Resistant germs

For the moment, they remain the exception at Benedikt Huttner's hospital. Yet increasingly, the German infectologist at University Hospital in Geneva has to treat patients who have been infected with multi-resistant germs which no antibiotic can fight.

"The extremely resistant germs that we're seeing here often affect patients who were perhaps in an intensive care unit in another country, for example, after a car accident in India or Egypt. And then they were transferred here."

A global problem

The report on the extent of antibiotic resistance was long overdue. It has been welcomed not only by medical professionals such as Benedikt Huttner, who work in well-equipped hospitals in countries with excellent health care, but also by the medical aid organization Doctors Without Borders (MSF). The latter is relieved that the World Health Organization (WHO) has finally placed antibiotic resistance high on the international agenda.

"This is a daily problem we're facing everywhere in the world," says Jennifer Cohn of the MSF's Access Campaign program. "For instance, in Niger, we're seeing this in malnourished children - all the way to countries like Jordan, where were seeing this in trauma patients. Everywhere we look, we're seeing lots of different kinds of bacteria that are resistant to antibiotics."

The WHO collected data on seven widespread species of disease-triggering bacteria from 114 countries throughout the world. The result was alarming: much of the world's population now carry bacteria that do not respond to antibiotics.

"While the numbers vary from region to region, the picture is consistent. And what we're seeing is that he capacity to treat serious infections is really dropping in all parts of the world," says the WHO's assistant director, Keiji Fukuda.

The weak at risk

Without effective medicines, blood poisoning, pneumonia, sexually transmitted diseases such as gonorrhea or diarrheal diseases threaten again to be as life threatening as before the invention of penicillin. The WHO warned of a "post-antibiotic era."

The weak and physically vulnerable individuals are the first to be affected, a fact Benedikt Huttner knows from clinical experience. He recalls the complicated case of a patient from Greece who had been infected during an operation at home and was then transferred to Switzerland.

"That was a patient with a brain tumor who was operated on. He had a post-operative infection with bacteria that responded to none of the drugs that we have available. So it's already dramatic when, as a doctor, you practically don't have anything else available."

Antibiotics in meat and drinking water

According to WHO estimates, 25,000 Europeans die in Europe alone each year as a result of antibiotic resistance. No data exists on a similar global measurements, as many countries aren't taking the threat posed by resistant organisms seriously and do not collect relevant data.

As for the causes of antibiotic resistance, however, there is consensus. "Antibiotics are prescribed too much, not only for people, but also for animals. About 80 percent of antibiotics are given to animals," Huttner says.

As a result, antibiotics are everywhere: hidden in the meat on a plate or even in drinking water, the result of manure from fattening farms used on fields and then washed into the water supply. Germs thus have ample opportunity to develop resistance. And they do so at a speed which renders moot the development of new drugs by the for-profit pharmaceutical industry.

Much would be gained, according to the WHO, if antibiotics were only given under medical supervision and were taken correctly by patients. Even more effective measures, says Fukuda at the WHO, are the simple measures which sink the risk of person-to-person infection.

"These may range from the better use of vaccines - to make sure that we reduce infections - to the use of common infection control methods, like washing your hands."

Act now

Even if the full extent of the problem has yet to be grasped, doctors hope the WHO report will raise awareness to the dangers of antibiotics resistance. The complexity of the problem, Huttner says, is still underestimated.

The Geneva infectologist calls for decisive and coordinated action.

"We've seen in the past again and again: If you don't recognize it at an early stage and do something, it becomes much more difficult to control. Once the resistances are there, they don't usually go away very easily."