Experts Ponder a World Without Antibiotics, Lack of Hand Hygiene and Hidden Cross Transmission

Jean Carlet, a consultant with the WHO African Partnerships for Patient Safety, and colleagues, observe in an editorial in the journal Antimicrobial Resistance and Infection Control, that resistance to antibiotics has increased dramatically over the past few years and has now reached a level that places future patients in real danger. Microorganisms such as Escherichia coli and Klebsiella pneumoniae, which are commensals and pathogens for humans and animals, have become increasingly resistant to third-generation cephalosporins.  Moreover, in certain countries, they are also resistant to carbapenems and therefore susceptible only to tigecycline and colistin.

Carlet, et al. (2012) say further that resistance is primarily attributed to the production of beta-lactamase genes located on mobile genetic elements, which facilitate their transfer between different species. In some rare cases, Gram-negative rods are resistant to virtually all known antibiotics. The causes are numerous, but the role of the overuse of antibiotics in both humans and animals is essential, as well as the transmission of these bacteria in both the hospital and the community, notably via the food chain, contaminated hands, and between animals and humans. In addition, there are very few new antibiotics in the pipeline, particularly for Gram-negative bacilli. The situation is slightly better for Gram-positive cocci as some potent and novel antibiotics have been made available in recent years. A strong and coordinated international program is urgently needed, they say.

To meet this challenge, 70 internationally recognized experts met for a two-day meeting in June 2011 in France and endorsed a global call to action ("The Pensieres Antibiotic Resistance Call to Action"), and Carlet et al. outline bundles of measures that must be implemented simultaneously and worldwide. In particular, they say that antibiotics, which represent a treasure for humanity, must be protected and considered as a special class of drugs.
 
The authors comment on the current lack of antimicrobial stewardship: "The most important cause is that there has been a massive overuse of antibiotics worldwide across all ecosystems over the past decades, including humans, animals, aquaculture, and agriculture. When selected silently by antibiotics, a hidden cross-transmission of resistant bacteria occurs daily, both in hospitals and communities. Compliance with hand hygiene practices is far from optimal in many healthcare settings, including hospitals and long-term care facilities, thus resulting in a continuous succession of small-size transmission events difficult to detect, as well as large outbreaks. Exchange of resistant bacteria via travel activities and patient transfers has led to a rapidly growing resistance globalization as recently exemplified by the spread of NDM-1. As a consequence, some countries recommend the preemptive isolation of patients admitted from outside their borders based on a suspicion of MDRO carriage in the same philosophy as the Search and Destroy program in The Netherlands. Cross-transmission occurs also in community settings (e.g., schools,
families, daycare centres). Finally, hospital and community wastewater systems are an additional source for the dissemination of resistant bacteria." To read further, CLICK HERE.

Reference: Carlet J, Jarlier V, Stephan Harbarth S, Voss A, Goossens H, and Pittet D. Ready for a world without antibiotics? The Pensieres Antibiotic Resistance Call to Action. Antimicrobial Resistance and Infection Control 2012, 1:11 doi:10.1186/2047-2994-1-11