hans wolf-watz, professor, ucmr, mims, department of microbiology, umeå university, sweden, , ...

Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se

Antibiotic resistancea new pandemia


Economic and social impact ofantibiotic resistance

• ca. 25 000 patients per year die from antibiotic resistant infections

• ca. 2.5 Mio. extra hospital days to a cost of EUR 900 Mio.

• Out-patient care costs increase ca. EUR 10 Mio.

• Loss of work costs EUR 150 Mio.

• Productivity losses are estimated to around EUR 150 Mio.

Overall social costs of antibiotic-resistant infections are estimated to EUR 1.5 billion each year.


Recent initiatives

• European Antibiotic Awareness Day

• EU/US transatlantic task force on antibiotic resistance

• A conference on incentives for effective antibiotics hosted by the Swedish EU presidency


MRSA in Europe 2006. S.aureus: Proportion of invasive isolates resistant to oxacillin (MRSA) in 2006. * These countries did not report any data or reported less than 10 isolates, Source: http://www.earss.rivm.nl, March 2008

Methicillin-resistant S. aureus (MRSA) - most common multidrug resistant bacterium in EU


An increasing problem is resistance among Gram-negative bacteria

The biggest challenge is treatment of infections caused by penicillin resistant bacteria so called ESBL (extended spectrum beta-lactamase)

In Sweden, this year, 3 children died during a few weeks inneonatal care in a Swedish hospital due to a ESBL infection


The industry has failed to launch new antibiotics

• Between 1996 and 2004: more than 125 antibacterial screens on 60 different antibacterial targets were run by 34 companies

• None of these efforts resulted in novel mechanism compounds.

• Pharmaceutical companies left the antibacterial sector

The industrial failure to meet the need of new antibacterial drugs indicates that novel approaches are needed to combat antibiotic resistant infections


What can be done immediately?

LegislationRestricted use of antibiotics, e. g. clear rules how antibiotics

should be used in whole EU to minimize the spread of antibiotic resistance

Surveillance/Epidemiology Develop a monitoring systems including a large database to

monitor the epidemiology of antibiotic resistance and make this information rapidly available which also should include details about the infecting organism as such,meta-genomics

Create a task force on EU level and national level against antibiotic resistance to take immediate actions


Improve hygieneCombination therapy of known antibiotics to improve effect of treatment and possible resistance development

New and improved methodsfor rapid diagnosis of the infectious agents and resistance patterns based on large scale genome sequencing

reduce the need of antibiotics through disease prevention

What can be done immediately?


Characteristics of the ideal novel antibiotic

• Narrow spectrum

• Coupled to rapid diagnosis

• Not leading to resistance

What can be donein a sustainable perspective?

find new anti-bacterial agents or therapies with novel mechanisms of action that will limit resistance development


• Anti virulence strategies to disarm infectious bacteria

• Functional genomics - targeted drug design

• Continue high throughput screening of natural products

• Novel vaccines based on meta-genomics

• Therapeutic antibodies

• Antibacterial peptides

Areas of research that will have the highest probability to solve the antibiotic resistance problem:

EU: international leading research on molecular mechanisms of microbial

pathogenesis


When do we expect results?Measures Immediate

resultsResults within1-5 years

Results within5-15 years

- Improve hygiene- New and improved diagnostic

-Restricted use-Clear rules for usage

Surveillance/epidemiology/monitoring of resistance

Research on new antimicrobial strategies combined with modern genomics, metagenomics and proteomics

High throughput screening of natural productsNovel vaccines, therapeutic antibodies, antibacterial peptides

Funding of small and medium sized biotech companies for translational research on new antimicrobials


• Maximise the effectiveness of research efforts through coordination of funding and resources

• Boost research advances and innovations

• Increase competitiveness of the EU on a global scale

Joint Programming- the way forward


European Centre for Disease Control (ECDC) European Medicines Agency (EMEA) report:

• > 25 000 patients in the EU die each year from infections caused by multidrug-resistant bacteria

• antibacterial drug resistance - one of the major health threats in Europe


• Support for small and medium sized biotech companies needed

• Coordinated funding in EU networks of excellence

Development of new antimicrobials in biotech companies:

EU: translational research


• Epidemiology and surveillanceInformatics based on genomics

Rapid diagnosis

• Prevention and treatment of infectionRapid diagnosis

Improved hygien

Novel anti-microbial drugs


Swedish MRSA cases 2000-2009


Swedish ESBL cases 2005-2009

hans wolf-watz, professor, ucmr, mims, department of microbiology, umeå university, sweden, , ...

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