Antibiotic resistance was once again flagged by the World Health Organization in a recent report. The urgency of combatting this is spelled out by the rising resistance to carbapenems, a group of last-resort antibiotics. Sarthak Ray looks at why antibiotic resistance is such a big threat and what needs to be done
WHO warns of growing resistance again
WHO launched the Global Antimic-robial Resistance and Use Surveillance System (GLASS) in 2015. Antibiotic resistance is believed to have caused 1.27 million deaths worldwide in 2019. As many as 10 million annual deaths from AMR are projected to occur by 2050, per one estimate.
Based on data from 87 nations, GLASS 2022 reports resistance in as many as 50% of the cases studied for bacteria causing common blood-stream infections in hospitals, such as Klebsiella pneumoniae and Acinetobacter spp. Such cases are treated with last-resort antibiotics like carbapenems. However, WHO says the risk of death from nmanageable infections is rising with rising carbapenem-resistance.
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Key findings of the WHO’s latest report
There is rising resistance across the antibiotic hierarchy. Over a fifth of Escherichia coli isolates — the most common pathogen in urinary tract infection — were resistant to both first-line and second-line antibiotics.
High levels of resistance to third-line antibiotics in Klebsiella pneumoniae, a pathogen widely reported in blood-stream infections, pushes up the use of carbapenems. Worryingly, 8% of K.pneumoniae showed carbapenem resistance. Even more concerning is the high rate of such resistance (>56%) among Acinetobacter spp., reported often in respiratory infections. Resistance seems to have risen by as much as 15% for some blood-stream bacteria from 2017 levels. Low- and middle-income nations are likely to report higher resistance levels.
Behind rising resistance…
Antibiotic misuse and overuse, in humans and livestock, is a key factor. Over-the-counter use of antibiotics, not completing/using beyond the prescribed regimen, inadequate use of diagnostics, overcrowding in hospitals and cross-infections, increased use for livestock and poor living conditions contribute to growing resistance. A UK-commissioned 2014 review projected a loss of $100 trillion by 2050 from AMR.
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For India, which leads global human antibiotic use (10.7 units/person), resistance is of particular concern. Changing dietary preferences also mean indirect exposure through animal products. Though antibiotic consumption by livestock in India significantly lags that in China, Brazil, and the US — the world leaders— it is projected to shoot up by 2030. India joined GLASS in 2017. Kerala last month released an antibiogram, which maps bacteria against their susceptibility to antibiotics.
Antibiotic research is ailing: What can be done to remedy this?
A February 2022 report by Biotechnology Innovation Organization, a prominent trade body for the biotech industry, says antibiotic R&D received just $1.6 billion from venture capital versus $26.5 billion for oncology research; in 2020, the funding for antibiotic R&D was lower than what it was in 2010.
This is important because small companies and non-profits account for nearly 88% of the antibiotics currently in the pipeline for clinical trials. Investor enthusiasm, BIO says, has been affected by big pharmaceutical companies exiting the space. Most big companies have either shut their antibiotic research or have considerably reduced spending. In 2016, AstraZeneca had halted antibiotic research, while Sanofi and Novartis made similar announcements in 2018. Nature reported in 2020 that just four big pharma companies remain invested. BIO attributes such decisions to ‘market realities’.
While nations must step up citizen awareness and usage surveillance efforts to fight resistance, there have been several calls for them to also incentivise antibiotic research through funding schemes, such as the UK’s NHS-linked subscription scheme, and regulatory interventions, such as the US’s GAIN Act.
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* India leads in human antibiotic consumption with10.7 units per person
* Antibiotic resistance caused1.27 mn deaths in 2019
* UK-commissioned Review of Antimicrobial Resistance projects deaths to reach 10 mn by 2050
