WHO warns of ‘post-antibiotic era’

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Antimicrobial resistance has become “a problem so serious that it threatens the achievements of modern medicine,” according to Keiji Fukuda, MD.

“A post-antibiotic era—in which common infections and minor injuries can kill—far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century,” he wrote.

The mannitol-salt agar medium in this culture plate changed from red to yellow with growth of methicillin-resistant Staphylococcus aureus. (Photo by James Gathany/CDC)

Dr. Fukuda, the assistant director-general of health security for the World Health Organization, made those statements in a WHO report, “Antimicrobial resistance: global report on surveillance 2014,” which was published in April and calls for coordinated global action to improve surveillance for antimicrobial resistance and increase sharing of data on resistance.

“The reported and published data sets indicate that there are limitations in effective oral treatment options for some common community-acquired infections in several countries, and that there remain few, if any, treatment options for some common severe and health care–associated infections in many places,” the report states.

The report uses data provided by 114 countries on resistance found in nine combinations of pathogenic bacteria and antibacterial drugs, chosen because they represent common infections and treatments. Examples of those combinations are resistance among Escherichia coli isolates to third-generation cephalosporins and resistance among Staphylococcus aureus isolates to methicillin.

Resistance of Klebsiella pneumoniae to the carbapenems class of broad-spectrum antimicrobials, reported in all WHO regions, is particularly concerning, as the drug usually is the last available treatment, the report states.

The data collected by WHO show that, in some countries, more than 50 percent of isolates of some bacteria are resistant to the drugs commonly used to treat infections. For example, at least one country each in five of the six WHO regions reported finding that degree of resistance to fluoroquinolones among E coli isolates.

Use and misuse of antimicrobials in humans and animals are accelerating resistance development, and lack of new antimicrobials to replace ineffective ones increases the urgency of protecting drug efficacy, according to the report, which also describes a growing threat of drug resistance among parasites, viruses, and fungi.

In a section of the report on antimicrobial-resistant organisms in food-producing animals and in foods, the report describes the use of the same anti­microbial classes in human and veterinary medicine as a factor that is increasing the risk of drug-resistant infections for both. That risk is influenced not only by the spread of pathogens from animal reservoirs—which likely varies by bacterial species—but also by the transfer of genes that confer drug resistance, the report states.

The report authors call for global recognition of the need to avoid inappropriate antimicrobial uses and to reduce administration of those drugs in animal husbandry and aquaculture, as well as reduce their use in humans.

“Herd treatment and antibiotic use in healthy food-producing animals constitute the main differences between the use of antibiotics in animals and in humans,” the report states. “In many countries, the total amount of antibiotics use in animals (both food-producing and companion animals), measured as gross weight, exceeds the quantity used in the treatment of disease in humans.”

The sources cited for that statement are data from the Food and Drug Administration on amounts of antimicrobials sold or distributed for use in food-producing animals and a European Union report on sales of veterinary antimicrobial agents in 19 other countries.

The FDA has cited the threat of antimicrobial resistance in its efforts to limit livestock use of those antimicrobials that are deemed to be important for human medicine. The agency has asked that, by 2016, pharmaceutical companies withdraw drug approvals that allow administration of those drugs to livestock for benefits such as promoting growth or increasing feed efficiency.

More than two dozen companies have so far agreed to make such changes, and agency officials have warned that they will consider regulatory action against those who do not comply.

At a meeting in March of the Forum on Microbial Threats, a panel of the Institute of Medicine of the National Academies, Dr. Fukuda said antimicrobials cannot be sold at will, and a global plan on uses would need to involve leaders in health care and agriculture.

Dr. Fukuda said antimicrobial resistance is one of three priority areas, along with influenza and rabies, identified for work by an alliance of the WHO, the World Organisation for Animal Health (OIE), and the Food and Agriculture Organization of the United Nations.

The World Health Organization report “Antimicrobial resistance: global report on surveillance 2014” is available at who.int/drugresistance/documents/surveillancereport/en/.