A record number (more than 3 million) of laboratory-confirmed infection cases, along with their antimicrobial resistance (AMR) results, were reported to WHO in response to the 2020 call for input to its Global Antimicrobial Resistance and Use Surveillance System (GLASS).
Collectively, country reports show high numbers of bloodstream infections caused by E. coli with resistance to third generation cephalosporins and by antimicrobial resistant Staphylococcus aureus (MRSA) - the two AMR Sustainable Development Goal indicators. Resistance seem to be higher in low and middle-income countries (LMICs) than in richer countries and could be particularly worrying for countries with limited access to modern antibiotics effective against these infections.
However, more research is required to better understand these differences. High levels of resistance to last-resort antibiotics such as carbapenems were reported for bloodstream infections caused by common hospital pathogens such as Acinetobacter spp. and some enterobacteria, highlighting the threat of highly resistant human pathogens. The reports also indicated a high proportion of resistance to commonly used antibiotic treatments for urinary tract infections and for gonorrhoea.
"The volume of AMR infections is alarming," observed Dr Hanan Balkhy, Assistant Director General at WHO. "However, it is encouraging to see that despite the ongoing challenges of COVID-19, more countries are reporting in on AMR. Five years ago, when we ran WHO's first AMR surveillance report, there were only 700 surveillance sites. Now, considering also the countries that reported after the GLASS data call due to COVID-19, there are 74 000. The more information we have, the better placed we are to tackle this increasingly serious health threat."
Improving surveillance
GLASS has not only become more widely used, but it now covers a greater range of surveillance activities, such as the monitoring of antimicrobial consumption. Of the 109 countries or territories participating in GLASS, the majority (107) AMR in clinical samples, and 19 now measure antimicrobial consumption (i.e. the quantity of antimicrobials used in a setting over a pre-defined time period). This is key to identify AMR drivers, which is even more now in view of well-documented antibiotic misuse related to COVID-19 treatment.
Importantly, GLASS provides a standardized approach for the collection, analysis, interpretation and dissemination of data relating to AMR. The system iteratively and continuously updates and improves the methodologies for measuring and reporting the burden of AMR, as well as the consumption of antimicrobials at country, regional and global levels.
Despite this progress, further work is needed to improve the representativeness and quality of the data. Following the "Third high level technical consultation and meeting on surveillance of antimicrobial resistance and use for concerted actions" co-hosted by the Republic of Korea and Sweden in April 2021, 88 countries and key technical partners agreed that in addition to building and strengthening quality routine surveillance, complementary surveillance approaches are required. For example, GLASS is also now moving towards the application of population-based surveys.
Antimicrobial resistance
AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making it harder to treat infections and increasing the risk of disease spread, severe illness and death. It is driven by the misuse and over-use of antimicrobials. AMR is a major challenge to achieving health and development goals, and imposes a significant cost on national and global economies. In addition to death and disability, prolonged illness results in longer hospital stays, the need for more expensive medicines and financial challenges for those affected.
