Editorial: Containment of Antimicrobial Resistance Is an International Challenge
Published: 14.12.09 Updated: 14.12.2009 11:26:30
K. Kutsar, Editor-in-Chief, EpiNorth Journal
I. Velicko, Managing Editor, EpiNorth Journal
Citation: Kutsar K., Velicko I. Containment of antimicrobial resistance is an international challenge.EpiNorth,2009;10(3): 107-109.
The emergence and spread of antimicrobial resistance has become a major public health threat in Europe and worldwide, and the number of infections caused by resistant pathogens continues to increase in the European Union (1,3). Methicillin-resistant Staphylococcus aureus (MRSA) is currently the most commonly identified antibiotic-resistant pathogen in hospitals in many parts of the world, including Europe, the Americas, North Africa and the Middle and Far East. However, in the northern part of the EpiNorth region, MRSA rates are below 3%. Although they are higher in the Baltic states (8%-9%) (see figure), MRSA rates have decreased considerably, in Latvia – from 25% in 2004 to 8% in 2007 (3). In Finland and Denmark, on the other hand, a significant increase was reported over the period 1999-2007 (3). The MRSA rates in Estonia, Iceland, Norway and Sweden remain relatively stable.
Figure. Proportion of invasive isolates of Staphylococcus aureus resistant to methicillin/oxacillin (MRSA) in 2007. Data from the European Antimicrobial Resistance Surveillance System (EARSS) (www.earss.rivm.nl)
Other clinically and epidemiologically important pathogens have also developed higher resistance to antimicrobials over time, such as Streptococcus pneumoniae, Enterococci, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa (3). These resistant pathogens can cause serious conditions that may result in prolonged hospital stays and higher mortality as well as higher costs. It should not be forgotten that drug resistance is also a serious problem in many viral, fungal and parasitic diseases, including HIV infection and malaria. The emerging resistance of the influenza virus to oseltamivir has serious implications, especially now that the influenza pandemic is on its way. HIV resistance is also of great concern: in two studies, 10% of patients who had never previously been exposed to antiretroviral therapy were found to be carrying HIV with ≥1 drug-resistance mutation (4,5).
In 2001, the WHO Global Strategy for Containment of Antimicrobial Resistance was developed to address this problem (6). It provides a framework for interventions to slow the emergence and reduce the spread of antimicrobial-resistant microorganisms through:
- reducing the disease burden and the spread of infection,
- improving access to appropriate antimicrobials,
- improving use of antimicrobials,
- strengthening health systems and their surveillance capabilities,
- enforcing regulations and legislation,
- encouraging the development of appropriate new drugs and vaccines.
As health care and public health professionals, we have a duty to contribute to the containment of antimicrobial resistance through improved surveillance and response, training of public health professionals to respond to emerging threats now and in the future, and promotion of applied research on the emerging molecular mechanisms of drug resistance and the epidemiologic risk factors associated with its development and spread. One of the initiatives undertaken by European Centre for Disease Prevention and Control is the European Antibiotic Awareness Day, which will take place on 18 November (7). The aim of the Antibiotic Awareness Day is to inform the public and health professionals about the responsible use of antibiotics.
In this issue we present reports on antimicrobial resistance in some countries of EpiNorth region: Ukraine, Belarus, Latvia and Sweden. The countries share information and experience on surveillance of antimicrobial resistance, consumption of antimicrobials and measures to control the spread of antimicrobial resistance.
- European Centre for Disease Prevention and Control: Annual Epidemiological Report on Communicable Diseases in Europe 2008. Stockholm, European Centre for Disease Prevention and Control, 2008. Available from: http://www.ecdc.europa.eu/en/publications/Publications/0812_SUR_Annual_Epidemiological_Report_2008.pdf
- Health Protection Agency. Antimicrobial Resistance and Prescribing in England, Wales and Northern Ireland, 2008. London: Health Protection Agency, July 2008. Available from: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1216798080469
- The European Antimicrobial Resistance Surveillance System (EARSS) Annual Report 2007. Available from: http://www.rivm.nl/earss/Images/EARSS%202007_FINAL_tcm61-55933.pdf
- SPREAD programme, Europe HIv Resistance, Available at: http://www.umcutrecht.nl/subsite/spread-programme/
- Wensing AM, van de Vijver DA, Angarano G, Asjö B, Balotta C, Boeri E et al., Prevalence of drug-resistant HIV-1 variants in untreated individuals in Europe: implications for clinical management. J Infect Dis2005;192:958-66.
- The WHO Global Strategy for Containment of Antimicrobial Resistance addresses this challenge http://whqlibdoc.who.int/hq/2001/WHO_CDS_CSR_DRS_2001.2.pdf
- ECDC, The European Antibiotic Awareness Day, http://www.ecdc.europa.eu/en/eaad/Pages/Home.aspx