The World Health Organization (WHO) has updated its fact sheet on Antimicrobial Resistance (AMR).

Background Information:

Antimicrobial resistance happens when microorganisms (including bacteria, fungi, viruses and parasites) change when they are exposed to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials and anthelmintics) used to treat the infections they cause. These are sometimes referred to as “superbugs”.

As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.

Key Messages:

Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.

In many places, antibiotics are overused and misused in people and animals, and often given without professional oversight. Examples of misuse include when they are taken by people with viral infections like colds and flu, and when they are given as growth promoters in animals and fish.

Antimicrobial resistant-microbes are found in people, animals, food, and the environment (in water, soil and air). They can spread between people and animals, and from person to person. Poor infection control, inadequate sanitary conditions and inappropriate food-handling encourage the spread of antimicrobial resistance.

AMR is an increasingly serious threat to global public health that requires action across all government sectors and society.

Without effective antibiotics, the success of major surgery and cancer chemotherapy would be compromised.

The cost of health care for patients with resistant infections is higher than care for patients with non-resistant infections due to longer duration of illness, additional tests and use of more expensive drugs.

Globally, 480 000 people develop multi-drug resistant TB each year, and drug resistance is starting to complicate the fight against HIV and malaria, as well.

Present Situation

A. Resistance in Bacteria

Klebsiella pneumoniae: Resistance to carbepenem antibiotics has spread to all regions of the world. In some countries, because of resistance, carbapenem antibiotics do not work in more than half of people treated for K. pneumoniae infections.

E. coli: Resistance to fluoroquinolone antibiotics is very widespread. There are countries in many parts of the world where this treatment is now ineffective in more than half of patients.

Gonorrhoea: Treatment failure to third generation cephalosporins has been confirmed from at least 10 countries. New WHO guidelines do not recommend quinolones for the treatment of gonorrhoea due to widespread resistance.

Staphylococcus aureus: Resistance to first line drugs is widespread. 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.

Colistin is the last resort treatment for life-threatening infections caused by Enterobacteriaceae which are resistant to carbapenems. Resistance to colistin has recently been detected in several countries and regions, making infections caused by such bacteria untreatable.

B. Resistance in TB

WHO estimates that, in 2014, there were about 480 000 new cases of multidrug-resistant tuberculosis (MDR-TB, a form of tuberculosis that is resistant to the 2 most powerful anti-TB drugs).

MDR-TB requires treatment courses that are much longer and less effective than those for non-resistant TB. Globally, only half of MDR-TB patients were successfully treated in 2014.

Among new TB cases in 2014, an estimated 3.3% were multidrug-resistant. The proportion is higher among people previously treated for TB, at 20%.

Extensively drug-resistant tuberculosis (XDR-TB, a form of tuberculosis that is resistant to at least 4 of the core anti-TB drugs) has been identified in 105 countries. An estimated 9.7% of people with MDR-TB have XDR-TB.

C. Resistance in Malaria

As of July 2016, resistance to the first-line treatment for P. falciparum malaria (artemisinin-based combination therapies, orACTs) has been confirmed in 5 countries.

In most places, patients with artemisinin-resistant infections recover fully after treatment, provided that they are treated with an ACT containing an effective partner drug.

However, along the Cambodia-Thailand border, P. falciparum has become resistant to almost all available antimalarial medicines, making treatment more challenging and requiring close monitoring.

There is a real risk that multidrug resistance will soon emerge in other parts of the subregion as well.

The spread of resistant strains to other parts of the world could pose a major public health challenge and jeopardize important recent gains in malaria control.

D. Resistance in HIV

In 2010, an estimated 7% of people starting antiretroviral therapy (ART) in developing countries had drug-resistant HIV.

In developed countries, the same figure was 10-20%.

Some countries have recently reported levels at or above 15% amongst those starting HIV treatment, and up to 40% among people re-starting treatment. This requires urgent attention.

Useful Links:

Link to the updated fact sheet:

http://who.int/mediacentre/factsheets/fs194/en/

Link to WHO’s Global Action Plan on Antimicrobial Resistance (2015):

http://apps.who.int/iris/bitstream/10665/193736/1/9789241509763_eng.pdf?ua=1

Link to WHO’s Policy Briefs on antimicrobial resistance (2011):

http://who.int/world-health-day/2011/policybriefs/en/

Link to WHO’s Frequently Asked Questions about Antimicrobial Resistance:

http://who.int/world-health-day/2011/presskit/WHD2011-QA-EN.pdf?ua=1

Link to Executive Summary of ‘Worldwide country situation analysis: response to antimicrobial resistance’:

http://apps.who.int/iris/bitstream/10665/163473/1/WHO_HSE_PED_AIP_2015.1_eng.pdf?ua=1&ua=1

Link to the full report of ‘Worldwide country situation analysis: response to antimicrobial resistance’:

http://apps.who.int/iris/bitstream/10665/163468/1/9789241564946_eng.pdf?ua=1&ua=1