December 9, 2022, Geneva — A new report from the World Health Organization (WHO) reveals high levels of resistance in bacteria that cause life-threatening sepsis, as well as increasing resistance to treatments in several bacteria that cause infections common among the population, according to data reported by 87 countries in 2020.
For the first time, the Global Antimicrobial Resistance and Use Surveillance System (GLASS) report analyzes rates of antimicrobial resistance (or antimicrobial resistance) in relation to analytical testing coverage in each country, as well as trends in this regard since 2017 and data on human consumption of antimicrobials in 27 countries. In six years, 127 countries, representing 72% of the world’s population, have participated in GLASS. The report is also presented in an innovative interactive digital format that makes it easy to extract data and create graphs.
The report reveals that high levels of resistance (above 50%) were described and reported in bacteria that are a frequent cause of sepsis in hospitals, such as Klebsiella pneumoniae or Acinetobacter spp. Last-resort antibiotics, such as carbapenems, are required to treat these life-threatening infections. According to reported data, however, 8% of sepsis caused by Klebsiella pneumoniae were resistant to carbapenems, increasing the risk of death from an untreatable infection.
Common bacterial infections are increasingly resistant to treatments. More than 60% of the isolated strains of Neisseria gonorrhea, the cause of a frequent sexually transmitted disease, have shown resistance to one of the most widely used oral antibacterials, ciprofloxacin. More than 20% of the isolates of E. coli, which is the most common pathogen in urinary tract infections, were resistant to both first-line drugs (ampicillin and cotrimoxazole) and second-line treatments (fluoroquinolones ).
“Antimicrobial resistance erodes modern medicine and puts millions of lives at risk,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “To truly grasp the scale of the global threat and mount an effective public health response against antimicrobial resistance, we must scale up microbiological testing and generate quality-assured data in all countries, not just the wealthiest.”
Although in the last 4 years most of the trends in this regard have remained stable, sepsis caused by resistant strains of Escherichia coli and Salmonella spp. and resistant gonorrheas have increased by at least 15% compared to 2017 levels. More research is needed to discover the reasons behind this progression of antimicrobial resistance and to what extent this is related to the increased number of hospitalizations and antibiotic treatments recorded during the COVID-19 pandemic. The pandemic also prevented several countries from reporting data for 2020.
The new analyzes show that countries with lower analytical testing coverage, which tend to be low- or middle-income countries, are more likely to report significantly higher rates of antibacterial resistance for most “germ-drug” combinations. , which (in part) can be attributed to the fact that in many low- and middle-income countries there are only a few referral hospitals reporting data to GLASS. These hospitals usually care for the sickest patients, who may have received prior antibiotic treatment.
By way of example, it should be noted that the global average level of antibiotic resistance in E. Coli and in methicillin-resistant Staphylococcus aureus (the two microorganisms used as indicators in this regard in the Sustainable Development Goals) was 42%, respectively. and 35%. But when considering only the countries with high coverage of analytical tests, the levels obtained were much lower: 11% and 6.8% lower, respectively.
With regard to human consumption of antimicrobials, 65% of the 27 reporting countries had met the WHO target of at least 60% of the antimicrobials consumed being from the “Access” group of antibiotics, i.e. those which, according to the WHO AWaRE classification, are effective against a wide spectrum of common infections and carry a relatively low risk of developing resistance.
Due to insufficient coverage of analytical tests and low laboratory capacity, especially in low- and middle-income countries, it remains difficult to interpret antimicrobial resistance rates. To fill this critical gap, WHO will follow a two-pronged line of work: in the short term, collect evidence through surveys; in the long term, build capacity for systematic surveillance. This will result, on the one hand, in the implementation of nationally representative surveys on the prevalence of antimicrobial resistance, in order to generate a collection of reference data and trend data on the subject that serve to formulate policies and closely monitor interventions and, on the other hand, an increase, at all levels of the health system, in the number of quality-assured laboratories that report representative data on antimicrobial resistance.
To cope with the increasing course of antimicrobial resistance, countries need to make every effort, at a high level, to enhance their surveillance capacity and provide quality-assured data, knowing that it is also the responsibility of all individuals and communities to act. The next phase of GLASS, by enhancing the collection of standardized and quality data on antimicrobial resistance and the consumption of these drugs, will build the foundation for effective and scientifically sound action to tackle the emergence and spread of antimicrobial resistance and protect the use of medicines antimicrobials for future generations.
