We are losing the arms race against many common bugs.

Bad Bugs Behaving Badly

Robert Welliver, MD, an infectious disease physician at the University of Oklahoma, chose the World Health Organization(WHO) 2014 summary of its antimicrobial resistance global report on surveillance^[1] as the most important paper of the year. He states, "This issue is a major threat to the United States—more than Ebola, more than methicillin-resistant Staphylococcus aureus, more even than obesity."

The summary notes the following key findings.

1. In many WHO regions, very high rates of antimicrobial resistance have been observed for common bacteria, such as Escherichia coli, Klebsiella pneumoniae, and S aureus; these organisms cause common infections involving the urinary tract, bloodstream, respiratory system, and wounds.

2. There is a significant gap in surveillance techniques, standards for methodology, and data sharing and coordination.

3. Multidrug-resistant tuberculosis is a growing, and largely underreported, problem.

4. Increasing levels of transmitted anti-HIV drug resistance have been observed among patients initiating antiretroviral treatment.

The bottom line as to why this is significant is as follows. According to the summary, "Patients with infections caused by bacteria resistant to a specific antibacterial drug generally have an increased risk of worse clinical outcomes and death, and consume more healthcare resources, than patients infected with the same bacteria not demonstrating the resistance pattern in question." In a phrase, more resistant bugs means more lost lives and more money.

Antimicrobial resistance is not a topic for medical journals alone. From the New York Times ^[2] to The Economist,^[3] articles in lay publications have brought this issue to the fore in many countries. Yet inappropriate requests for antibiotics, accompanied by their injudicious use, indicate that there is more to do to reverse these trends.

Antimicrobial stewardship programs are one such approach. A second involves the curtailment of antibiotic use in livestock. According to the National Resources Defense Council, 80% of antibiotic in the United States is used to promote livestock growth.^[4]

The pharmaceutical research and development pipeline is losing the arms race against many common bugs. The WHO 2014 summary is likely to be a harbinger, unless some drastic policy changes come about.