ANTIMICROB IAL R E S I S TANCE
Fighting AMR in the era of COVID-19
The threat posed by antimicrobial resistance was high on the agenda at the FIS/HIS International online conference. Evelina Tacconelli – a professor of infectious diseases, at the University Hospital of Verona, and a consultant for the World Health Organization – called for action. Louise Frampton reports.
Antimicrobial Resistance (AMR) threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi, leading WHO to declare AMR as “one of the top 10 global public health threats facing humanity”. However, countries across Europe report significant variations in performance, when it comes to antibiotic resistance, prompting Prof. Tacconelli to call for consistent healthcare standards in Europe, along with an increased focus on infection control. “The ‘Healthcare Standards in Europe’ document (2013) clearly states that ‘access to healthcare is an essential element of human dignity and human rights, guaranteed by the European Union’s Charter of Fundamental rights’,” she pointed out.1 As part of the FIS/HIS Lowbury Lecture,
Prof. Tacconelli gave a presentation on: ‘Linking infection control to clinical management of infections to overcome antimicrobial resistance.’ While the COVID-19
pandemic has hit the headlines, the threat posed by AMR has the potential to pose the greatest risk of all, if nations do not act now. “When we see the resistance rates for carbapenem-resistant Acinetobacter, reported by the Combacte-Magnet Epidemiology Network (
EPI.Net),2
can we really believe we
have the same healthcare standards across Europe? The difference in resistance rates must be considered a threat for EU public health and the rights of EU citizens for equal healthcare standards,” she argued. Prof. Tacconelli went on to point out that there are factors “other than gross national income” influencing the differences in rates of the top-ranked antibiotic resistant bacteria on the 2017 WHO priority list (Savoldi and Tacconelli, 2019).3
“What is really concerning is the potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis,” warned Prof. Tacconelli. She highlighted a study by Teillant et al (2015)4
which modelled the additional infections for a 10% reduction in antibiotic efficacy in various surgical specialties, through to a 100% reduction in antibiotic efficacy. The most affected specialties will be colorectal surgery and Caesarean section, she warned. Prof. Tacconelli explained that there are many microorganisms that are affected by antimicrobial resistance, including Helicobacter pylori. Analysis of 178 studies, covering 65 countries has shown there is increasing resistance in most WHO regions. In fact, primary and secondary resistance rates to clarithromycin, metronidazole and levofloxacin were found to be ≥15% in all WHO regions (Savoldi and Tacconelli, 2018).5 A paper by Prof. Tacconelli, published
in Lancet Infectious Diseases, outlined the WHO priority list for R&D of new, effective antibiotics. While WHO outlines multi- drug resistant and extensively resistant Mycobacterium tuberculosis as a key focus for R&D, there are also many other antibiotic resistant pathogens on the WHO list.6 The ‘critical priority’ list includes:
l Pseudomonas aeruginosa (Carbapenem resistant).
l Enterobacteriaceae (Carbapenem and 3rd generation cephalosporins resistant).
l Acinetobacter baumannii (Carbapenem resistant).
‘High priority’ includes: l Staphylococcus aureus (vancomycin resistant)
l Salmonella species (fluoroquinolone resistant)
l Neisseria gonorrhoeae (3rd generation cephalosporins and fluoroquinolone resistant)
l Helicobacter pylori (clarithromycin resistant) l Enterococcus faecium (vancomycin resistant)
l Campylobacter species (fluoroquinolone resistant)
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