BioEd Online

The post-antibiotic era is near, according to a report released today by the World Health Organization (WHO). The decreasing effectiveness of antibiotics and other antimicrobial agents is a global problem that requires the establishment of a surveillance system to monitor its worldwide spread, the group says.

There is nothing hopeful in the WHO report, which pulls together research papers estimating antibiotic resistance in 129 member states to show extensive antibacterial resistance in every region of the world. Overuse of antibiotics in hospitals and in agriculture, to promote livestock growth, quickly select for bacteria that resist the drugs, while human movement and poor sanitation practices contribute to the spread of genes that confer resistance.

“A post-antibiotic era — in which common infections and minor injuries can kill — far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century,” the report says.

Perhaps the most worrying trend is the spread of resistance to carbapanems, the so-called antibiotics of last resort, says Timothy Walsh, a medical microbiologist at Cardiff University, UK, who was an advisor for the report. “That’s taken us by surprise,” he says. “All of us are rather like rabbits in front of the headlights in how quickly this has taken off.”

The report finds that, in some areas of the world, more than half the infections caused by Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae contain bacteria resistant to carbapenem drugs.

Meanwhile, there are few if any replacements for carbapenems in development, says Elizabeth Jungman, director of drug safety and innovation at the Pew Charitable Trusts in Washington DC. Companies lack economic incentives to develop new antibiotics, she says, and researchers have found it difficult to find new ways to get Gram-negative bacteria to take up antibiotics.

Ultimately, experts say, the WHO report's most surprising finding may be the lack of global data on anti-microbial resistance. “Despite the fact we've known the potential of this going cataclysmic for 10 years, as a global unit we haven't managed to get our act together,” says Walsh. Just 22 of the 129 WHO member states that contributed to the report had data on the nine most concerning antibiotic-bacteria pairs.

While the report calls for the establishment of a centralized global monitoring network, it is unlikely that any new money is forthcoming. “It’s a huge problem and I'm not sure the resources are available,” says Keith Klugman, an epidemiologist at the Bill and Melinda Gates Foundation in Seattle, Washington.