Increasing Reliance on Last Resort Antibiotics Reveals “Worrying” Superbug Trend - Study Finding
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A study co-conducted by a UKZN academic has revealed a “worrying” five-year trend in South Africa of rapidly increasing reliance on last resort antibiotics as bacteria continue at an increasing rate to develop resistance to the most common “access” and “watch” antibiotics - the first and second line of defence against bacterial infections.
The research paper was co-authored by UKZN’s South African Chair in Antibiotic Resistance and One Health, Professor Sabiha Essack, and Mr Daniel Berman, Director of Global Health and Longitude Prize at Nesta Challenges.
The paper - titled: Global Access to Existing and Future Antimicrobials and Diagnostics: Antimicrobial Subscription and Pooled procurement - was published in the prestigious journal, The Lancet, https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00463-0/fulltext.
Examining the five-year trend of drug-resistant infections and the procurement of “watch” and “reserve” (ie last resort) antibiotics in South Africa’s public health system, the study found statistically significant increases in non-susceptibility (ie resistance) to meropenem and tigecycline for Klebsiella pneumoniae, increasing by approximately 215% and 332% respectively, from 2015 to 2019.
In addition, statistically significant increases in procurement of “watch” (carbapenems) and “reserve” (linezolid) antibiotics further indicate increasing reliance on these drugs due to escalating non-susceptibility to narrower-spectrum “access” antibiotics. Procured quantities of last resort “watch” antibiotic meropenem increased from 55.09kg in 2015 to 411.91kg in 2020, an increase of 647.7% in only five years. It demonstrated that clinicians are increasingly reliant on reserve antibiotics as bacterial infections develop resistance to multiple antibiotics.
The study highlights the importance of access to new antibiotics to address the dwindling efficacy of existing broad-spectrum, watch and reserve antibiotics, particularly for Gram-negative bacteria priority pathogens.
Essack said, ‘The corroboration of non-susceptibility data and antibiotic procurement data demonstrates clearly the pace of change at which infections are developing resistance to our first and second lines of infection defence - “access” and “watch” antibiotics. The significant increase in the procurement and use of reserve antibiotics reveals that the drugs we have available to us as clinicians are becoming less effective at treating infections. This is not a situation unique to South Africa - it is a global trend that requires new mechanisms to ensure uninterrupted access to efficacious antimicrobials and diagnostics to ensure their appropriate use and stewardship.’
The study proposes a novel approach to create a predictable low and middle-income country (LMIC) market to ensure access to products to address growing resistance and treatment failure. It describes how antimicrobial subscription and pooled procurement (ASPP) could be implemented as a multinational or regional mechanism in which countries (or states within a country), leverage their combined purchasing power for a portfolio of newer and future antimicrobials and diagnostic products. Based on multi-year subscription contracts that are negotiated on behalf of these aggregated (ie pooled) procurers, ASPP could reshape the LMIC market for essential antimicrobials and diagnostics.
Berman said: ‘Since markets in high income countries provide the best chance to recoup investments, the focus of test developers is on the 20% of the global population that live in these countries. This means that the parts of the world with the most urgent need for new point-of-care diagnostic tests are being overlooked. If we want to change the situation in LMICs, we need to create viable markets for these products. Antibiotic subscription and pooled procurement would have the dual benefit of making antimicrobial diagnosis and treatment accessible in countries with the highest levels of resistance, while stimulating engagement of producers in LMIC markets.’
Words: MaryAnn Francis and Andrew McKay