India: High Levels Of Antibiotic Resistance Found Worldwide: GLASS Report

On January 29, 2018 World Health Organization (WHO) released the surveillance data of new "Global Antimicrobial Surveillance System (GLASS)" on antibiotic resistance. GLASS report reveals high levels of resistance to a number of serious bacterial infections among 500 000 people with suspected bacterial infections across 22 countries. The aim of the report is to document participation efforts and outcomes across countries, and highlight differences and constraints identified to date.

Common Resistant Bacteria

The most commonly reported resistant bacteria were - Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pneumoniae, followed by Salmonella spp. The system does not include data on resistance of Mycobacterium tuberculosis, which causes tuberculosis (TB), as WHO has been tracking it since 1994 and providing annual updates in the Global tuberculosis report.

Among patients with suspected bloodstream infection, the proportion that had bacteria resistant to at least one of the most commonly used antibiotics ranged tremendously between different countries – from zero to 82%. For example - resistance to penicillin, the medicine used for decades worldwide to treat pneumonia – ranged from zero to 51% among reporting countries. Similarly, E. coli associated with urinary tract infections presented for resistance to ciprofloxacin between 8% to 65%, an antibiotic commonly used to treat this condition.

The Participating Countries

At present, 52 countries (25 high-income, 20 middle-income and 7 low-income countries) are enrolled in WHO's Global Antimicrobial Surveillance System. For the first report, 40 countries provided information about their national surveillance systems and 22 countries also provided data on levels of antibiotic resistance.

Data presented in this first GLASS report varies widely in quality and completeness. Some countries face major challenges in building their national surveillance systems like a lack of personnel, funds and infrastructure. However, WHO is supporting more countries to set up national antimicrobial resistance surveillance systems that can produce reliable, meaningful data.

The rollout of GLASS is already making a difference in many countries. For example, Kenya has enhanced the development of its national antimicrobial resistance system; Tunisia started to aggregate data on antimicrobial resistance at national level; the Republic of Korea completely revised its national surveillance system to align with the GLASS methodology, providing data of very high quality and completeness. Countries such as Afghanistan and Cambodia, that face major structural challenges, have enrolled in the system and are using the GLASS framework as an opportunity for strengthening their Antimicrobial resistance (AMR) surveillance capacities. In general, national participation in GLASS is seen as a sign of growing political commitment to support global efforts to control antimicrobial resistance.

About GLASS

In October 2015, WHO launched the Global Antimicrobial Surveillance System (GLASS) working closely with WHO Collaborating Centres and existing antimicrobial resistance surveillance networks, based on the experience of other WHO surveillance programmes. GLASS is a system that enables standardized global reporting of official national AMR data. It collaborates with existing regional and national AMR surveillance networks to produce timely and comprehensive data. It is built upon the experience gained by longstanding WHO AMR surveillance programmes like the tuberculosis (TB) surveillance at global level, and CAESAR (Central Asian and Eastern European Surveillance of Antimicrobial Resistance) and ReLAVRA (Latin American Antimicrobial Resistance Surveillance Network) at regional levels.

GLASS is expected to perform a similar function for common bacterial pathogens like TB, Malaria, and HIV surveillance programmes of WHO. Any country, at any stage of the development of its national antimicrobial resistance surveillance system, can enroll in GLASS. Countries are encouraged to implement the surveillance standards and indicators gradually, based on their national priorities and available resources.

Conclusion:

The AMR surveillance standards established by GLASS proved to be a valuable and feasible methodology and represented a major achievement for the participating countries and GLASS, both. There is still large variability in terms of data submission, not only with respect to the types of data submitted, but also its completeness. GLASS also encourages countries to report on population data, to calculate the incidence rates and infection types globally, which eventually inform and direct mitigation strategies and interventions to control AMR in the most affected groups.

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