Antimicrobial Resistance

Generated Summary

This document, published by the World Health Organization (WHO), addresses the critical global health and development threat of antimicrobial resistance (AMR). It outlines the key facts, drivers, and consequences of AMR, including its impact on human health, the economy, and the success of modern medicine. The document emphasizes the urgent need for multisectoral action to achieve the Sustainable Development Goals (SDGs). It details the global scope of AMR, highlighting the spread of drug-resistant pathogens, the misuse and overuse of antimicrobials, and the impact of inadequate sanitation and infection control. The document further explores the concept of antimicrobial resistance, describing how bacteria, viruses, fungi, and parasites evolve over time, becoming resistant to medicines. It also provides an overview of the global concern surrounding AMR, the challenges in developing new antimicrobials, and the factors that accelerate the emergence and spread of resistance.

Key Findings & Statistics

• The rate of resistance to ciprofloxacin, an antibiotic commonly used to treat urinary tract infections, varied from 8.4% to 92.9% for Escherichia coli and from 4.1% to 79.4% for Klebsiella pneumoniae in countries reporting to the Global Antimicrobial Resistance and Use Surveillance System (GLASS).
• In some countries, carbapenem antibiotics do not work in more than half of the patients treated for K. pneumoniae infections due to resistance.
• Infections with methicillin-resistant Staphylococcus aureus (MRSA) are 64% more likely to result in death than infections with drug-sensitive strains.
• The median rate observed for methicillin-resistant S. aureus was 12.11% (IQR 6.4–26.4) and that for E. coli resistant to third generation cephalosporins was 36.0% (IQR 15.2–63.0).
• In 2018, there were about half a million new cases of rifampicin-resistant TB (RR-TB) identified globally.
• Less than 60% of those treated for MDR/RR-TB are successfully cured.
• In 2018, an estimated 3.4% of new TB cases and 18% of previously treated cases had MDR-TB/ RR-TB.
• Levels of pretreatment HIVDR (PDR) to non-nucleoside reverse-transcriptase inhibitors (NNRTIs) among adults initiating first-line therapy exceeded 10% in the majority of the monitored countries in Africa, Asia, and Latin America.
• In sub-Saharan Africa, over 50% of the infants newly diagnosed with HIV carry a virus that is resistant to NNRTI.

Other Important Findings

• AMR is a global health and development threat, requiring urgent multisectoral action to achieve the Sustainable Development Goals (SDGs).
• Misuse and overuse of antimicrobials are the main drivers in the development of drug-resistant pathogens.
• Lack of clean water and sanitation, and inadequate infection prevention and control, promote the spread of microbes, some of which can be resistant to antimicrobial treatment.
• The cost of AMR to the economy is significant, leading to death, disability, prolonged illness, longer hospital stays, and financial challenges.
• Without effective antimicrobials, the success of modern medicine in treating infections, including during major surgery and cancer chemotherapy, would be at increased risk.
• Antimicrobials include antibiotics, antivirals, antifungals, and antiparasitics, used to prevent and treat infections in humans, animals, and plants.
• AMR occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness, and death.
• The clinical pipeline of new antimicrobials is dry, with antibiotic shortages affecting countries of all levels of development.
• The emergence and spread of drug-resistant pathogens threaten our ability to treat common infections.
• The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials, lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals, poor infection and disease prevention and control in health-care facilities and farms, poor access to quality, affordable medicines, vaccines, and diagnostics, lack of awareness and knowledge, and lack of enforcement of legislation.
• Resistance to fluoroquinolone antibiotics in E. coli, used for the treatment of urinary tract infections, is widespread.
• Colistin is the only last resort treatment for life-threatening infections caused by carbapenem-resistant Enterobacteriaceae.
• Antibiotic resistant Mycobacterium tuberculosis strains are threatening progress in containing the global tuberculosis epidemic.
• Antiviral drug resistance is an increasing concern in immunocompromised patient populations.
• The emergence of drug-resistant parasites poses one of the greatest threats to malaria control and results in increased malaria morbidity and mortality.
• The prevalence of drug-resistant fungal infections is increasing, leading to more difficult to treat fungal infections, treatment failures, longer hospital stays, and more expensive treatment options.

Limitations Noted in the Document

• The document does not specify any limitations to the data collection methods.
• The data presented is not nationally representative, indicating a potential for sampling bias.
• The reliance on the GLASS system for data collection might be affected by the quality and consistency of data from different reporting countries.
• The information provided is based on data available up to November 2021, and therefore, it does not reflect more recent developments or research findings.
• The document primarily focuses on the issue of antimicrobial resistance and does not delve deeply into specific solutions or interventions.

Conclusion

Antimicrobial resistance poses a formidable threat to global health and development, necessitating immediate and coordinated action. The document effectively underscores the multifaceted nature of AMR, driven by the misuse and overuse of antimicrobials, inadequate sanitation and hygiene, and the spread of drug-resistant pathogens. The consequences are dire, ranging from increased mortality and morbidity to economic burdens and the erosion of modern medicine’s effectiveness. The call for multisectoral collaboration through the One Health approach highlights the complexity of this challenge. The document points out the urgent need for innovation and investment in research, development of new antimicrobials, and diagnostic tools, alongside efforts to enhance public awareness and enforce effective legislation. The success of modern medicine, especially in major surgeries and cancer chemotherapy, relies on the availability of effective antimicrobials. Therefore, addressing AMR is not only crucial for protecting public health but also for preserving the advancements of medical science. The document stresses the importance of global cooperation and the need for a united front to combat AMR. The document’s final message underscores the urgency of coordinated action, highlighting that the health and well-being of future generations depend on how effectively the global community tackles this critical challenge.