High levels of antimicrobial resistance in bacteria causing life-threatening bloodstream infections, as well as increasing resistance to treatment in several bacteria causing common infections in the community, has been revealed by a new report from the World Health Organization (WHO).

The report, by the Global Antimicrobial Resistance and Use Surveillance System (GLASS), is based on data reported by 87 countries in 2020.

High levels of antimicrobial resistance (AMR) – above 50% – were reported in bacteria frequently causing bloodstream infections in hospitals, such as Klebsiella pneumoniae and Acinetobacter spp.

WHO said that these life-threatening infections would require treatment with last-resort antibiotics, such as carbapenems. However, 8% of bloodstream infections caused by Klebsiella pneumoniae were reported as resistant to carbapenems, which WHO said increased the risk of death due to unmanageable infections.

The report also showed that other common bacterial infections are becoming increasingly resistant to treatments. For instance, while the sexually transmitted disease gonorrhoea is commonly treated with the oral antibacterial ciprofloxacin, over 60% of Neisseria gonorrhoea isolates have shown resistance to this treatment. WHO added that resistant gonorrhoea infections had increased by at least 15% compared to rates in 2017.

And over 20% of E.coli isolates, the most common pathogen in urinary tract infections (UTIs), were resistant to both first-line drugs (ampicillin and co-trimoxazole) and second-line treatments (fluoroquinolones).

‘Antimicrobial resistance undermines modern medicine and puts millions of lives at risk,’ said Dr Tedros Adhanom Ghebreyesus, WHO director-general. ‘To truly understand the extent of the global threat and mount an effective public health response to AMR, we must scale up microbiology testing and provide quality-assured data across all countries, not just wealthier ones.’

WHO said that more research would be needed to identify the reasons why an increase in antimicrobial resistance had been observed, and to what extent it may be related to raised hospitalisations and increased antibiotic treatments during the Covid-19 pandemic.

It also said that the results of the survey might be influenced by the fact that reporting data on AMR was inhibited by the pandemic. It suggested that countries with a lower testing coverage would be more likely to report ‘significantly higher’ rates of resistance as data collection came from hospitals with more severely unwell patients who were more likely to have received previous antibiotic treatment.

For instance, while the global median AMR levels were 42% (E. Coli) and 35% (methicilin-resistant Staphylococcus aureus – MRSA), in countries with high testing coverage these levels were ‘markedly lower’ at 11% and 6.8% respectively.

Over half – 65% of 27 reporting countries – met WHO’s target of ensuring that at least 60% of antimicrobials consumption in humans are from the ‘ACCESS’ group of antibiotics – those which are effective in a wide range of common infections and have a relatively low risk of creating resistance.

Earlier this month, leaders at the third global high-level ministerial conference on antimicrobial resistance in Muscat, Oman, agreed global targets to combat antimicrobial resistance, including ensuring that ‘Access’ group antibiotics represent at least 60% of overall antibiotic consumption in humans by 2030.

A Department of Health and Social Care (DHSC) spokesperson said endorsement of the Muscat Ministerial Manifesto can be provided up to two weeks after the conference, and the UK is finalising its position.

The spokesperson also highlighted that the UK has launched a call for evidence to help shape its next five-year National Action Plan (NAP) on AMR, starting in 2024.

The World Health Organization also said that it was working to improve AMR reporting, both through short-term evidence generation through surveys and long-term capacity building for routine surveillance. It said that representative national AMR prevalence surveys would be introduced, which would generate AMR baseline and trend data that could be used in policy development, monitoring of interventions and an increase of quality-assured laboratories reporting representative AMR data at all levels of the health system.

WHO said that this would ‘underpin effective data-driven action to stop the emergence and spread of AMR and protect the use of antimicrobial medicines for future generations’.