Antibiotic resistant superbugs ‘a global crisis’

The discovery of antibiotics had a huge impact on treating infections. They have saved many lives and contributed significantly to increased life expectancy.

But increased resistance to antibiotics, in part caused by overuse and misuse, has resulted in the growth of resistant ‘superbugs’. If solutions can’t be found a UN committee report warns that up to 10 million people may die annually by 2030 as a result of drug-resistant diseases – more than the combined deaths from all cancers.

Interagency Coordination Group on Antimicrobial Resistance report to the Secretary-general of the United Nations:


NO TIME TO WAIT:
SECURING THE FUTURE FROM DRUG-RESISTANT INFECTIONS
April 2019

KEY MESSAGES IN THIS REPORT

Antimicrobial resistance is a global crisis that threatens a century of progress in health and achievement of the Sustainable Development Goals.

  • Antimicrobial (including antibiotic, antiviral, antifungal and antiprotozoal) agents are critical tools for fighting diseases in humans, terrestrial and aquatic animals and plants, but they are becoming ineffective.
  • Alarming levels of resistance have been reported in countries of all income levels, with the result that common diseases are becoming untreatable, and lifesaving medical procedures riskier to perform.
  • Antimicrobial resistance poses a formidable challenge to achieving Universal Health Coverage and threatens progress against many of the Sustainable Development Goals, including in health, food security, clean water and sanitation, responsible consumption and production, and poverty and inequality.
  • Misuse and overuse of existing antimicrobials in humans, animals and plants are accelerating the development and spread of antimicrobial resistance.
  • Inadequate access to clean water, sanitation and hygiene in health care facilities, farms, schools, households and community settings; poor infection and disease prevention; lack of equitable access to affordable and quality-assured antimicrobials, vaccines and diagnostics; and weak health, food and feed production, food safety and waste management systems are increasing the burden of infectious disease in animals and humans and contributing to the emergence and spread of drug-resistant pathogens.

There is no time to wait. Unless the world acts urgently, antimicrobial resistance will have disastrous impact within a generation.

  • Drug-resistant diseases already cause at least 700,000 deaths globally a year, including 230,000 deaths from multidrug-resistant tuberculosis, a figure that could increase to 10 million deaths globally per year by 2050 under the most alarming scenario if no action is taken. Around 2.4 million people could die in highincome countries between 2015 and 2050 without a sustained effort to contain antimicrobial resistance.
  • The economic damage of uncontrolled antimicrobial resistance could be comparable to the shocks experienced during the 2008-2009 global financial crisis as a result of dramatically increased health care expenditures; impact on food and feed production, trade and livelihoods; and increased poverty and inequality.
  • In higher-income countries, a package of simple interventions to address antimicrobial resistance could pay for itself due to costs averted. In lower income countries, additional but still relatively modest investments are urgently needed.
  • If investments and action are further delayed, the world will have to pay far more in the future to cope with the disastrous impact of uncontrolled antimicrobial resistance.

https://www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG_final_report_EN.pdf


Perhaps arms and war budgets should be redirected to dealing with this. Ten million deaths a year is a far bigger death rate than either of the World Wars.

The growing risk of superbugs

Penicillin, followed by a range of antibiotics, revolutionised medicine. Many of us are alive thanks to antibiotics. But evolution, and the overuse and misuse of antibiotics, are leading to bugs that can beat antibiotics, and this poses major risks for the future.

Two years ago (Guardian):  Almost untreatable superbug CPE poses serious threat to patients, doctors warn

Doctors are warning that the rise of an almost untreatable superbug, immune to some of the last-line antibiotics available to hospitals, poses a serious threat to patients.

The number of lab-confirmed cases of the bug, called carbapenemase-producing Enterobacteriaceae (CPE), rose from three to nearly 2,000 in the 12 years to 2015, according to Public Health England (PHE). But that may be far short of the real number because hospitals are not compelled to report suspected cases. PHE admits it does not know where the infections are coming from or how many people are dying.

CPE is carried harmlessly in the gut, but may kill if it enters the bloodstream through a wound of a patient who is already sick or frail, which makes it a real danger in hospitals. About 40-50% of patients with a CPE bloodstream infection die. CPE is not untreatable, but it is difficult as antibiotic combinations or older, more toxic drugs have to be used.

Experts have warned that antibiotic resistance is a major threat to the world and could turn the clock back on medical advances by making some surgery, such as heart transplants, impossible.

From 2014 (BBC):  Superbugs to kill ‘more than cancer’ by 2050

Drug resistant infections will kill an extra 10 million people a year worldwide – more than currently die from cancer – by 2050 unless action is taken, a study says.

But while we keep hearing of the risks of climate change this risk is not publicised much. And it is a problem here in new Zealand, now.

Newsroom:  Can we save our sickest from superbugs?

In 2015, a New Zealand-born woman in her early twenties contracted a superbug called Carbapenemase-producing Enterobacteriaceae (CPE).

She wasn’t the first New Zealander to have it, but she was the first known Kiwi to catch it at her house, not overseas or in hospital.

Since her CPE wasn’t hurting her, the young woman had no reason to suspect she was a carrier when she went to Middlemore Hospital with an injury. She spent 13 days in hospital without anyone noticing she was colonised by an almost untreatable superbug, one which health authorities view as one of the world’s most serious emerging infectious disease threats.

In September 2016, a United States woman died after being infected with a strain of CPE resistant to 26 different antibiotics, including colistin. A recent study in China, where antibiotic overuse is widespread, reported that bacteria resistant to colistin were in the guts of 15 percent of people on average and as high as 33 percent in one province.

While New Zealand doesn’t seem to have the colistin-resistant version, in the 11 months to November, the Crown Research Institute ESR counted 71 CPE cases, more than twice as many as in 2017. That included a baby who’d caught it from its mother, and an unexplained cluster of cases around Wellington.

Before Christmas, Juliet Gerard, the Prime Minister’s Chief Science Adviser, warned New Zealand was in the early stages of a CPE epidemic.

Unfortunately, there are no new treatments on the way anytime soon. According to a 2017 article in the New Zealand Medical Journal, “the prospects of new antibiotics becoming available to treat CPE over the short- to medium-term are poor.”

The overuse of antibiotics is a major problem here.

Although the World Health Organisation is pushing a global effort to shrink antibiotic use, human efforts seem to move much slower than the microbes. There are still many countries where animals eat antibiotics routinely, even when they aren’t sick, and human overuse is widespread, too.

Statistics from ESR show total antibiotic consumption in New Zealand increased by 50 percent from 2006 to 2012, with kids under five and adults over 80 consuming the most per capita.

Juliet Gerard has echoed the microbiologists’ 2017 call for an urgent national response to CPE. “New Zealand is in the early stages of an epidemic of…CPE that requires a coordinated infection control response at the national level across the entire New Zealand health sector,” says last year’s fact sheet.

She has also pointed out some serious gaps in New Zealand’s response to the problem so far.

What New Zealand needs urgently to fight superbugs, according to the office of the Prime Minister’s Chief Science Adviser:

– A detailed assessment of current use of antibiotics, appropriateness of use, and the extent of antibiotic resistance in humans and animals.

– Laboratory-based surveillance in both humans and animals to identify emerging and persisting patterns of antibiotic resistance.

– Comprehensive use of recording systems for prescribing and dispensing statistics;

– Data on environmental isolates (bacteria in the environment).

– Research on the best ways to contain the crisis.

– A widespread and continuing education programme to healthcare professionals, trainees, the public, and in schools on the dangers of inappropriate prescribing.

– Response systems and pathways to investigate and respond to significant changes over time in antibiotic resistance in both humans and animals.

– A nationally coordinated infection prevention and response plan to address epidemic transmissible antibiotic resistance threats such as CPE in healthcare facilities. This must include surveillance and response systems and pathways for responding to outbreaks and increases in incidence.

Perhaps what is needed to get the superbug the attention it deserves is for a study to find that superbugs will get worse as the climate warms up.