Antimicrobial Resistance, April 2014

256 Pages·2014·3.89 MB·English

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ANTIMICROBIAL
RESISTANCE
Global Report
on surveillance
2014
WHO Library Cataloguing-in-Publication Data
Antimicrobial resistance: global report on surveillance.
1.Anti-infective agents - classification. 2.Anti-infective agents - adverse effects. 3.Drug resistance,
microbial - drug effects. 4.Risk management. 5.Humans. I.World Health Organization.
ISBN 978 92 4 156474 8 (NLM classification: QV 250)
© World Health Organization 2014
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IV
Contents
Foreword ..................................................................................................................................................................IX
Summary ................................................................................................................................................................. X
Acknowledgements ........................................................................................................................................... XIV
Abbreviations. ...................................................................................................................................................... XVI
Introduction. ......................................................................................................................................................... XIX
Resistance to antibacterial drugs
SECTION
O1 1

1.1 Background. .............................................................................................................................1
1.1.1 Limitations. .......................................................................................................................2
1.2 R egional surveillance of antibacterial resistance ..............................................................................3
1.2.1 WHO African Region ............................................................................................................3
1.2.2 WHO Region of the Americas .................................................................................................3
1.2.3 WHO Eastern Mediterranean Region .......................................................................................4
1.2.4 WHO European Region .........................................................................................................4
1.2.5 WHO South-East Asia Region. ................................................................................................5
1.2.6 W HO Western Pacific Region .................................................................................................5
1.3 References...............................................................................................................................5
Resistance to antibacterial drugs in selected bacteria of international concern
SECTION
O2 9

2.1 A vailability of national resistance data ......................................................................................... 10
2.1.1 K ey messages..................................................................................................................12
2.2 R esistance data on specific pathogens ......................................................................................... 12
2.2.1 E scherichia coli – resistance to third-generation cephalosporins and to fluoroquinolones..................12
2.2.2 K lebsiella pneumoniae – resistance to third-generation cephalosporins and to carbapenems .............15
2.2.3 S taphylococcus aureus – resistance to methicillin. .................................................................... 19
2.2.4 S treptococcus pneumoniae – resistance (non-susceptibility) to penicillin. ....................................... 21
2.2.5 Nontyphoidal Salmonella – resistance to fluoroquinolones ......................................................... 23
2.2.6 S higella species – resistance to fluoroquinolones. .................................................................... 25
2.2.7 N eisseria gonorrhoeae – decreased susceptibility to third-generation cephalosporins ...................... 27
2.3 References.............................................................................................................................30
The health and economic burden due to antibacterial resistance
SECTION
O3 35

3.1 Methods ................................................................................................................................ 35
3.2 Findings ................................................................................................................................ 36
3.2.1 H ealth burden ..................................................................................................................36
3.2.2 E conomic burden ..............................................................................................................37
3.3 K nowledge gaps. ..................................................................................................................... 39
3.4 K ey messages ........................................................................................................................ 40
3.5 References.............................................................................................................................40
VV
ANTIMICROBIAL RESISTANCE Global Report on surveillance 2014
Surveillance of antimicrobial drug resistance in disease-specific programmes
SECTION
O4 43

4.1 Tuberculosis. .......................................................................................................................... 43
4.1.1 E volution of drug resistance in tuberculosis. ........................................................................... 44
4.1.2 S urveillance of drug-resistant tuberculosis ............................................................................ 44
4.1.3 G lobal public health response to drug-resistant tuberculosis .....................................................46
4.1.4 N otification of MDR-TB cases and enrolment on treatment .........................................................46
4.1.5 P ublic health implications: treatment outcomes for multidrug-resistant
and extensively drug-resistant tuberculosis ...........................................................................47
4.1.6 Key messages..................................................................................................................49
4.2 Malaria ................................................................................................................................. 49
4.2.1 E volution of antimalarial drug resistance ............................................................................... 49
4.2.2 S urveillance of antimalarial therapeutic efficacy and resistance ................................................. 50
4.2.3 G lobal public health implications of antimalarial drug resistance ................................................ 51
4.2.4 K ey messages..................................................................................................................51
4.3 HIV ....................................................................................................................................... 51
4.3.1 S urveillance of anti-HIV drug resistance ................................................................................52
4.3.2 G lobal public health implications of anti-HIV drug resistance ......................................................53
4.3.3 K ey messages..................................................................................................................53
4.4 Influenza ............................................................................................................................... 53
4.4.1 E volution of resistance in influenza viruses ............................................................................ 53
4.4.2 Anti-influenza drug resistance .............................................................................................54
4.4.3 S urveillance of anti-influenza drug resistance ........................................................................ 54
4.4.4 P ublic health implications of anti-influenza drug resistance .......................................................55
4.4.5 K ey messages..................................................................................................................55
4.5 References.............................................................................................................................55
Surveillance of antimicrobial resistance in other areas
SECTION
O5 59

5.1 A ntibacterial resistance in food-producing animals and the food chain. ............................................... 59
5.1.1 O ngoing surveillance of antimicrobial resistance in food-producing animals and food. ..................... 59
5.1.2 I ntegrated surveillance of antimicrobial resistance in foodborne bacteria ..................................... 60
5.1.3 A ntimicrobials of particular importance in human and veterinary medicine ................................... 61
5.1.4 I mplications for human health from zoonotic transmission of resistant bacteria and genetic material .61
5.1.5 WHO–FAO–OIE tripartite intersectoral collaboration on action .....................................................62
5.1.6 K ey messages..................................................................................................................62
5.2 A ntifungal drug resistance: the example of invasive Candidiasis ........................................................ 62
5.2.1 A ntifungal drug resistance in Candida species. ........................................................................ 63
5.2.2 A ntifungal drug resistance surveillance .................................................................................63
5.2.3 M agnitude of resistance at a global level ................................................................................64
5.2.5 K ey messages..................................................................................................................65
5.3 References.............................................................................................................................65
Conclusions
SECTION
O6 69

6.1 Main findings. ......................................................................................................................... 69
6.1.1 C urrent status of resistance to antibacterial drugs ................................................................... 69
6.1.2 B urden of resistance to antibacterial drugs ............................................................................ 69
6.1.3 S urveillance of antibacterial resistance .................................................................................69
6.1.4 S urveillance and present status of antimicrobial drug resistance in disease-specific programmes ..... 70
6.1.5 A ntibacterial resistance in food-producing animals and the food chain ......................................... 71
6.1.6 R esistance in systemic candidiasis ....................................................................................... 71
6.2 Gaps. .................................................................................................................................... 71
6.3 The way forward ..................................................................................................................... 71
6.4 References.............................................................................................................................71
VI
Annex 1 Methods for collecting data on surveillance
and antibacterial resistance
ANNEXES 73
A1.1 Definitions ........................................................................................................................... 73
A1.2 Data collection from Member States and networks ....................................................................... 74
A1.3 Literature search for data in scientific publications ....................................................................... 74
A1.4 Reference ............................................................................................................................ 75
Annex 2 Reported or published resistance rates in common bacterial pathogens,
by WHO region
77
A2 Tables:
A2.1-A2.6 Escherichia coli: Resistance to third-generation cephalosporins ........................................77-87
A2.7-A2.12 Escherichia coli: Resistance to fluoroquinolones ...................................................................88-96
A2.13-A2.18 Klebsiella pneumoniae: Resistance to third-generation cephalosporins. .........................97-102
A2.19-A2.24 Klebsiella pneumoniae: Resistance to carbapenems ........................................................103-108
A2.25-A2.30 Staphylococcus aureus: Resistance to methicillin (MRSA) ....................................109-116
A2.31-A2.36 Streptococcus pneumoniae: Resistance, or non-susceptibility, to penicillin ..............117-126
A2.37-A2.42 Nontyphoidal Salmonella (NTS): Resistance to fluoroquinolones ...........................128-135
A2.43-A2.48 Shigella species: Resistance to fluoroquinolones ..............................................136-142
A2.49-A2.54 Neisseria gonorrhoeae: Decreased susceptibility to third-generation cephalosporins 143-149
A2.55 References ........................................................................................................................150
Annex 3 The burden of antibacterial resistance: a systematic review of published
evidence (technical report on methods and detailed results)
169
A3.1 Methods .............................................................................................................................169
A3.2 Results. ..............................................................................................................................171
A3.3 References. .........................................................................................................................206
Appendix 1 Questionnaires used for data collection
APPENDICES 221

Ap1.1 Q uestionnaire and data template for national antimicrobial resistance (AMR) surveillance..............221
Ap1.2 Q uestionnaire and data template for antimicrobial resistance (AMR) surveillance networks ............222
Appendix 2 WHO tools to facilitate surveillance of antibacterial resistance
225
Ap2.1 WHONET .......................................................................................................................225
Ap2.2 Guiding WHO documents for surveillance of AMR ..................................................................226
Ap2.3 ICD 10 codes for antimicrobial resistance ............................................................................229
Ap2.4 References. ...................................................................................................................229
Appendix 3 Additional international antibacterial resistance
surveillance networks
231
Ap3.1 N etworks performing general surveillance of antibacterial resistance .......................................231
Ap3.2 References. ...................................................................................................................232
VII
ANTIMICROBIAL RESISTANCE Global Report on surveillance 2014
VIII
Foreword
Foreword
Antimicrobial resistance (AMR) within a wide range of infectious agents is a growing public health
threat of broad concern to countries and multiple sectors. Increasingly, governments around the world
are beginning to pay attention to a problem so serious that it threatens the achievements of modern
medicine. 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.
Determining the scope of the problem is essential for Nonetheless, the report makes a clear case that
formulating and monitoring an effective response to resistance to common bacteria has reached alarming
AMR. This WHO report, produced in collaboration with levels in many parts of the world indicating that
Member States and other partners, provides as accurate many of the available treatment options for common
a picture as is presently possible of the magnitude of infections in some settings are becoming ineffective.
AMR and the current state of surveillance globally. Furthermore, systematic reviews of the scientific
evidence show that ABR has a negative impact on
The report focuses on antibacterial resistance (ABR)
outcomes for patients and health-care expenditures.
in common bacterial pathogens. Why? There is a
major gap in knowledge about the magnitude of this Generally, surveillance in TB, malaria and HIV to detect
problem and such information is needed to guide resistance, determine disease burden and monitor
urgent public health actions. ABR is complex and public health interventions is better established and
multidimensional. It involves a range of resistance experiences from these programmes are described
mechanisms affecting an ever-widening range of in the report, so that lessons learnt can be applied
bacteria, most of which can cause a wide spectrum to ABR and opportunities for collaboration identified.
of diseases in humans and animals.
WHO, along with partners across many sectors,
One important finding of the report, which will is developing a global action plan to mitigate AMR.
serve as a baseline to measure future progress, Strengthening global AMR surveillance will be a critical
is that there are many gaps in information on aspect of such planning as it is the basis for informing
pathogens of major public health importance. global strategies, monitoring the effectiveness of
In addition, surveillance of ABR generally is neither public health interventions and detecting new trends
coordinated nor harmonized, compromising the and threats.
ability to assess and monitor the situation.
Dr Keiji Fukuda
Assistant Director-General
Health Security
IX
ANTIMICROBIAL RESISTANCE Global Report on surveillance 2014
Summary
Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever-increasing
range of infections caused by bacteria, parasites, viruses and fungi. This report examines, for the first
time, the current status of surveillance and information on AMR, in particular antibacterial resistance
(ABR), at country level worldwide.
Key findings and public health implications Nevertheless, it is critical to obtain a broad picture
of ABR are: of the international scope of the problem of ABR.
To accomplish this, WHO obtained, from 129 Member
• Very high rates of resistance have been observed in
States, the most recent information on resistance
bacteria that cause common health-care associated
surveillance and data for a selected set of nine
and community-acquired infections (e.g. urinary tract
bacteria–antibacterial drug combinations of public
infection, pneumonia) in all WHO regions.
health importance. Of these, 114 provided data for
• There are significant gaps in surveillance, and a at least one of the nine combinations (22 countries
lack of standards for methodology, data sharing provided data on all nine combinations).
and coordination.
Some data sets came from individual surveillance
Key findings from AMR surveillance in disease-specific sites, or data from several sources rather than national
programmes are as follows: reports. Many data sets were based on a small
number of tested isolates of each bacterium (<30),
• Although multidrug-resistant TB is a growing concern,
adding to uncertainty about the precision of the data;
it is largely under-reported, compromising control
this reflects a lack of national structures to provide an
efforts.
overview of the situation and limited capacity for timely
• Foci of artemisinin resistance in malaria have information sharing. Most data sets, individual sites or
been identified in a few countries. Further spread, aggregated data, were based on hospital data. Non-
or emergence in other regions, of artemisinin-
representativeness of surveillance data is a limitation
resistant strains could jeopardize important recent
for the interpretation and comparison of results.
gains in malaria control.
The data compiled from countries indicate where there
• Increasing levels of transmitted anti-HIV drug
may be gaps in knowledge and lack of capacity to
resistance have been detected among patients
collect national data. Among WHO regions, the greatest
starting antiretroviral treatment.
country-level data were obtained from the European
Region and the Region of the Americas, where long-
standing regional surveillance and collaboration exist.
Surveillance of ABR and sources of data
There is at present no global consensus on
methodology and data collection for ABR surveillance. Current status of resistance in selected
Routine surveillance in most countries is often based bacteria
on samples taken from patients with severe infections
In the survey forming the basis for this part of the report,
– particularly infections associated with health care,
information was requested on resistance to antibacterial
and those in which first-line treatment has failed.
drugs commonly used to treat infections caused by nine
Community-acquired infections are almost certainly
bacteria of international concern. The chosen bacteria
underrepresented among samples, leading to gaps
are causing some of the most common infections in
in coverage of important patient groups.
different settings; in the community, in hospitals or
transmitted through the food chain. The main findings
are summarized in the following tables:
X