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Dangerous antibiotic-resistant bacteria and other pathogens have now emerged in every part of the world and threaten to roll back a century of medical advances. That’s the message from the World Health Organization in its first global report on this growing problem, which draws on drug-resistance data in 114 countries.
“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,” wrote Keiji Fukuda, WHO’s assistant director general for Health Security, in an introduction to the report. The crisis is the fruit of several decades of overreliance on the drugs and careless prescribing practices as well as routine use of the medicines in the rearing of livestock, the report noted.
Antibiotic resistance is putting patients in peril in both developing and developed countries, as bacteria responsible for an array of dangerous infections evolve resistance to the drugs that once vanquished them.
Gonorrhea, once well treated by antibiotics, is once again a major public health threat due to the emergence of new, resistant strains. Drugs that were once a last resort treatment for the sexually transmitted disease—which can lead to infertility, blindness and increased odds of HIV transmission if left untreated—are now the first-line treatment and are sometimes ineffective among patients in countries such as the U.K., Canada, Australia, France, Japan, Norway, South Africa, Slovenia and Sweden.
Drugs to treat Klebsiella pneumoniae—a common intestinal bacteria that can cause life-threatening infections in intensive care unit patients and newborns—no longer work in more than half of patients in some countries. And fluoroquinolones, drugs used to treat urinary tract infections, are also ineffective in more than half of sufferers in many parts of the world. Efforts to limit the spread of multidrug-resistant tuberculosis, malaria and HIV are also all under threat due to increasing bacterial resistance.
Although the development of resistance is to be expected over time, overuse of the drugs has accelerated the process by supplying additional selective pressure, noted the report, which was authored by an extensive team of researchers with WHO. And there are few drugs to replace the ones that are now ineffective: The last entirely new class of antibacterial drugs was discovered 27 years ago, according to the report.
WHO warns that the situation could have sweeping effects on global medicine, economics and societies unless global actions are taken swiftly. A dearth of effective antibiotics will mean that infected patients will need more extensive care, require longer hospital stays and die in greater numbers.
To tackle the problem, the report calls for global, coordinated actions on the scale of those that nations are taking to mitigate and adapt to climate change.
The report recommends a multipronged approach. In many cases, WHO noted, available diagnostic tests can already be used to help identify the bacteria that fueled an infection—allowing doctors to select more targeted drug treatments instead of resorting to broad-spectrum medications that exacerbate drug resistance. The problem is that such tests take time to run and thus prescribers often forgo the tests and migrate toward those broad-spectrum drugs. Developing faster tests is therefore crucial, according to the report. The agency also proposes renewed focus—and standardized methods—to track resistant strains across the globe. There is currently no global consensus on methodology and data collection in this area.
There are also essential everyday solutions that communities and clinicians should adopt—including better hygiene practices by health care workers, such as washing hands more frequently and vaccinating populations against key diseases to reduce the need for antibiotics in the first place. Patients, too, have a vital part to play by using antibiotics only when they are prescribed, WHO said.
The assessment, collected information on nine particularly troublesome bacteria from 114 countries that track data on at least one of the microorganisms and the antibiotics used to treat them.
Although limited by significant data gaps, the report noted that in the case of many of these bacteria, resistance levels to first-line drugs have reached 50 percent or more in at least half of the countries analyzed. As a result, health care providers must frequently rely on last-resort drugs. “It is terrifying in scope. This is a massive public health problem that is just starting to bubble to the surface,” says Brad Spellberg, associate professor of medicine at the Los Angeles Biomedical Research Institute at Harbor–U.C.L.A. Medical Center. As the global usage of last-resort drugs grows, resistance to these drugs also accelerates, compounding the crisis. With fewer drug options, the WHO report points out, patients who live in poverty or lack health insurance have nowhere to turn for effective treatments.
“We are already seeing this,” says Stuart Levy, director of the Center for Adaptation Genetics and Drug Resistance at Tufts University School of Medicine, who assisted with the WHO report. “For respiratory diseases in Uganda, we had a multidrug-resistant pneumococcus being treated with recommended drugs—but the bacteria were already 90 percent resistant.” Alternative drugs, in that setting, were not readily available.