The result of the first Global Antimicrobial Resistance Surveillance System (GLASS) is out: 500,000 cases of drug-resistant infections in 22 countries.

The World Health Organization (WHO) launched the GLASS programme in 2015, enlisting 52 countries from various WHO regions to contribute to its data gathering on resistant pathogens.

“The report is a vital first step towards improving our understanding of the extent of antimicrobial resistance (AMR),” said Dr Carmem Pessoa-Silva, the WHO coordinator of the surveillance system.

AMR is a global public health threat - where some bacterial infections are no longer responsive to commonly used antibiotics.

AMR is a natural phenomenon as microorganisms are exposed to different antimicrobial substance over time, but the indiscriminate use of antibiotics as “cure for all” accelerated the rate.

In 2014, WHO warned that by 2050, antibacterial resistance will undo the gains created by the discovery of antibiotics.

How GLASS works

“GLASS is a system that enables standardised global reporting of official national AMR data. It collaborates with existing regional and national AMR surveillance networks to produce timely and comprehensive data,” the UN health agency explained.

The overall aim of GLASS is to strengthen research on antimicrobial resistance globally.

Of the 52 enrolled countries, 25 are classified as high-income, 22 are middle-income, and 7 are low-income countries. Forty countries provided information on their national surveillance, while 22 countries provided their data on antibiotic resistance.

“Surveillance is in its infancy, but is it vital to develop it if we are to anticipate and tackle one of the biggest threats to global public health,” said Dr Pessoa-Silva.

GLASS 2016-2017 implementation report looked at the reported data on Escherichia coli, Klebsiella pnuemoniae, Staphylococcus aureus and Streptococcus pneumonia - the human priority bacterial pathogen. However, GLASS did not include data on mycobacterium tuberculosis (tuberculosis) as the WHO is already tracking the pathogen since 1994.

Specimens collected from national sites include blood, urine, stool and urethral and cervical swabs.

The GLASS reporting system includes a national coordinating centre (NCC), a national reference laboratory and surveillance sites such as hospitals, clinics, and outpatients clinics.

GLASS was launched in Copenhagen, Denmark in October 2015.

‘No respect for boundaries’

“Some of the world’s most common - and potentially most dangerous - infections are proving drug-resistant, and most worrying of all, pathogens don’t respect national borders,” said Dr Marc Sprenger, WHO director for Antimicrobial Resistance Secretariat.

The report said GLASS revealed widespread occurrence of antibiotic resistance among 500,000 people with suspected bacterial infections across 22 countries.

Results greatly varied from country to country, ranging from zero percent to as high as 82 percent, such as in the case of suspected bloodstream infection caused by bacteria resistant to at least one commonly used antibiotic.

Penicillin resistance among reporting countries, meanwhile, ranged from zero to 51 percent, and 8 percent to 65 percent for ciprofloxacin resistance, which is used for treating E. coli associated with urinary tract infections.

Dr Sprenger said the early report confirmed the situation of antibiotic resistance worldwide.

Philippine situation

In the Philippines, there are 24 coordinating sites enrolled under the GLASS programme which are primarily hospitals. The country enrolled in GLASS in June 2016.

However, data against a population of 101 million at the time of research, was partially completed. GLASS estimates the country has less than 70 percent of data collected in all specimen types. There is no overview yet for data collection from January to December 2016.

Available data published in the report looked at antibiotics used for acinetobacter, E. coli, klebsiella pneumoniae, salmonella, shigella, Staphylococcus aureus, streptococcus pneumoniae and neisseria gonorrhoeae.

GLASS did note the Philippines' National Action Plan to Combat Antimicrobial Resistance: One Health Approach, which has been in existence since 2015.

The plan outlined priority areas such as leadership, surveillance, access to essential medicines and awareness and promotion.

Relatedly, during the ASEAN 2017, the Philippines along with member states committed to tackling AMR in the region, and adopted the One Health approach.

“Antimicrobial resistance poses a serious threat not only in the Philippines but also the whole ASEAN with major implications in health, trade, agriculture, the economy and global security,” said Secretary of Health Francisco Duque III, referring to the agreement.

WHO noted GLASS findings will be incorporated with data from other surveillance systems related to AMR and food chain and targeted surveillance population, leading to a global data bank available online. MIMS