Common diseases such as tuberculosis are becoming untreatable while lifesaving medical procedures like surgeries carry increasing risks because of “alarming levels” of resistance to antimicrobial drugs, according to a new United Nations committee report. Resistance to antibiotics, antivirals, antifungals and antiprotozoals, which has been seen in countries of all income levels, is now a “global crisis,” the authors wrote.
The Ad hoc Interagency Coordination Group on Antimicrobial Resistance, made up of scientific experts and representatives of major UN scientific agencies, was convened in March 2017 and tasked with providing practical guidelines for global action to address antimicrobial resistance.
Drug-resistant diseases cause at least 700,000 deaths globally a year, including 230,000 deaths from multidrug-resistant tuberculosis, according to the report, which was published Monday.
In the absence of concerted global action, the authors estimate that up to 10 million people may die annually by 2030 as a result of drug-resistant diseases.
Focus on One Health
Two million Americans develop antibiotic resistance infections each year, and 23,000 die from those infections, according to the US Centers for Disease Control and Prevention.
The new report emphasizes that misuse and overuse of existing antimicrobial agents in humans as well as animals and plants accelerate the development and spread of resistance. Factors contributing to the emergence and spread of drug-resistant pathogens include inadequate access to clean water, sanitation and hygiene; poor infection and disease prevention; lack of equitable access to affordable antimicrobials, vaccines and diagnostics; and weak health, food and feed production, food safety and waste management systems.
Ultimately, antimicrobial resistance threatens global progress toward improved health, food security, clean water and sanitation, and sustainable consumption and production, according to the Interagency Coordination Group.
Melinda Pettigrew, a professor of epidemiology in the Department of Epidemiology of Microbial Diseases at the Yale School of Public Health, wrote in an email that the report is especially notable for its emphasis on One Health, a concept that recognizes how the health of people is connected to the health of animals and the environment and that seeks to achieve optimal health outcomes by recognizing this interconnection, according to the CDC.
This approach is fundamental because 6 out of every 10 infectious diseases found in humans are spread from animals, the CDC estimates.
Pettigrew, who was not involved with the new report, said it emphasizes “the interdependence and interconnectedness of humans, animals, and the environment” in a world where many people are working in silos: for example, doctors who are experts in antimicrobial resistance may never or only rarely connect with veterinarians.
“If we are going to develop successful strategies to reduce the impact and spread of antimicrobial resistance the scientists, clinicians, veterinarians, policymakers, and members of the community will have to work together to address the problem from a One Health perspective,” she said.
Three urgent threats in the United States
The problem of antimicrobial resistance includes “more resistant” infections that lead to extensive, expensive treatment, if not death, experts say. Dramatically increased health care expenditures due to uncontrolled antimicrobial resistance, plus the impact on food production and livelihoods, could result in economic damage comparable to that of the 2008-09 global financial crisis, according to the authors of the new report.
In the United States, the CDC describes three “urgent” antimicrobial resistant threats: C. difficile or C. diff, which causes life-threatening diarrhea and colitis (an inflammation of the colon) in, mostly, patients who have recently been given antibiotics, infects 500,000 people annually and leads to 15,000 deaths. Carbapenem-resistant Enterobacteriaceae (CRE), which is known as the “nightmare bacteria” and is usually acquired in health care facilities, causes 9,000 infections and results in about 600 deaths annually. Finally, N. gonorrhoeae, which causes the sexually transmitted disease gonorrhea and has developed resistance to antibiotics, infects 246,000 people each year.
Meanwhile, the World Health Organization reports that the number of drugs in development is simply not enough. Although dozens of antibiotics and biologics – medical products made from natural sources – may be in the pipeline, new drugs have just a 14% chance of gaining approval for use in humans.
The report concludes with a summary of five recommendations: Accelerate progress (including implementation of One Health National Antimicrobial Resistance Action Plans); innovate to secure the future (including development of new antimicrobials); collaborate for more effective action; invest for sustainable response; and strengthen accountability and global governance.
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What can people do? Pettigrew advises, “Work to reduce the use of antibiotics in livestock and fish farming – especially for growth promotion. And make sure family and community members and children have their vaccines!”
Pettigrew said that the ongoing measles outbreak illustrates this point, although all antiviral vaccines, including the flu shot, can help in the fight against antimicrobial resistance.
Vaccines “prevent secondary bacterial infections that might require antibiotics,” and they “prevent the use of broad spectrum antibiotic, empiric, and inappropriate prescribing,” she explained. “Fewer antibiotics will be used if we prevent people from getting sick in the first place.”