The report points to the rise of antibiotic resistance in human bacterial infections and the need for better data

A new report from the World Health Organization (WHO) reveals high levels of resistance in bacteria that cause life-threatening bloodstream infections, as well as increasing resistance to treatment in several bacteria that cause common infections in the community, based on data reported by 87 countries in 2020.

For the first time, the Global Antimicrobial Resistance and Use Surveillance System (GLASS) report provides analyzes of antimicrobial resistance (AMR) rates in the context of national testing coverage, AMR trends since 2017, and data on human antimicrobial drug use in 27 countries. Within six years, GLASS achieved participation from 127 countries with 72% of the world’s population. The report includes an innovative interactive digital format to facilitate data extraction and graphics.

The report shows high levels (over 50%) of resistance in bacteria that often cause bloodstream infections in hospitals, such as Klebsiella pneumoniae and Acinetobacter spp. These life-threatening infections require treatment with antibiotics of last resort, such as carbapenems. However, 8% of bloodstream infections caused by Klebsiella pneumoniae have been reported to be resistant to carbapenems, increasing the risk of death from incurable infections.

Common bacterial infections are becoming increasingly resistant to treatment. Over 60% of Neisseria gonorrhea isolates, a common sexually transmitted disease, showed resistance to one of the most commonly used oral antibacterial drugs, ciprofloxacin. Over 20% of E coli isolates – the most common pathogen in urinary tract infections – were resistant to both first-line drugs (ampicillin and co-trimoxazole) and second-line therapy (fluoroquinolones).

“Antimicrobial resistance is undermining modern medicine and putting millions of lives at risk,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “To truly understand the scale of the global threat and mount an effective public health response to AMR, we need to expand microbiological testing and provide quality-verified data in all countries, not just wealthier ones.”

Although most resistance trends have remained stable over the past 4 years, bloodstream infections due to resistance Escherichia coli and Salmonella spp. and resistant gonorrhea infections increased by at least 15% compared to rates in 2017. Further research is needed to determine the reasons behind the observed increase in AMR and to what extent this is related to increased hospitalizations and increased antibiotic treatment during the COVID-19 pandemic. The pandemic also meant that several countries were unable to report data for 2020.

New analyzes show that countries with lower testing coverage, mainly low- and middle-income countries (LMICs), are more likely to report significantly higher antimicrobial response rates for most “bug-drug” combinations. This may be (in part) due to the fact that in many LMICs a limited number of referral hospitals are reported to GLASS. These hospitals often treat the sickest patients who may have previously been treated with antibiotics.

For example, global mean levels of AMR were 42% (E coli) and 35% (resistant to methicillin Staphylococcus aureus – MRSA) – two AMR indicators of the Sustainable Development Goal. But when only countries with high testing coverage were considered, these levels were significantly lower at 11% and 6.8% respectively.

Regarding the consumption of antimicrobials in humans, 65% of the 27 reporting countries met the WHO goal that at least 60% of antimicrobials consumed should be from the ‘ACCESS’ group of antibiotics, i.e. antibiotics that – according to the WHO AWaRE classification – are effective in a wide range of common infection and have a relatively low risk of developing resistance.

AMR rates remain difficult to interpret due to insufficient testing coverage and weak laboratory capacity, particularly in low- and middle-income countries. To overcome this critical gap, WHO will follow a two-pronged approach aimed at gathering evidence through surveys in the short term and building capacity for routine surveillance in the long term. This will entail the introduction of nationally representative AMR prevalence surveys to generate baseline data on AMR and trends for policy development and intervention monitoring, and an increase in the number of quality-assured laboratories reporting representative AMR data at all levels of the health system .

Responding to antimicrobial resistance trends requires a high level of commitment from countries to strengthen surveillance capacity and provide quality-assured data, as well as action by all people and communities. By strengthening the collection of standardized quality AMR and AMC data, the next phase of GLASS will support effective data-driven action to stop the emergence and spread of AMR and protect the use of antimicrobials for future generations.