The World Health Organization (WHO) presented its first-ever global attempt to assess the spread of drug resistance today—and the results are sobering. Antimicrobial resistance "threatens the achievements of modern medicine," warns the study, which shows that high rates of resistance occur in most parts of the world.
"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," wrote Keiji Fukuda, WHO's assistant director-general for health security, in a press statement.
The study presents some data on drugs against influenza, HIV, tuberculosis, and malaria, but it focuses on seven common bacteria and nine classes of drugs used to treat them—for instance, fluoroquinolones to treat Escherichia coli, which can cause urinary tract or bloodstream infections. WHO asked its 194 member states to contribute information on how common resistances to these drugs are and how they survey them; 129 countries provided information, but only 114 of those could provide data for at least one of the nine combinations of pathogen and drug.
The report finds high rates of resistance for some of the bacteria almost everywhere. For instance, nations in all six WHO regions report that more than half of Klebsiella pneumoniae isolates have acquired resistance to third-generation cephalosporins, an important class of antibiotics. That leaves only one class of drugs, the carbapenems, to treat severe infections with the bacterium, which causes pneumonia as well as bloodstream and urinary tract infections. But even resistance against these drugs of last resort is now cropping up around the world.
For gonorrhea, which infects more than 1 million people every day, third-generation cephalosporins are the last resort. But treatment failure has already been confirmed in Austria, Australia, Canada, France, Japan, Norway, South Africa, Slovenia, Sweden, and the United Kingdom.
And other countries may have the same problem without knowing it. The report warns that many countries do not even manage to monitor resistances adequately and that surveillance, where it happens, is neither coordinated nor harmonized. "I think it's scary how bad the antibiotic surveillance is, given the seriousness of the problem," says Andrew Read, who directs the Center for Infectious Disease Dynamics at Pennsylvania State University, University Park.
It is not the first time that WHO has highlighted the problem. In 2000, then–director-general Gro Harlem Brundtland called the increase in antibiotic resistances a "global crisis." The following year, she issued a major report on the topic, which also called for better surveillance. The report came out on 11 September, however, and garnered little attention.
The new report confirms what doctors around the world are experiencing daily. “We see horrendous rates of antibiotic resistance wherever we look in our field operations, including children admitted to nutritional centres in Niger, and people in our surgical and trauma units in Jordan," said Jennifer Cohn, medical director of the Access Campaign at Doctors Without Borders, in a written statement issued today. “Ultimately, WHO’s report should be a wake-up call to governments to introduce incentives for industry to develop new, affordable antibiotics that do not rely on patents and high prices and are adapted to the needs of developing countries."
Petra Gastmeier, head of the Institute for Hygiene and Environmental Medicine at Charité University Medicine Berlin, says the study is an important step in tackling the problem. Maps in the report show which countries provide good data on resistances and which ones are lagging. "That may stimulate some of those countries to finally do something about their surveillance," Gastmeier says.
But the report falls short when it comes to what should be done about resistance itself, Read says. "Avoiding infections in the first place is of course critical, and so is drug discovery," he writes—but more research on how to best use drugs is also needed. "The science of resistance management is in its infancy."