Report warns that superbug threat continues to increase

A report released last week by the World Health Organization (WHO) shows common bacterial infections are becoming increasingly difficult to treat, as antimicrobial resistance (AMR) continues to rise globally.
 
According to the Global Antimicrobial Resistance and Use Surveillance System (GLASS) 2022, common bacterial infections with increasing resistance include over 60% of Neisseria gonorrhoea isolates and more than 20% of E. coli isolates – the most common pathogen in urinary tract infections.
 
High levels of antibiotic resistance were also reported for bacteria known to frequently cause bloodstream infections, such as Klebsiella pneumoniae and Acinetobacter spp – 50% of which required treatment with last-resort antibiotics, such as carbapenems.
 
Moreover, 8% of bloodstream infections caused by Klebsiella pneumoniae were reported as being resistant to carbapenems as well, increasing the risk of death due to unmanageable infections.
 
Associate Professor Mark Blaskovich, Director of the Centre for Superbug Solutions in the Institute for Molecular Bioscience at The University of Queensland, told newsGP Australia needs a more proactive stance to combat antibiotic resistance.
 
‘To date, most of Australia’s response is focused on surveillance and on studies examining what we should be doing,’ he said.
 
‘Australia punches above its weight on a global level in AMR research, but it needs money.
 
‘Participating in international initiatives such as CARB-X and GARDP would provide more bang for the buck and position Australia as a leading global citizen.’
 
WHO Director-General Dr Tedros Adhanom Ghebreyesus called GARDP ‘an essential element of delivering the Global Action Plan on Antimicrobial Resistance’.
 
In relation to the GLASS22 findings, he highlighted the morbidity and mortality related to AMR.
 
‘Antimicrobial resistance undermines modern medicine and puts millions of lives at risk,’ he said.
 
From its inception, GLASS has analysed AMR rates, trends and antimicrobial consumption in humans with data from 127 countries, which comprises 72% of the world’s population.
 
The most recent report contains data from 87 countries from 2020, including Australia.
 
The analysis shows that regions with lower testing coverage, mostly low- and middle-income countries, are more likely to report significantly higher AMR rates.
 
For example, the global median AMR levels were 42% for E. coli and 35% for MRSA, but when only countries with high testing coverage were considered, the levels were markedly lower at 11% and 6.8% respectively.
 
‘To truly understand the extent of the global threat and mount an effective public health response to AMR, we must scale up microbiology testing and provide quality-assured data across all countries, not just wealthier ones,’ Dr Ghebreyesus said.
 
Other concerning trends in AMR include resistant gonorrhoea and bloodstream infections from E. coli and Salmonella spp infections increasing by at least 15% since 2017.
 
Associate Professor Blaskovich sees issue with long-term antibiotic use for conditions such as acne, or prophylactic doxycycline for chlamydia and gonorrhoea.
 
‘Where other, non-antibiotic treatments are equally effective and the disease is not life-threatening, antibiotic usage should be avoided as much as possible to reduce the pressure on bacteria developing more resistance,’ he said.
 
‘We need to preserve the life-saving properties of antibiotics for when they are really needed.
 
‘Long term exposure without directly treating an infection has potential to create resistance, not only in chlamydia and gonorrhoea, but in other types of bacteria present in the patient, which can then transfer their resistance if a sexual infection eventuates.’
 
The WHO has predicted that efforts aimed at tackling AMR will be required for decades, labelling it as ‘among the global threats of deepest concern, with severe consequences to human health and economies’.
 
Part of these efforts include the creation of an AWaRe classification system to help guide clinicians on antibiotic use in order to prevent resistance. It has also published an AWaRe antibiotic book that lists common infectious conditions in primary care and hospital settings, with suggested antibiotic regimens.
 
First- or second-line options – contained in the ACCESS group – include amoxycillin, cefalexin, doxycycline, metronidazole and trimethoprim, as they have less resistance potential.
 
The WATCH group contains antibiotics with a higher resistance potential and should be limited to specific infectious syndromes. Antibiotics in this group include ceftriaxone, ciprofloxacin, meropenem, norfloxacin and vancomycin.
 
The RESERVE group contains classes that should be used as a last resort or for confirmed or suspected multi-drug-resistance organisms. They include aztreonam, fosfomycin, faropenem and linezolid.
 
The GLASS22 report found that 65% of reporting countries met the WHO’s target of ensuring that at least 60% of antimicrobials consumed are taken from the ACCESS group.
 
Meanwhile, Associate Professor Blaskovich says other treatments for bacteria are emerging, including non-antibiotics.
 
‘Returning to the past, phage therapy is showing promise at using bacteria’s natural viral killers, and Australia has a strong presence in the area,’ he said.
 
‘Microbiome therapy can treat some indications, such as C. difficile infection, while the new developments in vaccine technology may allow for new vaccines against other types of bacterial infections.’
 
Associate Professor Blaskovich says rapid diagnostics with the ability to quickly detect if you really have a bacterial infection, what type of bacteria it is and what antibiotics it is resistant to, would have the most immediate impact in reducing unnecessary antibiotic use and improving infection treatment.
 
‘There are new antibiotics that target different components of bacteria in various stages of development,’ he said.
 
‘The problem with all these approaches is that they will take time to reach GP clinics.’
 
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antibiotics antimicrobial resistance superbugs