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Science Alert: Experts Respond

UN brings the battle to superbugs – Expert Reaction

Posted in Science Alert: Experts Respond on September 22nd, 2016.

After a high-level meeting yesterday, all 193 United Nations member states have pledged to work together to tackle superbugs – disease-causing bacteria, viruses, fungi and parasites that have developed resistance to drugs.

superbug or Staphylococcus aureus (MRSA) bacteriaIt was only the fourth time the UN held a high-level meeting on infectious diseases. UN Secretary-General Ban Ki-moon outlined the number of diseases running “rampant” due to antimicrobial resistance, including typhoid and tuberculosis. “These trends are undermining hard-won achievements under the Millennium Development Goals,” he said.

World Health Organization Director-General Dr Margaret Chan said antimicrobial resistance posed a fundamental threat to human health, development and security. “The commitments made today must now be translated into swift, effective, lifesaving actions.”

The SMC gathered expert reaction to the announcement, feel free to use these comments in your reporting.

Dr Heather Hendrickson, senior lecturer, Molecular Biosciences, Massey University, comments:

“A recent report suggested that if antibiotic use does not change by 2050 10 million people will die each year of antibiotic resistant infections. This is why the UN leaders’ commitment to act on Anti-Microbial Resistance (AMR) is of such crucial importance.

“Global action is required in the case of AMR because there are no borders for these organisms. This was highlighted in the 2014 WHO report on antibiotic resistance where the globe was split into 6 major regions. In New Zealand, 14.9% of Streptococcus pneumoniae found in clinics were already resistant to penicillin and 12.7% of Klebsiella pneumoniae were resistant to 3rd generation cephalosporins.  Every major region, including the Western Pacific contains nations in which 50% of K. pneumoniae are now resistant to cephalosporins.

“Every use of antibiotics drives additional resistance in the organisms around us. Without unified action eliminating non-necessary use of these precious drugs, we will lose them and we will not have alternatives. Non-necessary use includes antibiotics that are taken for viral infections like flu or the cold, agricultural use that keeps animals from getting sick in less than ideal conditions and antibiotics sprayed on crops. We can all contribute to keeping these uses to a minimum by being mindful patients and consumers.”

Our colleagues at the Australian Science Media Centre gathered expert reaction on the announcement (full commentary on scimex.org).

Dr Rietie Venter, Senior Lecturer and Head of Microbiology, School of Pharmacy & Medical Sciences, The University of South Australia, comments:

“Antimicrobial resistance (AMR) is a global threat that should be addressed with a global response. The commitment by Heads of State at the UN general assembly to adopt a broad, coordinated approach is therefore a much-needed and very timely global incentive. Good stewardship is needed; not only in the medical use of antimicrobials, but also in the use of antimicrobials in animal health, the abundant use of antimicrobials in agriculture and the widespread use of biocides in common household products as all these practices are hastening the development of AMR. To this extent, the banning of triclosan and 17 other chemicals in soaps by the FDA [in the USA] is an initiative that could be extended and adopted globally.

“We grew up in the golden age of antibiotics. A world without effective antimicrobials – where a simple scratch could cost you your life and where most modern medical procedures would no longer be possible – is unthinkable. Yet, the development of new antimicrobials is not pursued by pharmaceutical companies due to the low profit margins. Therefore, funding to research and develop new antibiotics and to curb the development of resistance have to come from governments. The UN agreement is testimony to the commitment of nations to address AMR and prevent us from sliding into a post-antibiotic era.”

Associate Professor Sanjaya Senanayake, practising infectious diseases physician, Australian National University Medical School, comments:

“It is reassuring to hear the UN member states have made a pledge to make a coordinated global response to combat antibiotic resistance.

“It was also important to see a non-medical figure and leading international diplomat such as Ban Ki-Moon talking about the deaths of 200,000 newborns every year due to antibiotic-resistant infections, and a host of antibiotic-resistant infections, such as typhoid, gonorrhoea, HIV/AIDS and TB. This shows that the world’s political leaders are officially acknowledging on the global stage that this is a problem.

“But the goodwill coming out of today’s meeting must be followed up by the less exciting but nevertheless vital documented/signed commitment to funding, surveillance, research etc. Otherwise, the momentum from today’s meeting will be lost and the problem of antibiotic resistance will continue to grow.

“Antibiotic resistance is responsible for 700,000 deaths globally and 50,000 deaths within the USA and Europe every year. By 2050, if the problem is not addressed, it will potentially cause ten million deaths per year at a cost of $100 trillion dollars.

“What is most worrying is that this is already happening now, and only within 80 years of antibiotics being used. It doesn’t simply involve the medical sector, but also the pharmaceutical, agricultural and farming industries. Due to its complexity and enormous reach, global political will is needed to address and fund this problem. The political recognition is now there with official reports and bodies created by the Obama and UK governments to tackle antibiotic resistance.

“However, today’s historic meeting of the UN General Assembly (only the 4th for an infectious diseases issue) will take this problem to another level, giving its profile a massive boost with all 193 member nations hopefully becoming signatories to combat this problem.

“While this unprecedented recognition of antibiotic resistance is good, it would be ideal if firm targets were proposed at the UN, such as per capita antibiotic consumption, and firm commitments to funding. One scientist involved in the panel today’s meeting has previously suggested $5 billion/year.

“If there is a lack of universal commitments from today’s UN meeting from all the member states, especially with regard to funding, it will be disappointing, despite the high profile it brings to this issue.

“Decisive coordinated global action and funding is required now.”

Michael Gillings, Professor of Molecular Evolution, Department of Biological Sciences, Macquarie University, comments:

“Antibiotics were one of the greatest discoveries of the 20th Century. They have saved countless lives, including mine, and probably yours.

“However, antibiotics are now becoming much less effective as more and more bacteria become resistant. We face a bleak future, where a simple wound or infection could kill. It is estimated that resistant infections will kill 10 million people per year by 2050, more than cancer. We need to protect the antibiotics we still have, we need to use alternative methods for disease control, and we need to develop new antimicrobial compounds.

“These efforts require international cooperation. Like many issues that face humanity, antibiotic resistance is a global problem that requires global solutions.”

Professor Mary-Louise McLaws, Professor Epidemiology of Hospital Infection and Infectious Diseases Control, University of New South Wales, comments:

“Preventing Antibiotic resistance from becoming an even bigger pandemic requires us all to act responsibly; when we attend our general practice with a respiratory tract infection we need to be mindful that most of the time we may have a virus that won’t respond to antibiotics and in fact antibiotic treatment for viruses can place bacteria in our body, that are not causing us any problem, under pressure to develop resistance.

“Your doctor may want you to wait a few days as we mostly improve after three days of feeling miserable. But take your doctor’s advice and return for another consultation if your cold- or flu-like illness doesn’t improve. It’s a wake-up call that antibiotic use in the community peaks in flu season and causes a peak in antibiotic-resistant diarrhoea. We excrete the antibiotic we consume into the sewerage system and we haven’t researched the flow-on effect to the environment.

“Doctors prescribing antibiotics in public hospitals have been audited and found that a quarter have been given inappropriately. Doctors must be mindful and prescribe according to our excellent Australian guidelines and in accordance with the hospital’s Antimicrobial stewardship program. Patients can ask their doctor in hospitals and GP what they are being given and why they are being given an antibiotic, and take their treatment according to advice.

“Hospital cleaning is more important than we credited it. It’s pivotal for removing bacteria that include antibiotic resistant bacteria from the patient environment. All healthcare workers must not touch you without using alcohol-based hand rub as this is one of the most effective methods of reducing the spread of an infection that requires antibiotic treatment. And finally, we must demand our food animals to be antibiotic-free so we don’t consume unnecessary antibiotics that could place our own bacteria under stress to produce resistance.

“Antibiotics are a treasure and we all need to protect them for our future by reducing unnecessary use and healthcare workers must practice hand hygiene to prevent infection transmission as these will inevitably need antibiotic treatment.”

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