Washington, D.C., 30 April 2014 (PAHO/WHO) — Despite early and major investments in surveillance and collaboration, the countries of the Americas are still vulnerable to antimicrobial resistance and must be part of an urgent and coordinated global effort to address this serious and present threat to public health.

Medication in packetsA new report by the World Health Organization (WHO) says that antimicrobial resistance—including antibiotic resistance—is no longer a prediction but a reality that can affect anyone, of any age, in any country. Antibiotic resistance occurs when bacteria change so that antibiotics no longer work in people who need them to treat infections, and it is now a major threat to public health, the report says.

"We all need to hear, disseminate and act on the message of this important report, which demonstrates that unless we act, we are headed towards an era when the antibiotics we have used for decades to treat and cure common infections will no longer work," said Dr. Carissa F. Etienne, Director of the Pan American Health Organization (PAHO), Regional Office for the Americas of WHO.

The report, Antimicrobial resistance: global report on surveillance, describes resistance across many different infectious agents but focuses on antibiotic resistance in seven different bacteria responsible for such common and serious diseases as bloodstream infections (sepsis), diarrhea, pneumonia, urinary tract infections and gonorrhea. It documents resistance to antibiotics, especially "last resort" antibiotics, in all six of the WHO regions.

Key findings include:

  • Resistance to carbapenem antibiotics, which are the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumoniae, has spread to all regions. K. pneumoniae is a major cause of such hospital-acquired infections as pneumonia, sepsis and infections in newborns and intensive-care unit patients. In some places, because of resistance, carbapenem antibiotics would be ineffective in less than half of people treated for K. pneumoniae infections.
  • Resistance to fluoroquinolones, one of the most widely used antibiotics for the treatment of urinary tract infections caused by E. coli, is very widespread. In the 1980s, when these drugs were first introduced, resistance was virtually zero. Today, there are countries in many parts of the world where this treatment is now ineffective in more than half of patients.
  • Treatment failure to third-generation cephalosporins, the last resort drug for treatment of gonorrhea, has been confirmed in Canada and nine other countries (Austria, Australia, France, Japan, Norway, South Africa, Slovenia, Sweden and the United Kingdom). Gonorrhoea infects more than 1 million people around the world every day.
  • Antibiotic resistance causes people to be sick longer and increases the risk of death. For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection. Resistance also increases the costs of health care, with lengthier hospitalizations and more intensive care required.

Major contributors to the emergence and spread of antimicrobial resistance are overuse and inappropriate use of these drugs. For example, patients may pressure doctors to prescribe antibiotics for illnesses that are caused by viruses, against which antibiotics are not effective. In other cases, patients may stop taking antibiotics before completing a full course because their symptoms improve or to save money. In many countries—including countries in the Americas—antibiotics are sold over-the-counter without a doctor's prescription, even where laws forbid this practice. Counterfeit and substandard antibiotics also contribute to resistance, as does the use of antimicrobials in animal husbandry.

"In the Americas, antibiotics are often overused and sold inappropriately," said Dr. Pilar Ramon-Pardo, PAHO/WHO's advisor on antimicrobial resistance. "There is growing emphasis on regulatory controls of these and other drugs, but misuse remains widespread in our region."

PAHO/WHO has since 1996 coordinated collection of data on antibiotic resistance from hospitals and laboratories in its member countries. There are currently 21 countries in its Latin American Antimicrobial Resistance Surveillance Network. Canada and the United States also participate in the network, exchanging data and providing technical cooperation.

Data from the Americas show high levels of E. coli resistance to third-generation cephalosporins and fluoroquinolones—two important and commonly used types of antibiotics. Resistance to third-generation cephalosporins in K. pneumoniae is also high and widespread. Some settings have reported a high percentage of Staphylococcus aureus infections to be methicillin-resistant, meaning that treatments with standard antibiotics do not work.

Globally, the WHO report also includes information on resistance to drugs for the treatment of tuberculosis, malaria, HIV and influenza.

"We cannot afford to lose our current arsenal of antibiotics because in the short term, the current development pipeline does not contain many new ones," said Dr. Etienne. "Our hope is that the report will raise awareness of the problem and kick-start a global effort it to address it. Everyone has a stake in ensuring that we successfully address this problem."

People can help by:

  • using antibiotics only when prescribed by a certified health professional
  • taking the full prescription, even if they feel better
  • never sharing antibiotics with others or using leftover prescriptions

Health workers and pharmacists can help by:

  •  enhancing infection prevention and control
  •  only prescribing and dispensing antibiotics when they are truly needed
  •  prescribing and dispensing the right antibiotic(s) to treat the illness

Policy-makers can help by:

  •  strengthening resistance tracking and laboratory capacity
  •  strengthening infection control and prevention
  •  regulating and promoting appropriate use of medicines
  •  promoting cooperation and information sharing among all stakeholders

Policy-makers and industry can help by:

  • fostering innovation and research and development of new vaccines, diagnostics, infection treatment options and other tools

Other important actions include preventing infections from happening in the first place through better hygiene, access to clean water, infection control in health-care facilities and vaccination to reduce the need for antibiotics.

Links:

WHO's policy package to combat antimicrobial resistance:

 

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