Neonatal mortality is approaching 50% in parts of Oslo, epidemics of cholera and typhoid fever forces families to abandon their homes, and parts of the city to be quarantined. Mortality due to tuberculosis is more than 400 per 100.000 people, and 50% of children are absent from school – many due to infectious diseases. These were the grim statistics in Norway when our grandparents were born, 100 years ago [1].
The British focus on antimicrobial resistance is highly relevant. If epidemics of resistant infectious diseases reach proportions which resemble those of the past, health care systems as we know them will collapse, and social and economic consequences will be tremendous.
The resistant microorganisms are already here. As many as 7 out of 8 Swedish tourists, returning from India, were colonized with multidrug resistant microorganisms [2]. In Norway, 10% of patients with gastrointestinal infections due to multidrug resistant pathogenic E. coli had no history of recent travel. Among patients who did report travelling abroad within the last 6 months, the carrier rate of such organisms were 33% [3].
Drug resistant pathogens are incorporated into the microbiota, where horizontal gene transfer may escalate the problem of antibiotic resistance. Studies with streptococci show, for instance, that antibiotic resistance can be transferred from commensals to high pathogenic species colonizing humans [4]. This indicates that the microbiota may serve as a reservoir of resistance genes. Results from our laboratory shows that the transfer of genes between commensals and pathogens may also include large pieces of DNA encoding virulence factors such as the pneumococcal capsule [5].
However, infectious disease control today and 100 years ago does not only differ by the introduction of antibiotics. Vaccines, food and water safety, screening and diagnostics, improved water- and sewers- infrastructure, housing conditions and nutritional status, hygiene, and understanding of microbial transmission are only some aspects that reduce the likelihood that drug resistant microorganisms will lead to devastating epidemics in developed countries in the future. For the compromised patients however, such organisms may turn opportunistic and prove fatal.
We acknowledge that pharmaceutical industry is reluctant to develop new antimicrobial drugs. Their painful experience is that the costs of development are not recovered before the drugs are rendered inefficient [6]. It is therefore especially uplifting that Dame Sally Davies wants to find ways to give the pharmaceutical industry incentives to invest in finding new antibiotics. These incentives should not be restricted to the industry, however. They desperately need to encourage all kinds of research institutions to find new anti-infectious substances.
References
1 Statistics Norway, http://www.ssb.no/a/histstat/aarbok/1900.pdf.
2. Tängdén T, Cars O, Melhus A et al. Foreign travel is a major risk factor for colonization with Escherichia coli producing CTX-M-type extended-spectrum beta-lactamases: a prospective study with Swedish volunteers. Antimicrob Agents Chemother 2010; 54: 3564 – 8
3. Jørgensen SB, Grinaker E, Bhatti E et al. Faecal colonisation of ESBL producing bacteria inpatients with gastrointestinal symptoms –an epidemiological cross-sectional study from a multi-ethnic community in Norway. Clin Microbiol Infection 2012: 18 (Suppl 3): 15-6.
4. Hakenbeck, R., Brückner, R., Denapaite, D., and Maurer, P. (2012) Molecular mechanism of beta-lactam resistance in Streptococcus pneumoniae. Future Microbiol 7: 395–410.
5. Rukke HV, Petersen FC. Capsule locus transfer between Streptococcus mitis and Streptococcus pneumoniae. Lancefield International Symposium; 2011-09-04 - 2011-09-08, Palermo, Italy
6. The guardian, http://www.guardian.co.uk/society/2013/mar/11/superbugs-antibiotics-bact...
Rapid Response:
Re: Antimicrobial resistance—an unfolding catastrophe
Editor,
Neonatal mortality is approaching 50% in parts of Oslo, epidemics of cholera and typhoid fever forces families to abandon their homes, and parts of the city to be quarantined. Mortality due to tuberculosis is more than 400 per 100.000 people, and 50% of children are absent from school – many due to infectious diseases. These were the grim statistics in Norway when our grandparents were born, 100 years ago [1].
The British focus on antimicrobial resistance is highly relevant. If epidemics of resistant infectious diseases reach proportions which resemble those of the past, health care systems as we know them will collapse, and social and economic consequences will be tremendous.
The resistant microorganisms are already here. As many as 7 out of 8 Swedish tourists, returning from India, were colonized with multidrug resistant microorganisms [2]. In Norway, 10% of patients with gastrointestinal infections due to multidrug resistant pathogenic E. coli had no history of recent travel. Among patients who did report travelling abroad within the last 6 months, the carrier rate of such organisms were 33% [3].
Drug resistant pathogens are incorporated into the microbiota, where horizontal gene transfer may escalate the problem of antibiotic resistance. Studies with streptococci show, for instance, that antibiotic resistance can be transferred from commensals to high pathogenic species colonizing humans [4]. This indicates that the microbiota may serve as a reservoir of resistance genes. Results from our laboratory shows that the transfer of genes between commensals and pathogens may also include large pieces of DNA encoding virulence factors such as the pneumococcal capsule [5].
However, infectious disease control today and 100 years ago does not only differ by the introduction of antibiotics. Vaccines, food and water safety, screening and diagnostics, improved water- and sewers- infrastructure, housing conditions and nutritional status, hygiene, and understanding of microbial transmission are only some aspects that reduce the likelihood that drug resistant microorganisms will lead to devastating epidemics in developed countries in the future. For the compromised patients however, such organisms may turn opportunistic and prove fatal.
We acknowledge that pharmaceutical industry is reluctant to develop new antimicrobial drugs. Their painful experience is that the costs of development are not recovered before the drugs are rendered inefficient [6]. It is therefore especially uplifting that Dame Sally Davies wants to find ways to give the pharmaceutical industry incentives to invest in finding new antibiotics. These incentives should not be restricted to the industry, however. They desperately need to encourage all kinds of research institutions to find new anti-infectious substances.
References
1 Statistics Norway, http://www.ssb.no/a/histstat/aarbok/1900.pdf.
2. Tängdén T, Cars O, Melhus A et al. Foreign travel is a major risk factor for colonization with Escherichia coli producing CTX-M-type extended-spectrum beta-lactamases: a prospective study with Swedish volunteers. Antimicrob Agents Chemother 2010; 54: 3564 – 8
3. Jørgensen SB, Grinaker E, Bhatti E et al. Faecal colonisation of ESBL producing bacteria inpatients with gastrointestinal symptoms –an epidemiological cross-sectional study from a multi-ethnic community in Norway. Clin Microbiol Infection 2012: 18 (Suppl 3): 15-6.
4. Hakenbeck, R., Brückner, R., Denapaite, D., and Maurer, P. (2012) Molecular mechanism of beta-lactam resistance in Streptococcus pneumoniae. Future Microbiol 7: 395–410.
5. Rukke HV, Petersen FC. Capsule locus transfer between Streptococcus mitis and Streptococcus pneumoniae. Lancefield International Symposium; 2011-09-04 - 2011-09-08, Palermo, Italy
6. The guardian, http://www.guardian.co.uk/society/2013/mar/11/superbugs-antibiotics-bact...
Competing interests: No competing interests