Monday, January 29, 2018

WHO: First Global Antimicrobial Surveillance System (GLASS) Report


While pandemics and outbreaks of novel diseases like avian flu, MERS, and Ebola, and pneumonic plague make the immediate headlines, in terms of medium-to-long term threats, there is little that can match the threat we face from the rise of antimicrobial resistant (AMR) bacteria.
Despite decades of warnings, this threat is largely under appreciated by the public because its progression has been gradual, the loss of antibiotics incremental, and so far at least . . . there have always been replacement drugs available when an antibiotic has failed.
But the number of new antibiotics in the pipeline are desperately few (see WHO: The World Is Running Out Of Antibiotics), and new and improved antimicrobial resistant threats keep emerging.

Five months ago CIDRAP reported on a Hypervirulent, highly resistant Klebsiella identified in China, one which a week later was described as New Klebsiella strains 'worst-case scenario,' experts say.

A press release from The Hong Kong Polytechnic University described this emerging threat. 
Furthermore, these CRKP strains are also hypervirulent and belong to ST11 type of CRKP, the most prevalent and transmissible CRKP strains in Asia. As these strains simultaneously exhibit the features of hyper-resistance, hypervirulence and high transmissibility, they can be considered a real superbug known as ST11 CR-HvKP (ST11 carbapenem-resistant hypervirulent K. pneumoniae).
It would be bad enough if this were the only significant antibiotic resistant threat we face, but below you'll find some of my blogs on a few (of dozens) of other unwelcome antimicrobial resistant milestones reported in the past couple of years:
Eurosurveillance: Mcr-One, Two, Three And Counting
MMWR: Fatal Pan-Drug Resistant CRE - Nevada 2016
mBio: 1st Colistin & Carbapenem Resistant E. Coli Infection In A U.S. Patient
Eurosurveillance: Identification Of A Novel Colistin-Resistant MRC-2 Gene In E Coli - Belgium, 2016
CDC HAN: Alerting Healthcare Facilities Of 1st MCR-1 Gene Detection In US Patient

For years we've been warned the world is barrelling towards a `post-antibiotic era' (see  Chan: World Faces A `Post-Antibiotic Era’). One where simple, once-treatable infections can kill, and where routine surgeries become increasingly dangerous.
While we aren't there yet, today the World Health Organization has released a  survey of antibiotic resistance around the world, gathered from 52 nations (25 high-income, 20 middle-income and 7 low-income countries) who are enrolled in the Global Antimicrobial Surveillance System (GLASS). 
While this first look is far from complete, as is explained in the summary (excerpt below), it is a start :
In this data call, countries provided AMR data primarily for pathogens isolated from blood specimens, followed  by  urine, stool, cervical and urethral ones. The  total  number  of  isolates  with  submitted  AST results varied considerably,  from  a  minimum  of  72  isolates  per  country  to  a  maximum  of  167,331  (for  countries  combined  total  of  507,746  isolates).  Only  one  country  submitted  data  on  all  selected pathogens.
First some excerpts from the press release, and then a link to the 164 page report. 

High levels of antibiotic resistance found worldwide, new data shows

News release
WHO’s first release of surveillance data on antibiotic resistance reveals high levels of resistance to a number of serious bacterial infections in both high- and low-income countries.

WHO’s new Global Antimicrobial Surveillance System (GLASS) reveals widespread occurrence of antibiotic resistance among 500 000 people with suspected bacterial infections across 22 countries.

The most commonly reported resistant bacteria were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pneumoniae, followed by Salmonella spp. The system does not include data on resistance of Mycobacterium tuberculosis, which causes tuberculosis (TB), as WHO has been tracking it since 1994 and providing annual updates in the Global tuberculosis report

Among patients with suspected bloodstream infection, the proportion that had bacteria resistant to at least one of the most commonly used antibiotics ranged tremendously between different countries – from zero to 82%. Resistance to penicillin – the medicine used for decades worldwide to treat pneumonia – ranged from zero to 51% among reporting countries. And between 8% to 65% of E. coli associated with urinary tract infections presented resistance to ciprofloxacin, an antibiotic commonly used to treat this condition. 

“The report confirms the serious situation of antibiotic resistance worldwide,” says Dr Marc Sprenger, director of WHO’s Antimicrobial Resistance Secretariat. 

“Some of the world’s most common – and potentially most dangerous – infections are proving drug-resistant,” adds Sprenger. “And most worrying of all, pathogens don’t respect national borders. That’s why WHO is encouraging all countries to set up good surveillance systems for detecting drug resistance that can provide data to this global system.” 

To date, 52 countries (25 high-income, 20 middle-income and 7 low-income countries) are enrolled in WHO’s Global Antimicrobial Surveillance System. For the first report, 40 countries provided information about their national surveillance systems and 22 countries also provided data on levels of antibiotic resistance.
(Continue . . . )

Global antimicrobial resistance surveillance system (GLASS) report
Early implementation 2016-2017

Authors: WHO
Publication details

Number of pages: 164
Publication date: 29 January 2018
Languages: English
ISBN: 978-92-4-151344-9
Global antimicrobial resistance surveillance system (GLASS) report

Supplementary materials

The Global Antimicrobial Resistance Surveillance System (GLASS) Report: Early Implementation 2016-17 draws information from GLASS enrolled countries on the status of their AMR surveillance systems, and reports official national AMR data for selected bacteria that cause infections in humans: Acinetobacter spp., Escherichia coli, Klebsiella pneumoniae, Neisseria gonorrhoeae, Salmonella spp., Shigella spp., Staphylococcus aureus, and Streptococcus pneumoniae.

By the end of the first GLASS data call on 8 July 2017, 42 countries were enrolled in GLASS, of which 40 countries provided information on their AMR surveillance systems, and 22 provided 2016 AMR data. The aim of the report is to document participation efforts and outcomes across countries, and highlight differences and constraints identified to date. In this first GLASS report data vary considerably in terms of completeness, so no attempt was made to compare AMR status at a regional or global level. However, as GLASS and country participation evolves, the data reported will help understand surveillance capacities and mechanisms of reporting across countries in all regions, and will inform further GLASS development.

Related links

Antimicrobial Resistance: global report on surveillance (2014)
GLASS resource centre