World Health Day: Time to tackle resistance

Tomorrow, Thursday, is World Health Day, an annual observance that the World Health Organization uses to focus attention on some critical global-health issue. This year, they’ve chosen antimicrobial resistance as the issue that most needs highlighting. Noting the choice, the Lancet editorialized: “Resistance has joined the front rank of global health concerns.”

On the day, the WHO and some other agencies and organizations will be announcing plans and strategies. I’ll cover those tomorrow. For today, a scene-setter: Why you should care.

Having spent the last couple of years immersed in antibiotic resistance (because, you know, I wrote a book about it), I’m often puzzled why it doesn’t excite more alarm. I’ve concluded our situation is similar to the overused analogy of the frog in the slowly warming water: We don’t realize how bad things have gotten, even when we’re in imminent danger of death.

So here’s a round-up to remind us, drawn just from recent news.

In hospitals: Very large hospital systems are using more broad-spectrum last-resort drugs. Last weekend, representatives of the Veterans Health Administration disclosed that over 5 years, vancomycin use has gone up 79 percent, and carbapenem use, 102 percent. Vancomycin is the only affordable drug of last resort for MRSA; carbapenems are the drugs of last resort for gram-negative infections such as Klebsiella. The use of those drugs is growing because organisms are becoming multi-resistant to less-powerful drugs, but they are becoming resistant to the big guns too. Carbapenem resistance in Acinetobacter, a bacterium that afflicts ICU patients and gravely wounded military members, rose from 5 percent of isolates in US hospitals in 2000 to 40 percent in 2009. Israeli scientists reported this month that carbapenem-resistant Klebsiella pneumoniae (CRKP, subject of my Scientific American article this month) caused a nationwide outbreak in 2007 and 2008, sickening 1,275 patients in 27 hospitals before it was brought under control.

In the everyday world: On average, one out of every five urinary tract infections is resistant to the common drug Cipro — and we use Cipro because those infections are already resistant to the equally common drug Bactrim. Here’s what that looks like, courtesy of the ResistanceMap project of the research group Extending the Cure:

American women experience at least 6 million UTIs every year. In March, the Infectious Diseases Society of America released updated treatment guidelines for UTIs. Reading between the lines, the guidelines are both a plea for protecting the usefulness of Cipro and the class it belongs to (the fluoroquinolones) and also an acknowledgement of how unlikely that goal may be: They describe treatment regimens drawn from six different antibiotic classes and acknowledge that infections may be resistant to any of them.

In animals: In February, the European Center for Disease Control reported that E. coli isolated from pigs showed high levels of resistance to tetracycline, from a low of 25 percent of samples in Switzerland to an astounding 88 percent in Spain and 92 percent in Ireland. Last week, a project that surveys foodborne organisms in pigs in England and Wales reported that 28 percent of all the samples they collected contained Salmonella, and 92% of the Salmonella exhibited at least some drug resistance, while two-thirds of the samples were multi-drug resistant, to at least four different drug classes and up to nine. And the US CDC disclosed Monday that the expanding outbreak of  Salmonella in turkey burgers — which so far has affected 12 people in 10 states — involves a strain that is resistant to four different classes of antibiotics that might be used to treat that Salmonella if it affects a human.

So: There’s much more drug resistance, and increasingly complex drug resistance, in hospitals, in everyday life, and in food animals and on farms. That’s why Thursday’s observance of World Health Day is important.

Tomorrow: What authorities suggest we do about it.


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