Last Line Antibiotics Have Started Showing Signs Of Failure

Antimicrobial resistance (AMR) is a grave problem of the 21st century as microbes have developed resistance against the medications we have developed to counter them. Now on the occasion of the European Antibiotic Awareness Day 2016, the European Center for Disease Prevention and Control (ECDC) has announced that the last line of antimicrobial drugs, carbapenems, colistin and methicillin, is showing signs of failure at effectiveness.

The European Antibiotic Awareness Day 2016 is ongoing at this moment and the ECDC has released its statistics on antimicrobial resistance and antibiotic consumption. According to the EU, the average percentage of carbapenem resistance to Klebsiella pneumoniae increased from 6.2% to 8.1% from 2012 to 2015 and a combined resistance to both carbapemems and colistin has been reported in some cases.

As these two groups of antibiotics are considered the last option for patients not getting relief from other drugs, AMR to these drugs is a serious problem. While antimicrobial consumption in hospitals has increased in several EU member states, antimicrobial consumption in the community has decreased in six EU member states.

Acting Director of ECDC Dr Andrea Ammon says that the recent development of AMR in Klebsiella pneumoniae is of concern in Europe and resistance is quite common, to one group of antibiotic or to multiple antibiotic groups.

The resistance of bacteria to multiple drugs is of concern and this is a warning sign that options for treatment are limited. Proper use of antibiotics in both hospitals and among the people may ensure the effectiveness of drugs.

The data released by ECDC also shows that AMR in E. coli, one of the major perpetuators of bloodstream and urinary tract infections, requires close inspection as the resistance of E. coli to medications is increasing throughout Europe.

In contrast, the percentage of meticillin-resistant Staphylococcus aureus (MRSA) shows a decreasing usage at EU and European Economic Area (EEA) between 2012 and 2015. Despite this positive progress, MRSA remains a health concern in 8 out of 30 countries as it is above 25% of total cases of this infection in these countries.

European Commissioner for Health and Food Safety Vytenis Andriukaitis has pressed the need to tackle these health issues as it can make the simplest medical operations impossible to perform.

The World Health Organization (WHO) Regional Director for Europe, Dr Zsuzsanna Jakab says on the occasion, “Surveillance of antibiotic resistance is the backbone of our work in defense of antibiotics’ effectiveness. Until we know where resistance is, we cannot prioritize action. This is why we focus on expanding the map of antibiotic resistance beyond the European Union countries through the Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) network.”

Dr Jakab adds, “We urge our leaders to use this evidence and accelerate their response to a major global health threat of our time.”

The European Commission has announced that it will launch a new action plan next year in collaboration with EU member states and will continue to ensure the prevention and control of AMR to strength a “one-health approach”.

Speaking during the meeting titled “European Antibiotic Awareness Day: The Future is Now”, members of the veterinary sector have said that AMR is really a “one house topic” related to people, animals and the environment and there is need to work with farmers, doctors and dentists alike to address this issue.

They say that although disease prevention comes first and foremost, we have to do it in a responsible way even though it is not easy to change the views on usage of antibiotics.

Moreover, members from the International Hospital Federation in France have voiced their concerns and emphasized the need to counter AMR.

The WHO is also leading the World Antibiotics Awareness Week with the slogan “Antibiotics: Handle with Care”, which addresses the problem of AMR to governmental, health and agricultural professionals.

This will be the second World Antibiotic Awareness Week and is currently ongoing since 14th November, 2016, and will conclude on 20th November, 2016.

Is Antibiotic Resistance A Global Threat?

We were warned about antimicrobial resistance from none other than the discoverer of antibiotics himself, Alexander Fleming, who while accepting his Nobel Prize in 1945 believed that the there is a possibility of microbes becoming resistant to penicillin.

Currently, the overuse of antibiotics is the most common concern despite being aware of the damage it could cause. Most of the treatments for ailments and infections are treated with antibiotics and are used during seasonal change as they bring about common illnesses like influenza, strep throat and bronchitis.

According to the research, 90-95% of infections contracted by people are ear and sinus infections that are either viral or mildly harmful bacterial infections but studies have shown that more than half of patients in the US take antibiotics for common colds, influenza, allergies and bronchitis.

There is also evidence that 45% of patients suffering from respiratory tract infections (RTIs) are unreasonably given antibiotics for these illnesses which most of the time do not require antibiotics. These unnecessary prescription of antibiotics is also associated with more healthcare costs.

Experts have also noted that people with advanced dementia in nursing homes sometimes carry resistant strains of bacteria and 10% of these bacteria show resistance to at least 4 classes of antibiotics while community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has been observed in 26 nursing homes in California.

According to the US Department of Health Services, the second most common infections reported are those related to the urinary tract, accounting for 8.1 million visits annually of patients to healthcare services. But the overuse of antibiotics has led to AMR which makes it difficult to treat these common ailments.

The Centers for Disease Control and Prevention (CDC) reports that the threat of AMR in the United States is so grave that at least 2 million people acquire bacterial infections and at least 23,000 people die due to being infected with resistant strains of bacteria. Some of the resistant microbes are Acinetobacter, Campylobacter, Candida, Enterococcus, Pseudomonas aeruginosa, non-typhoidal Salmonella and Staphylococcus aureus.

However, none other is as problematic as the first strain of E. coli bacteria which has been termed as “superbug” due to their new found adaptation of mobile genes which makes them resistant to even the last line of defense.

The stain was found in two patients aged 76 and 49 years old and according to the authors of the study, the discovery of these resistant strains calls for a state of emergency. Another bacteria, known as arbapenem-resistant enterobacteriaceae (CRE), is also resistant to antibiotics.

Experts believe that if the traits of the ‘superbug’ E. coli are transferred to CRE, it could virtually result in a new species of bacteria completely resistant to all classes of antibiotics.

Experts have said that under-developed countries and the poor people within bear the brunt of infectious disease burden as diseases are more easily transmitted to people who have a weak immune system made so by malnutrition, repeated infection and unavailability to uncontaminated food and water.

For example, in South Africa, an outbreak of highly resistant tuberculosis, resilient to at least five anti-tuberculosis drugs, took hold of immunocompromised HIV patients who rapidly degraded to the infection.

In a similar situation in Kenya, multiresistant non-typhoidal Salmonella associated with food-borne gastroenteritis among poor children is the major cause of life-threatening conditions in infants and young children.

Are We Ready To Address Antimicrobial Resistance?

On a global scale, leaders are already discussing and planning ways to combat AMR by proposing new research to tackle the issue. To devise a suitable infrastructure to address this issue, the United Nations held its fourth General Assembly in New York, US, on 21st September this year.

During the meeting 193 UN members agreed to form a system of check and balance to counter the effects of AMR which is of grave concern as it already claims 50,000 lives in US and Europe and more than 700,000 lives annually around the world. 445,000 of these deaths are of infants less than 5 years of age due to pneumonia.

The UN Secretary General Ban Ki-moon declared that AMR is not just a threat of the future generation but data has shown it is already taking a toll on a global scale.

It has not only become a problem for human health but also for sustainable food production and development. In this regard, the Secretary also pressed governmental, non-governmental and academic organizations to join hands to provide support for controlling this global health issue.

The cost to control antibiotic resistance is around US $20 billion each year. Analysts and experts have estimated that by 2050 drug resistance will claim 10 million lives annually at the cost of resources and capital valued at US $100 trillion while the lethality of AMR will be felt more heavily by people living in developing countries.

In addition, surgeries and minor operations and infections will become life-threatening as they did before the 20th century and containment of infections will become a serious problem to tackle if proper steps are not taken now.

In a joint meeting organized by WHO, the World Organization for Animal Health (OIE) and the Food and Agriculture Organization (FAO) have collaborated to collectively fight AMR to reduce these concerns.

The former UK Prime Minister David Cameron ordered the Review on Antimicrobial Resistance earlier this year to express about the problem of AMR from an economic and social perspective. On occasion, he was quoted as saying, “If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine.”

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