 3rd generation cephalosporins and fluoroquinolones.
- For Klebsiella pneumoniae, 87 Member States provided data, and 6/6 WHO regions reported 50% resistance or more to 3rd generation cephalosporins, while 2/6 WHO regions reported 50% resistance or more to 3rd carbapenems.
- For Staphylococcus aureus, 85 Member States provided data, and 5/6 WHO regions reported 50% resistance or more to methicillin.
- For Streptococcus pneumoniae, 67 Member States provided data, and 6/6 WHO regions reported 25% resistance or more to penicillin.
- For non-typhoidal Salmonella, 68 Member States provided data, and 3/6 WHO regions reported 25% resistance or more to fluoroquinolones.
- For Shigella species, 35 Member States provided data, and 2/6 WHO regions reported 25% resistance or more to fluoroquinolones.
- For Neisseria gonorrhoeae, 42 Member States provided data, and 3/6 WHO regions reported 25% resistance or more to 3rd generation cephalosporins.
- In 2012, 3.6% of new TB cases and 20.2% of previously treated cases were estimated to have multidrug-resistant TB (MDR-TB).
- Only 48% of MDR-TB patients who started treatment in 2010 were cured after completion of treatment.
- In Australia, Europe, Japan, and the United States of America (USA), 10%-17% of patients without prior ART are infected with virus resistant to at least one antiretroviral drug.
Other Important Findings
- AMR develops when a microorganism no longer responds to a drug to which it was originally sensitive, making infections harder to control.
- The problem threatens the achievements of modern medicine.
- The report focuses on antibacterial resistance (ABR), as the state of surveillance in ABR is not generally as advanced as it is for diseases such as tuberculosis (TB), malaria, and HIV.
- Resistance has been observed in bacteria that cause common health-care associated and community-acquired infections.
- Gaps exist in information on pathogens of major public health importance, surveillance, methodology, data sharing, and coordination.
- Lessons learned from long-standing experience in TB, malaria and HIV programmes may be usefully applied to ABR.
- WHO is developing a global action plan for AMR that will include development of tools and standards for harmonized surveillance of ABR in humans and integrated surveillance in food-producing animals and the food chain, elaboration of strategies for population-based surveillance of AMR and its health and economic impact, and collaboration between AMR surveillance networks.
- The report highlights that surveillance that generates reliable data is the essential foundation of global strategies and public health actions to contain AMR.
- High proportions of resistance to 3rd generation cephalosporins reported for E. coli and K. pneumoniae mean that treatment of severe infections likely to be caused by these bacteria in many settings must rely on carbapenems, which are more expensive and may not be available in resource-constrained settings.
- High rates of methicillin-resistant Staphylococcus aureus (MRSA) imply that treatment for suspected or verified severe S. aureus infections must rely on second-line drugs in many countries.
- Reduced susceptibility to penicillin was detected in S. pneumoniae in all WHO regions.
- Widespread resistance to adamantanes in currently circulating A(H1N1) and A(H3N2) viruses have left neuraminidase inhibitors as the antiviral agents recommended for influenza prevention and treatment.
- The report indicates that surveillance of antimalarial drug efficacy is critical for the early detection of antimalarial drug resistance.
- Major gaps exist in surveillance and data sharing related to the emergence of ABR in foodborne bacteria and its potential impact on both animal and human health.
- Systemic candidiasis is a common fungal infection worldwide and is associated with high rates of morbidity and mortality in certain groups of patients.
Limitations Noted in the Document
- Many data sets were based on a small number of tested isolates of each bacterium, adding to uncertainty about the precision of the data.
- Non-representativeness of surveillance data is a limitation for the interpretation and comparison of results.
- Community-acquired infections are almost certainly underrepresented among samples.
- The extent of the problem of reduced susceptibility to penicillin in S. pneumoniae and its impact on patients is not completely clear because of variation in how the reduced susceptibility or resistance to penicillin is reported, and limited comparability of laboratory standards.
- Surveillance of poor quality in countries with high disease rates, where there is also a lack of reliable resistance data for gonorrhoea, and where the extent of spread of resistant gonococci may be high.
Conclusion
The “Antimicrobial Resistance: Global Report on Surveillance 2014” underscores the gravity of AMR as a serious threat to global public health, potentially reversing the achievements of modern medicine. The report provides a snapshot of the current state of AMR surveillance, revealing significant gaps and challenges in monitoring and data collection. Key findings highlight high resistance rates in common bacteria, gaps in surveillance, and the need for standardized methodologies. The report emphasizes the importance of coordinated global action, proposing a multi-pronged approach including enhanced surveillance, international collaboration, and the development of harmonized standards. This effort is crucial, as the spread of AMR threatens to increase infection rates, treatment failures, and mortality, while also imposing substantial economic burdens. The report’s emphasis on the need for reliable data, collaborative surveillance networks, and the sharing of best practices underscores the need for a concerted, global approach to tackling this critical health security threat. WHO’s global action plan is a critical step in mitigating the impacts of AMR, highlighting the need for a unified international response to safeguard public health.