Antibiotic resistance: the global public health threat of the 21st century

April, the World Health Organization released its first comprehensive review of global antimicrobial resistance. The findings of the report revealed that antimicrobial resistance – the ability of bacteria and other bugs to resist the effects of an antibiotic to which they were once sensitive – is now a major threat to public health around the world. 

According to WHO, “far from being an apocalyptic fantasy”, a post-antibiotic era in which minor infections and common injuries can be deadly is a very real possibility for the 21st century.

Professor Mike Richards, Director of the Victorian Infectious Disease Service (VIDS) at the Royal Melbourne Hospital and the Doherty Institute, says as a result of antibiotic resistance, diseases that were easily treatable in the past have the potential to be life-threatening. In particular, resistance is occurring across infectious agents responsible for many common, serious diseases, like bloodstream infections, diarrhoea, pneumonia, urinary tract infections, gonorrhoea and tuberculosis.

These multi-drug resistance pathogens – commonly called ‘super bugs’ – pose significant challenges both in the community, and in particular, in hospital settings. 

Intensive antibiotic therapy is often needed for the support of patients in intensive care units, patients who have undergone major surgery, and patients who are immunosuppressed for the treatment of cancer or organ transplantation. 

“Bugs that are almost untreatable with antibiotics are not just a problem for people getting pneumonia in the community, they are a particularly challenging problem to deal with in our hospitals,” Professor Richards says.

“If we have super bugs in our intensive care units and oncology wards, this will threaten our treatment of major surgery. It will threaten our ability to treat cancer patients who develop bloodstream infections. It will threaten our treatment of multi-trauma patients, and it will threaten our ability to treat patients undergoing organ and bone marrow transplants.

“It’s a huge threat to healthcare internationally. Overseas, we have already seen scenarios where intensive care units have had to close due to the frequency and high mortality of antibiotic resistant infections.”

The development of drug resistance is thought to be accelerated by the inappropriate use of medicines – such as a patient failing to finish a course of antibiotics, healthcare professionals prescribing and dispensing antibiotics to treat viral infections, or doctors using broad spectrum antibiotics when simpler, narrow spectrum agents would be equally effective.

The WHO report also identified that although the issue is gaining traction on the international health agenda, major gaps remain in global knowledge and consensus around how to address drug resistance and improve public health interventions to stop its spread.

The establishment of the Doherty Institute, Professor Richards says, is an opportunity for Australia to play a leading role in fostering innovation and research and development of new strategies to tackle antimicrobial resistance.

“For some time, Australia has had an international strategy outlining how we would address a flu pandemic. Now, in an important next step, we’re beginning to develop a comprehensive strategy for how we are going to, as a nation, address the problem of antimicrobial resistance. This strategy is necessarily multi-disciplinary and multi-dimensional.

“The partners in the Doherty Institute with other collaborators are leading initiatives for surveillance of infections in hospital settings, identifying resistant bacteria and using state-of-the-art genomics to understand why resistance is developing,” he says.

“At the same time, infectious diseases physicians, pharmacists and epidemiologists are leading innovative programs on ‘antimicrobial stewardship’ – the promotion of optimal use of antibiotics. We are international leaders in this area.”

The Doherty Institute will work closely with other groups in the University and the Parkville precinct, including the Faculty of Veterinary Science. A growing area of concern is the growing use of antibiotics in healthy livestock and poultry and the impact this is having on resistance.

“Human health and animal health are intimately linked,” Professor Richards says. 

“There is a growing recognition that we need to bring vets and doctors together in our research. Even larger volumes of antibiotics are used in animals than in people. Antibiotic resistance develops in animals, and these resistant bugs may end up in our food chain, and are occasionally transferred to us from companion animals.”

There have been no new classes of antibiotics developed in the past 25 years, and the development of new drugs could take more than a decade, according to experts. 

With a threat and challenge of this scope, says Professor Richards, the existence of institutes like the Doherty – which combine surveillance, laboratory capacity, and leadership in promoting co-operation among health practitioners and policymakers – is more important than ever.