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WHO|Antimicrobialresistance

Mediacentre
Antimicrobialresistance
FactsheetN194
UpdatedApril2015

Keyfacts
Antimicrobialresistancethreatenstheeffectivepreventionand
treatmentofaneverincreasingrangeofinfectionscausedby
bacteria,parasites,virusesandfungi.
Itisanincreasinglyseriousthreattoglobalpublichealththatrequires
actionacrossallgovernmentsectorsandsociety.
Antimicrobialresistanceispresentinallpartsoftheworld.New
resistancemechanismsemergeandspreadglobally.
In2012,WHOreportedagradualincreaseinresistancetoHIVdrugs,
albeitnotreachingcriticallevels.Sincethen,furtherincreasesin
resistancetofirstlinetreatmentdrugswerereported,whichmight
requireusingmoreexpensivedrugsinthenearfuture.
In2013,therewereabout480000newcasesofmultidrugresistant
tuberculosis(MDRTB).Extensivelydrugresistanttuberculosis
(XDRTB)hasbeenidentifiedin100countries.MDRTBrequires
treatmentcoursesthataremuchlongerandlesseffectivethanthose
fornonresistantTB.
InpartsoftheGreaterMekongsubregion,resistancetothebest
availabletreatmentforfalciparummalaria,artemisininbased
combinationtherapies(ACTs),hasbeendetected.Spreador
emergenceofmultidrugresistance,includingresistancetoACTs,in
otherregionscouldjeopardizeimportantrecentgainsincontrolofthe
disease.
Therearehighproportionsofantibioticresistanceinbacteriathat
causecommoninfections(e.g.urinarytractinfections,pneumonia,
bloodstreaminfections)inallregionsoftheworld.Ahighpercentage
ofhospitalacquiredinfectionsarecausedbyhighlyresistantbacteria
suchasmethicillinresistantStaphylococcusaureus(MRSA)or
multidrugresistantGramnegativebacteria.
Treatmentfailuresduetoresistancetotreatmentsoflastresortfor
gonorrhoea(thirdgenerationcephalosporins)havebeenreportedfrom
10countries.Gonorrhoeamaysoonbecomeuntreatableasno
vaccinesornewdrugsareindevelopment.
Patientswithinfectionscausedbydrugresistantbacteriaare
generallyatincreasedriskofworseclinicaloutcomesanddeath,and
consumemorehealthcareresourcesthanpatientsinfectedwiththe
samebacteriathatarenotresistant.

Whatisantimicrobialresistance?
Antimicrobialresistanceisresistanceofamicroorganismtoan
antimicrobialdrugthatwasoriginallyeffectivefortreatmentofinfections
causedbyit.
Resistantmicroorganisms(includingbacteria,fungi,virusesand
parasites)areabletowithstandattackbyantimicrobialdrugs,suchas
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antibacterialdrugs(e.g.antibiotics),antifungals,antivirals,and
antimalarials,sothatstandardtreatmentsbecomeineffectiveand
infectionspersist,increasingtheriskofspreadtoothers.
Theevolutionofresistantstrainsisanaturalphenomenonthatoccurs
whenmicroorganismsreplicatethemselveserroneouslyorwhen
resistanttraitsareexchangedbetweenthem.Theuseandmisuseof
antimicrobialdrugsacceleratestheemergenceofdrugresistantstrains.
Poorinfectioncontrolpractices,inadequatesanitaryconditionsand
inappropriatefoodhandlingencouragethefurtherspreadofantimicrobial
resistance.

Whatisthedifferencebetweenantibioticandantimicrobial
resistance?
Antibioticresistancerefersspecificallytotheresistancetoantibiotics
thatoccursincommonbacteriathatcauseinfections.Antimicrobial
resistanceisabroaderterm,encompassingresistancetodrugstotreat
infectionscausedbyothermicrobesaswell,suchasparasites(e.g.
malaria),viruses(e.g.HIV)andfungi(e.g.Candida).

Whyisantimicrobialresistanceaglobalconcern?
Newresistancemechanismsemergeandspreadgloballythreateningour
abilitytotreatcommoninfectiousdiseases,resultingindeathand
disabilityofindividualswhountilrecentlycouldcontinueanormal
courseoflife.
Withouteffectiveantiinfectivetreatment,manystandardmedical
treatmentswillfailorturnintoveryhighriskprocedures.
Antimicrobialresistancekills
Infectionscausedbyresistantmicroorganismsoftenfailtorespondto
thestandardtreatment,resultinginprolongedillness,higherhealthcare
expenditures,andagreaterriskofdeath.
Asanexample,thedeathrateforpatientswithseriousinfections
causedbycommonbacteriatreatedinhospitalscanbeabouttwicethat
ofpatientswithinfectionscausedbythesamenonresistantbacteria.
Forexample,peoplewithMRSA(methicillinresistantStaphylococcus
aureus,anothercommonsourceofsevereinfectionsinthecommunity
andinhospitals)areestimatedtobe64%morelikelytodiethanpeople
withanonresistantformoftheinfection.
Antimicrobialresistancehampersthecontrolofinfectiousdiseases
Antimicrobialresistancereducestheeffectivenessoftreatmentthus
patientsremaininfectiousforalongertime,increasingtheriskof
spreadingresistantmicroorganismstoothers.Forexample,the
emergenceofPlasmodiumfalciparummultidrugresistance,including
resistancetoACTsintheGreaterMekongsubregionisanurgentpublic
healthconcernthatisthreateningglobaleffortstoreducetheburdenof
malaria.
AlthoughMDRTBisagrowingconcern,itisstilllargelyunderreported,
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compromisingcontrolefforts.
Antimicrobialresistanceincreasesthecostsofhealthcare
Wheninfectionsbecomeresistanttofirstlinedrugs,moreexpensive
therapiesmustbeused.Alongerdurationofillnessandtreatment,often
inhospitals,increaseshealthcarecostsaswellastheeconomic
burdenonfamiliesandsocieties.
Antimicrobialresistancejeopardizeshealthcaregainstosociety
Theachievementsofmodernmedicineareputatriskbyantimicrobial
resistance.Withouteffectiveantimicrobialsforpreventionandtreatment
ofinfections,thesuccessoforgantransplantation,cancer
chemotherapyandmajorsurgerywouldbecompromised.

Presentsituation
Resistanceinbacteria
WHOs2014reportonglobalsurveillanceofantimicrobialresistance
revealedthatantibioticresistanceisnolongerapredictionforthefuture
itishappeningrightnow,acrosstheworld,andisputtingatriskthe
abilitytotreatcommoninfectionsinthecommunityandhospitals.
Withouturgent,coordinatedaction,theworldisheadingtowardsapost
antibioticera,inwhichcommoninfectionsandminorinjuries,which
havebeentreatablefordecades,canonceagainkill.
Treatmentfailuretothedrugoflastresortforgonorrhoeathird
generationcephalosporinshasbeenconfirmedinseveralcountries.
Untreatablegonococcalinfectionsresultinincreasedratesofillness
andcomplications,suchasinfertility,adversepregnancyoutcomes
andneonatalblindness,andhasthepotentialtoreversethegains
madeinthecontrolofthissexuallytransmittedinfection.
Resistancetooneofthemostwidelyusedantibacterialdrugsforthe
oraltreatmentofurinarytractinfectionscausedbyE.coli
fluoroquinolonesisverywidespread.
Resistancetofirstlinedrugstotreatinfectionscausedby
Staphlylococcusaureusacommoncauseofsevereinfections
acquiredbothinhealthcarefacilitiesandinthecommunityisalso
widespread.
Resistancetothetreatmentoflastresortforlifethreatening
infectionscausedbycommonintestinalbacteriacarbapenem
antibioticshasspreadtoallregionsoftheworld.Keytoolsto
tackleantibioticresistancesuchasbasicsystemstotrackand
monitortheproblemrevealconsiderablegaps.Inmanycountries,
theydonotevenseemtoexist.
Resistanceintuberculosis
In2013,therewereanestimated480000newcasesofMDRTBinthe
world.Globally,3.5%ofnewTBcasesand20.5%ofpreviouslytreated
TBcasesareestimatedtohaveMDRTB,withsubstantialdifferencesin
thefrequencyofMDRTBamongcountries.Extensivelydrugresistant
TB(XDRTB,definedasMDRTBplusresistancetoanyfluoroquinolone
andanysecondlineinjectabledrug)hasbeenidentifiedin100
countries,inallregionsoftheworld.
PercentageofnewTBcaseswithmultidrugresistanttuberculosis
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Viewgraph

PercentageofpreviouslytreatedTBcaseswithmultidrugresistant
tuberculosis

Viewgraph

Resistanceinmalaria
TheemergenceofP.falciparummultidrugresistance,including
resistancetoACTs,intheGreaterMekongsubregionisanurgentpublic
healthconcernthatisthreateningtheongoingglobalefforttoreducethe
burdenofmalaria.Routinemonitoringoftherapeuticefficacyisessential
toguideandadjusttreatmentpolicies.Itcanalsohelptodetectearly
changesinP.falciparumsensitivitytoantimalarialdrugs.
ResistanceinHIV
HIVdrugresistanceemergeswhenHIVreplicatesinthebodyofa
personinfectedwiththeviruswhoistakingantiretroviraldrugs.Even
whenantiretroviraltherapy(ART)programmesareverywellmanaged,
somedegreeofHIVdrugresistancewillemerge.
AvailabledatasuggestthatcontinuedexpansionofaccesstoARTis
associatedwithariseinHIVdrugresistance.In2013,12.9million
peoplelivingwithHIVwerereceivingantiretroviraltherapyglobally,of
which11.7millionwereinlowandmiddleincomecountries.
HIVdrugresistancemayrisetosuchalevelthatthefirstlineand
secondlineARTregimenscurrentlyusedtotreatHIVbecome
ineffective,jeopardizingpeopleslivesandthreateningnationaland
globalinvestmentsinARTprogrammes.
Asof2010,levelsofHIVdrugresistanceamongadultswhohadnot
beguntreatmentincountriesscalingupARTwerefoundtobeabout5%
globally.However,since2010,therearereportssuggestingthatpre
treatmentresistanceisincreasing,peakingat22%insomeareas.
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ContinuoussurveillanceofHIVdrugresistanceisofparamount
importancetoinformglobalandnationaldecisionsontheselectionof
firstandsecondlineARTandtomaximizeoverallpopulationlevel
treatmenteffectiveness.
Resistanceininfluenza
Overthepast10years,antiviraldrugshavebecomeimportanttoolsfor
treatmentofepidemicandpandemicinfluenza.Severalcountrieshave
developednationalguidanceontheiruseandhavestockpiledthedrugs
forpandemicpreparedness.Theconstantlyevolvingnatureofinfluenza
meansthatresistancetoantiviraldrugsiscontinuouslyemerging.
By2012,virtuallyallinfluenzaAvirusescirculatinginhumanswere
resistanttodrugsfrequentlyusedforthepreventionofinfluenza
(amantadineandrimantadine).However,thefrequencyofresistanceto
theneuraminidaseinhibitoroseltamivirremainslow(12%).Antiviral
susceptibilityisconstantlymonitoredthroughtheWHOGlobal
SurveillanceandResponseSystem.

Whatacceleratestheemergenceandspreadofantimicrobial
resistance?
Thedevelopmentofantimicrobialresistanceisanaturalphenomenon.
However,certainhumanactionsaccelerateitsemergenceandspread.
Theinappropriateuseofantimicrobialdrugs,includinginanimal
husbandry,favourstheemergenceandselectionofresistantstrains,
andpoorinfectionpreventionandcontrolpracticescontributetofurther
emergenceandspreadofantimicrobialresistance.

Needforconcertedactions
Antimicrobialresistanceisacomplexproblemdrivenbymany
interconnectedfactors.Assuch,single,isolatedinterventionshavelittle
impact.Coordinatedactionisrequiredtominimizeemergenceand
spreadofantimicrobialresistance.
Peoplecanhelptackleresistanceby:
handwashing,andavoidingclosecontactwithsickpeopletoprevent
transmissionofbacterialinfectionsandviralinfectionssuchas
influenzaorrotavirus,andusingcondomstopreventthe
transmissionofsexuallytransmittedinfections
gettingvaccinated,andkeepingvaccinationsuptodate
usingantimicrobialdrugsonlywhentheyareprescribedbyacertified
healthprofessional
completingthefulltreatmentcourse(whichinthecaseofantiviral
drugsmayrequirelifelongtreatment),eveniftheyfeelbetter
neversharingantimicrobialdrugswithothersorusingleftover
prescriptions.
Healthworkersandpharmacistscanhelptackleresistanceby:
enhancinginfectionpreventionandcontrolinhospitalsandclinics
onlyprescribinganddispensingantibioticswhentheyaretruly
needed
prescribinganddispensingtherightantimicrobialdrugstotreatthe
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illness.
Policymakerscanhelptackleresistanceby:
improvingmonitoringaroundtheextentandcausesofresistance
strengtheninginfectioncontrolandprevention
regulatingandpromotingappropriateuseofmedicines
makinginformationwidelyavailableontheimpactofantimicrobial
resistanceandhowthepublicandhealthprofessionalscanplaytheir
part
rewardinginnovationanddevelopmentofnewtreatmentoptionsand
othertools.
Policymakers,scientistsandindustrycanhelptackleresistanceby:
fosteringinnovationandresearchanddevelopmentofnewvaccines,
diagnostics,infectiontreatmentoptionsandothertools.

WHO'sresponse
WHOisguidingtheresponsetoantimicrobialresistanceby:
bringingallstakeholderstogethertoagreeonandworktowardsa
coordinatedresponse
strengtheningnationalstewardshipandplanstotackleantimicrobial
resistance
generatingpolicyguidanceandprovidingtechnicalsupportfor
MemberStates
activelyencouraginginnovation,researchanddevelopment.
WHOisalreadyworkingcloselywiththeWorldOrganisationforAnimal
Health(OIE)andtheFoodandAgricultureOrganizationoftheUnited
Nations(FAO)topromotebestpracticestoavoidtheemergenceand
spreadofantibacterialresistance,includingoptimaluseofantibioticsin
bothhumansandanimals.
WHOhasdeveloped,adraftglobalactionplantocombatantimicrobial
resistancewhichhasbeensubmittedtothesixtyeighthWorldHealth
Assembly,takingplaceinMay2015.

Formoreinformationcontact:
WHOMediacentre
Telephone:+41227912222
Email:mediainquiries@who.int

Relatedlinks
Antimicrobialresistance:global
reportonsurveillance2014
Worldwidecountrysituation
analysis:responseto
antimicrobialresistance
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Infographic:Antimicrobial
resistance:globalreporton
surveillance2014
pdf,653kb
WHOspolicypackagetocombat
antimicrobialresistance
WorldHealthDay7April2011
WHO'sworkonantimicrobial
resistance
Moreaboutantimicrobial
resistance

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