WASHINGTON, D.C. and NEW DELHI (17 September 2015) -- Researchers at the Center for Disease Dynamics, Economics & Policy (CDDEP) released new data today documenting alarming rates of bacteria resistant to last-resort antibiotics that can lead to life-threatening infections across the world. Though wealthy countries still use far more antibiotics per capita, high rates in the low- and middle-income countries where surveillance data is now available—such as India, Kenya, and Vietnam—sound a warning to the world. For example, in India, 57 percent of the infections caused by Klebsiella pneumoniae, a dangerous superbug found in hospitals, were found to be resistant to one type of last-resort drug in 2014, up from 29 percent in 2008. For comparison, these drugs, known as carbapenems, are still effective against Klebsiella infections in 90 percent of cases in the United States and over 95 percent of cases in most of Europe.
The findings were released via CDDEP's ResistanceMap, an interactive online tool that allows users to track the latest global trends in drug resistance in 39 countries, and antibiotic use in 69 countries. It includes infections caused by 12 common and potentially deadly bacteria, including Escherichia coli (E. coli), Salmonella, and methicillin-resistant Staphylococcus aureus (MRSA). This is the first time data from a significant number of developing countries have been brought together publicly.
CDDEP also issued the first report to look comprehensively at the current state of global antibiotic use and drug resistance in humans, livestock and the environment. The report, The State of the World's Antibiotics, 2015, lays out six strategies that belong in every national plan to halt the spread of resistance. Report authors say antibiotic stewardship is the key component of that action, and they challenge the frequently-cited notion that the problem with antibiotic resistance is a lack of new drugs in the antibiotic pipeline.
"For the first time, we have data on low- and middle-income countries, where antibiotic resistance is a serious problem but rarely the focus of policy solutions," said Ramanan Laxminarayan, CDDEP Director and report co-author. "We hope this report, together with the ResistanceMap online tool, will help empower these countries to understand the burden of antibiotic resistance in their region and then take coordinated, research-backed action to limit it."
Other Findings on Drug-Resistant Infections and Antibiotic Use from ResistanceMap
E. coli resistance is high and rising for many drug types and in many world regions, according to ResistanceMap. But compared to all other countries, India has the highest rates of resistance to nearly every drug used to treat it; strains of E. coli are more than 80 percent resistant to three different classes of drugs, meaning treatment options are becoming increasingly limited.
"Carbapenem antibiotics are for use in the most dire circumstances—when someone's life is in danger and no other drug will cure the infection," said Sumanth Gandra, an infectious diseases physician and CDDEP Resident Scholar in New Delhi. "We're seeing unprecedented resistance to these precious antibiotics globally, and especially in India. If these trends continue, infections that could once be treated in a week or two could become routinely life threatening and endanger millions of lives."
Incidence of methicillin-resistant Staphylococcus aureus (MRSA), a highly dangerous pathogen that people can contract in the community and in hospitals, is rising in sub-Saharan Africa, India, Latin America, and Australia. Incidence is highest in Latin America, where estimates published in the State of the World's Antibiotics, 2015 report show that in 2013, about 90 percent of Staph aureus infections were resistant to multiple antibiotics. Where antibiotic stewardship programs are beginning to take hold—in South Africa, Europe, the UK, and the US—MRSA rates have begun to decline.
ResistanceMap also tracks rates of antibiotic use, and findings indicate that both human and animal antibiotic use is rising dramatically in middle-income countries—particularly China, India, Brazil and South Africa. Per capita use in these countries is still less than half what it is in the United States, but the increase, driven by increased prosperity, includes a great deal of unnecessary and inappropriate use—mainly self-prescribed for coughs and colds. In many countries, antibiotics are easily purchased in pharmacies and shops without prescription. "A rampant rise in antibiotic use poses a major threat to public health, especially when there's no oversight on appropriate prescribing," said Laxminarayan. "Antibiotic use drives antibiotic resistance."
ResistanceMap's data come from a variety of sources, from small private laboratories in India to large datasets from the European Centre for Disease Prevention and Control, covering 30 countries. ResistanceMap, supported by a grant from the Bill & Melinda Gates Foundation, includes data from South Africa, India, Thailand, Vietnam, Kenya, Australia and New Zealand among others and will continue to be expanded and updated. Data from China, Nepal, Mozambique and the Philippines will be added soon.
First-Ever Report on the State of the World's Antibiotics
CDDEP's State of the World's Antibiotics, 2015 says limiting overuse and misuse of antibiotics are the only sustainable solutions. "We need to focus 80 percent of our global resources on stewardship and no more than 20 percent on drug development," said Laxminarayan. "No matter how many new drugs come out, if we continue to misuse them, they might as well have never been discovered."
One major drawback to focusing on drug development as a solution is that new antibiotics are significantly more expensive than those currently available—far more costly than people in low- and middle-income countries can afford. Dozens of new antibiotics have been developed in the last few years, but on a global scale, almost no one can afford them, say report authors. "When it comes to antibiotic-resistant infections, the rich pay with their wallets and the poor pay with their lives," said Laxminarayan.
Still, much can be done to conserve antibiotic effectiveness for future generations. Though ResistanceMap's findings indicate troubling trends in global antibiotic resistance rates, the State of the World report concludes that concerted action can help alleviate the problem.
The World Health Organization recently highlighted the need for country-level antibiotic resistance plans in May 2015 when it endorsed the Global Action Plan on Antimicrobial Resistance, which calls on all countries to adopt national strategies within two years. The new CDDEP report can help countries take action to achieve this goal.
CDDEP's Global Antibiotic Resistance Partnership (GARP) has worked in eight countries since 2008 to develop local capacity to analyze national conditions and propose locally-appropriate solutions to antibiotic resistance problems while sustaining antibiotic access. The State of the World's Antibiotics, 2015 uses the experience and knowledge gained from GARP working groups in Asia and Africa to identify policies that work—from antibiotic stewardship campaigns and hospital infection control to improving vaccination coverage to limit infections and reduce the need for antibiotics.
"Our research shows that antibiotic resistance and misuse is a dire—and growing—problem in every country on earth," said Laxminarayan. "The good news is that every country can work on solving it."