World headed for dangerous 'post-antibiotic era,' WHO warns in landmark report
Unless immediate action is taken, the world is headed for a post-antibiotic era where infections that were once treatable will turn deadly, according to a landmark report from the World Health Organization.
The report, issued Wednesday, says that antibiotics resistance is found in all parts of the world and can affect anyone of any age in any country. Antibiotics resistance, which the WHO says occurs when bacteria change and antibiotics no longer work against infections, “is now a major threat to public health.”
“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,” Dr. Keiji Fukuda, assistant director-general for health security at the WHO, said in a statement.
“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”
The study, entitled “Antimicrobial resistance: global report on surveillance,” gathered data from 114 countries. While it is not a complete picture of antibiotics resistance, it is “the most comprehensive picture that we’ve had to date,” Fukuda told reporters at a news conference Wednesday afternoon.
The report focused on antibiotics resistance in seven different types of bacteria that are responsible for common but serious diseases. These include blood infections such as sepsis, diarrhea, pneumonia, urinary tract infections and gonorrhea.
Rates of resistance to treatment among bacteria that cause some of the most common serious infections are “very high,” Fukuda noted.
In all regions of the world, hospitals are reporting “untreatable or nearly untreatable” infections, he said. And medications of “last resort” for some infections are proving completely ineffective.
For some infections, such as bacteria-related diarrhea or urinary tract infections, “we really are beginning to run out of medicines that can be taken by mouth.” This means patients require treatment in hospital, Fukuda said.
Not only will some infections simply become “untreatable,” but antibiotics will also become ineffective at preventing infections in people with compromised immune systems: cancer patients undergoing chemotherapy, premature babies and elderly patients undergoing joint replacements, he said.
What antibiotics resistance means “is that all of us, our family members…our friends, when we are most vulnerable and in need of these medicines, there is a chance that they simply are not going to be available and we are not going to be able to have access to effective medical care in a number of instances,” Fukuda said.
Highlights from the report:
- The agency found widespread resistance to the treatment of last resort for life-threatening infections caused by Klebsiella pneumoniae, a common intestinal bacteria. K. pneumoniae is responsible for a number of hospital-acquired infections, including pneumonia, bloodstream infections, and infections in newborns and patients in intensive care. In some countries, the treatment of last resort for K. pneumoniae infections -- carbapenem antibiotics -- would not work in more than half of patients.
- Resistance to fluoroquinolones, the most widely used antibiotic to treat urinary tract infections caused by E. coli, is “very widespread.” In some countries this treatment is ineffective in more than half of patients.
- Resistance to the treatment of last resort for gonorrhea -- third generation cephalosporins -- has been found in Canada, Australia, the U.K., Japan, South Africa, Norway, Sweden and parts of Eastern and Western Europe. Each day, more than one million people contract gonorrhea around the world, the WHO says.
“If you have an untreatable infection, in some of these instances, you are more likely to develop chronic consequences,” Fukuda noted. Using gonnorhea as an example, chronic consequences include infertility and ectopic pregnancies. A baby born to a mother with untreated gonnorhea can be born with blindness, he said.
In the Americas, the agency found “high levels” of E. coli resistance to two common antibiotics: third-generation cephalosporins and fluoroquinolones. “In some settings,” the report says, “as many as 90 per cent of Staphylococcus aureus infections are reported to be methicillin-resistant (MRSA), meaning treatment with standard antibiotics does not work.”
Resistance to antibiotics also prolongs illness and increases the risk of death, the report says. Patients who have contracted MRSA -- methicillin-resistant Staphylococcus aureus -- are 64 per cent more likely to die than patients with a non-resistant form of the infection.
“We should anticipate seeing more deaths,” Fukuda said.
What to do?
Most countries have inadequate systems or tools in place to deal with the problem of antibiotics resistance, the report says. Tackling the problem begins with preventing infections in the first place, the WHO says, thereby reducing the need for antibiotics altogether. Prevention methods include better hygiene, access to clean water, tighter infection-control in health care facilities and vaccination.
The report will serve as a jumping-off point for the WHO to develop health standards and tools to help countries track, prevent and design solutions to antibiotics resistance, the agency says. In the meantime, the agency has recommendations for stakeholders, including:
Citizens: Who are advised to take antibiotics only when prescribed by a doctor, finish the full course prescribed and to never share their antibiotics.
Health workers and pharmacists: Who are advised to improve infection prevention and control measures, to prescribe and dispense antibiotics only when necessary, and to prescribe and dispense the proper antibiotic for an infection.
Policymakers: Who are advised to strengthen tracking of antibiotics resistance, increase laboratory capacity, and regulate and promote the appropriate use of medications.
Industry: Which is advised to foster innovation and research and develop new treatment tools, and to share information.