The increase and spread of bacteria and fungi resistant to antimicrobial drugs is a global threat.
Health care is depending on antimicrobials in many areas, including oncology and surgery. Last December, the annual reports from the Centers for Disease Control and Prevention (CDC) and European Centre for Disease Prevention and Control (ECDC) on the incidence and distribution of drug resistant microbes were published.
Acquiring drug resistance
Drug resistance, or even multi drug resistance, is the phenomenon that microorganisms become resistant to the antimicrobials, or antibiotics. This resistance is induced by the use of antimicrobials. Within a population of bacteria, these drugs kill the bacteria that are not resistant, thereby selecting for the resistant bacteria. Drug resistant microbes can spread in several ways, including human to human contact, through surfaces in hospitals, and from animals that have resistant microorganisms as a result of antibiotics use in farming. In addition, resistant bacteria can induce resistance in other bacteria.
In the USA more than two million people get resistant infections per year and at least 23,000 people die as a result of this. In Europe, the differences between countries are profound. In the southern and south-eastern parts of Europe the percentage of resistant isolates is higher than in de rest of Europe. In the USA, as well as in Europe, a concern is the increase in resistance of Enterobacteriasceae, like Escherichia coli and Klebsiella pneumoniae, seen in recent years. Especially the increasing resistance to Carbapenems, a last-line antibiotic, is worrying. In addition, drug-resistant Neisseria gonorrhoeae and Clostridium difficile are considered an urgent threat by the CDC. Although C. difficile is often not directly drug resistant itself, infections are directly related to antibiotics use. In addition, eleven bacteria and one fungus (Candida) are labeled as serious threats by the CDC and three bacteria received the title concerning.
To deal with this problem it is important to prevent infection. In addition, new drug and tests need to be developed. However, maybe the most important point is improving the current use antibiotics. Since using antibiotics is the mean cause of resistance, they should only be used when needed both in humans and animals. There are big differences in the use of antibiotics between different states in the USA and between different European counties. According to the ECDC, surveillance of antimicrobial use must be enhanced to identify areas for improvement.
Tuberculosis in South Africa
The spread of resistance should be monitored and prevented as much as possible. In light of this, a recent publication from Pietersen and colleagues in The Lancet is striking. The researchers show in a South African cohort that the five year treatment outcomes of patients with drug-resistant tuberculosis were poor. Moreover, a large portion of the patient that were not cured and still a risk for spreading infection were discharged into the community. And even shown to indeed spread the infection, highlighting that much needs to be improved.
Sources: WHO, CDC, ECDC, and the Lancet