Antibiotic resistance and measures to control its consequences – need for a multidisciplinary approach

Convener: Cecilia Stålsby Lundborg, Department of Public Health Sciences, Karolinska Institutet


The topic of this multi-disciplinary panel is antibiotic resistance and how global visions and local practices can reinforce each other to control its consequences. Antibiotic resistance is according to the WHO one of the greatest current and future challenges to public health and functions of health systems globally. The recently adopted Global action plan reinforces the need to take a ‘One health’ approach to the topic and for several of the SDGs there is a need to analyze consequences of antibiotic resistance. Antibiotics are one of few life-saving groups of medicines and needed in many situations where bacteria can be involved like septicemia or pneumonia, in humans and animals. Much of antibiotics are however used unnecessarily in viral infections like common cold where they have no effect. Without effective antibiotics many procedures in health care will not be possible and many even simple bacterial infections might be fatal.

Resistance was for long considered as something only relevant to high-income countries, but recently it has become much more prominent on the global health agenda. The consequences of antibiotic resistance are most severe in low income settings where a major part of health care is paid out-of-pocket. The cost for treatment of one infection with bacteria resistant to first line treatment might require up to several years of income for a poor family. Two main drivers for antibiotic resistance are (i) antibiotic use and (ii) lack of measures to prevent spread of resistant bacteria. Antibiotics are not only used in humans and animals, but also in the agricultural sector, in food production etc. Antibiotic residues spread in the environment, often in water sources.

The aim for this panel is to elucidate consequences of antibiotic resistance from a range of disciplinary perspectives and give examples of effective measures to minimize its spread and consequences. Four to five panel members with different disciplinary background are expected.  Each panelist will first make a short presentation regarding the situation from their own disciplinary perspective, where after a discussion between the panel members about suggested solutions or means to reach solutions to mitigate the problem will follow.

22 Aug., 16:00–17:30, Seminar Room Y22

  • Addressing Antimicrobial Resistance to attain the Sustainable Development Goals: What role should aid play? Maria-Teresa Bejarano, Sida / Karolinska Institutet.
  • Antibacterial Drug Resistance in Uganda, the way forward. Freddie Bwanga, Makerere University.
  • Antibiotic Resistance in Nigeria: Causes and Possible Solutions. Chiamaka Lucymary Okechukwu, formerly Abia State University.
  • Levels and trends of antibiotic resistance among clinical bacterial isolates in the district of Nashik, India in the period 2004-2014. Ingvild Odsbu, Karolinska Institutet.


Addressing Antimicrobial Resistance to attain the Sustainable Development Goals: What role should aid play? Maria-Teresa Bejarano, Sida / Karolinska Institutet.

The resolution ‘Transforming our world: the 2030 Agenda for Sustainable Development’, which incorporates the UN’s SDGs, recognised antimicrobial resistance (AMR) as a threat to the world’s sustainability and development efforts. Addressing AMR requires policy and institutional coherence at all policy levels. Access to effective antibiotics is crucial to address reproductive, maternal, newborn and child health. The success in reducing maternal and neonatal infections may stall or reverse. The AMR impact extends beyond infectious diseases by threatening the safety of modern medicine interventions. Losing effective antibiotics for the treatment of infectious diseases adds an extra burden to states’ health expenditure, can lower productivity, household income and tax revenues and lead to losses in GDP. AMR is also a profound threat to the health of animals and to the security and safety of food and the environment. The increased demand of animal protein has resulted in intensive production systems and augmented antibiotic consumption. Waste products from agriculture, health facilities, and antibiotic manufacturing plants contribute to increased amounts of antibiotic residues and resistant bacteria in aquatic ecosystems. Incentives to reduce such pollution and overuse are urgently essential in the course of action against the spread of AMR. Because antimicrobials are a scarce and potentially non-renewable global resource, its sustainable consumption and production must be ensured. The burden of resistant infection is disproportionately borne by the poor, and LMICs, where the majority of the world’s population lives, are and will be particularly affected by AMR. AMR must be framed as a sustainability issue where aid plays an important role. However, these role(s) are so far not well defined.  The intention of the presentation is to discuss the roles that aid could and should play.

Antibacterial Drug Resistance in Uganda, the way forward. Freddie Bwanga*, Makerere University.

Background: In developing countries, scarcity of data makes it difficult to appreciate the problem of antibacterial drug resistance. We present summary results on drug resistance in Uganda. Methods: The primary studies employed Disk Diffusion Susceptibility testing or molecular detection of resistance at Mulago National Referral Hospital Kampala, Uganda. Results: Staphylococcus aureus: Studies in 2006, 2008, 2011, and 2013 found methicillin resistant staphylococcus aureus (MRSA) in 47 (21%) of 220 isolates, 17 (32%) of 54 isolates from surgical site infections, 41 (46%) of 89 isolates and in 24 (38%) of 64 S. aureus isolates from surgical site infections. All isolates were susceptible to vancomycin. Gram Negative Enteric Bacteria: Seni et al (2013) found 100% resistance to ampicillin among isolates from surgical site infections and resistance to 3rd generation cephalosporins in 78% of E. coli and 92% of Klebsiella ssp. The only sensitive drugs were amikacin and imipenem at 4% and at 0% resistance, respectively. Helicobacter pylori: Resistance to fluoroquinolones was in 8 (42%) of 19 and to clarithromyin in 6 (29%) of 21 strains. Salmonella spp: During the Typhoid outbreak in Kampala, among the 51 blood culture isolates, resistance to ampicillin, chloramphenicol, TRM-SXT, ceftrioxone, and ciprofloxacin, was found in 18%, 16%, 12%, 3% and 0%, respectively. Neisseria gonorrhea: Among 91 isolates from adult males with urethral discharge in 2014, resistance to drugs was: tetracycline 100%, ciprofloxacin 95%, cotrimoxazole 91%, penicillin 83%, cefixime 21%, ceftrioxone 5%, spectinomycin 2%, and azithromycin 0%. Conclusion. Drug resistance is a major public health problem in Uganda, and there is an urgent need to initiate ongoing surveillance for antibacterial drug resistance of public health importance such as MRSA.

*Co-authors: Denish Calmax Angol, Makerere University; Hannington Baluku, Makerere University; Florence Najjuka, Makerere University; George Ndawula, Makerere University; Patrick musinguzi, Mulago National Referral Hospital Kampala; Alfred Okeng, MBN Clinical Laboratories and Henry Kajumbula, Makerere University.

Antibiotic Resistance in Nigeria: Causes and Possible Solutions. Chiamaka Lucymary Okechukwu, formerly Abia State University.

The use of antimicrobial agents plays a critical role in reducing the morbidity and mortality due to communicable disease. Nigeria is a lower middle income country with the largest population size in Africa of approximately 182 million. Reports from different parts of Nigeria have observed temporal trends in the prevalence of resistance among enteric organisms, such as Escherichia coli and shigella, resistance to commonly used antimicrobials, as a result of weak laboratory infrastructure, widespread prescription of antibiotics without rigorous clinical testing and antimicrobial use based on livestock intensification patterns. Findings from review revealed that surveillance for antibiotic resistance in pulmonary tuberculosis was the only system in good function in Nigeria. Detection of resistance and monitoring its spread required appropriate laboratory based surveillance, better regulation and education by the government to the public, clinicians/prescribers and poultry farmers in the appropriate use of antibiotics. 

Levels and trends of antibiotic resistance among clinical bacterial isolates in the district of Nashik, India in the period 2004-2014. Ingvild Odsbu*, Karolinska Institutet.

Background: Antibiotic resistance (ABR) is a growing problem worldwide and it poses a great threat to human health. Surveillance data on the level of resistant bacteria is needed to inform strategies to reduce the development and spread of ABR. Aim: The aim of the study was to determine if there was a change in the proportions of resistant bacteria among common clinical pathogens in the district of Nashik, India between 2004 and 2014. Method: Proportions of resistant bacteria were calculated from data on antibacterial susceptibility. Trends in ABR were analysed by multivariable regression spline approach and piece-wise linear regression. Logistic regression was used to adjust for age, type of patient and type of specimen. Result: High levels of carbapenem-resistant and ESBL-producing E. coli (0-58.8%, 38.5-85.8%) and Klebsiella spp. (7.4-55.4%, 45.1-92.3%), and MDR Pseudomonas spp. (59.9-84.0%) were observed during the study period. For most Gram-negative bacteria, increasing trends of ABR were observed during the first half of the study period, while decreasing trends were observed during the second half of the period. The opposite trends were observed for the Gram-positive bacteria. Adjusting for age, type of patient and type of specimen showed no change in the trends of ABR. Conclusion: High levels of ABR were observed for most antibiotics tested. Of particular concern are the high levels of carbapenem-resistant and ESBL-producing E. coli and Klebsiella spp. The results show that there is great need to focus on optimal use of antibiotics in the district of Nashik to reduce the development of ABR.

*Co-authors: Frida Lind, Karolinska Institutet; Nicola Orsini, Karolinska Institutet; Uday Khedkar, BacTest Laboratory, India;  Smita Khedkar, BacTest Laboratory, India; Sandeep Nerkar, Karolinska Institutet; AJ Tamhankar, Karolinska Institutet / R.D. Gardi Medical College and Cecilia Stålsby Lundborg, Karolinska Institutet.