The dire warnings about the lethal consequences of unchecked antimicrobial resistance are getting louder and becoming more urgent. The U.S. Department of Health and Human Services has called antimicrobial resistance “one of the most important health security threats of our time,” with at least 2.8 million people in the United States acquiring antibiotic-resistant infections every year, resulting in more than 35,000 deaths.1
Globally, the burden of antimicrobial resistance, which occurs when bacteria, viruses, fungi, and parasites develop resistance against antimicrobials (such as antibiotics) is important. According to research published in The Lancet,2 more than 39 million people could die of antibiotic-resistance infections by 2050, an increase of nearly 70% per year compared with 2022.
For patients diagnosed with cancer, the threat posed by antimicrobial resistance is immediate and potentially life-threatening. According to the Union for International Cancer Control (UICC), one in five patients undergoing treatment is hospitalized because of infection, with pneumonia and sepsis among the most frequent causes of admission to intensive care units. In addition, 1 in 10 patients die of severe sepsis—not of cancer.3
“Infections are the second-leading cause of death in patients with cancer, so if antimicrobial resistance is not addressed, advances that have been made in cancer treatment could be undermined,” said Shalini Jayasekar Zurn, MSc, Senior Advocacy Manager at UICC. “Patients undergoing treatment are especially vulnerable to antimicrobial infections because their immune systems are compromised.”
Reducing the Human and Financial Impacts of Antimicrobial Resistance
Prolonged illness and possible death from antimicrobial resistance are not the only consequences of drug-resistant infections. The long-term cumulative economic effects of antimicrobial resistance on health-care systems, communities, and individuals are projected to result in a loss of $100 trillion of economic output by 2050.
However, the financial repercussions of uncontrolled antimicrobial resistance on health-care systems and society are already underway. According to a recent report by the Global Leaders Group on Antimicrobial Resistance, in 2025, health-care systems are expected to spend about $412 billion per year combating antimicrobial resistance. In addition, a $443 billion per year loss in workforce productivity is projected, with an average loss of 1.8 years of life expectancy globally.4
“Infections can lead to delays or interruptions in cancer treatments, negatively impacting the overall effectiveness of the therapy, so patients can die of an infection before they die of cancer.”— Shalini Jayasekar Zurn, MSc
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To reduce the perilous human and financial threats posed by antimicrobial resistance, during the United Nations General Assembly High-Level Meeting on Antimicrobial Resistance held this past September, global leaders approved a political declaration committing to a set of targets and actions, including reducing the estimated 4.95 million deaths associated with antimicrobial resistance annually by 10% by 2030. The declaration also calls for sustainable national financing and $100 million in catalytic funding to reach a target of at least 60% of countries having funded national action plans on antimicrobial resistance by 2030.
In a wide-ranging interview with The ASCO Post, Ms. Zurn discussed the efforts being made by UICC and other global organizations to combat the effects of antimicrobial resistance on human health and improve care for patients with cancer.
Developing Guidelines on the Use of Antibiotics in Cancer Care
Please talk about the impact of antimicrobial resistance on cancer care management and patient outcomes.
I will give you one example that was brought to us by Lillian Sung, MD, PhD, FRCPC, a member of our task force on Antimicrobial Resistance and Cancer Care, which exemplifies the debilitating effect of antimicrobial resistance on patients with cancer. Matilda (not her real name) was just 9 when she was diagnosed with cancer. The initial treatment she received failed to halt disease progression, and she then began receiving more aggressive treatment. She developed an ongoing fever and received antibiotics to treat the infection. Suddenly, her heart rate increased, her blood pressure dropped, and she had trouble breathing. She was taken to the intensive care unit, put on a ventilator, and died soon after.
The growing resistance of bacteria and other pathogens to antimicrobial treatments makes it difficult to manage these infections effectively, and the fact that patients’ cancer can be treated successfully won’t matter because of the development of a complicated drug-resistant infection. Infections can lead to delays or interruptions in cancer treatments, negatively impacting the overall effectiveness of the therapy, so patients can die of an infection before they die of cancer. This is the tragedy of unaddressed antimicrobial resistance. We need to develop guidelines on the appropriate use of antibiotics and other antimicrobials in patients with cancer, not just for infection management, but for infection control and prevention as well.
Mitigating the Effects of Antimicrobial Resistance
During the first United Nations High-Level Meeting on Antimicrobial Resistance, in 2016, a political declaration was adopted in which world leaders agreed to take a broad, coordinated approach to address antimicrobial resistance across multiple sectors, especially human health, animal health, and agriculture. They also recognized the need for stronger systems to monitor drug-resistant infections and the volume of antimicrobials used, as well as adequate funding to support implementation of antimicrobial resistance response on a national level. The second United Nations High-Level Meeting on Antimicrobial Resistance took place in September 2024. What progress has been made to curb antimicrobial resistance, globally, over the past 8 years?
Progress has been made, but, of course, there is more work to be done. The good news is that if all global leaders came together, instituted their national action plan on antimicrobial resistance, and pooled their resources, the effects of antimicrobial resistance on public health could be mitigated.
Following the 2016 meeting, as you mentioned, countries did commit to developing a national action plan on antimicrobial resistance, which is aligned with the World Health Organization’s (WHO’s) Global Action Plan on Antimicrobial Resistance; it outlines a global strategy for containment of antimicrobial resistance. By 2023, more than 170 countries had developed an action plan. However, only 27% of these countries have reported implementing their action plans effectively, and only 11% have allocated national budgets to fund the plan, so funding continues to be an issue.
The Food and Agriculture Organization of the United Nations, the United Nations Environment Programme, WHO, and the World Organization for Animal Health (known as the Quadripartite), formed in 2022, have been pivotal in promoting a “one-health” approach to address antimicrobial resistance, which recognizes that the health of people, animals, plants, and the wider environment is interdependent. We have to have this type of multisectoral approach to reach the goals of reducing global deaths from antimicrobial resistance by 10% over the next 5 years.
During the 2016 United Nations General Assembly, when member states adopted the Political Declaration of the High-Level Meeting on Antimicrobial Resistance, an ad hoc Interagency Coordination Group on Antimicrobial Resistance was formed. It comprised high-level representatives of relevant United Nations agencies, other international organizations, and individual experts from the various sectors mentioned (including animal health, agriculture, and the environment). The group is tasked with developing guidance on approaches to ensure sustained effective global action to address antimicrobial resistance, so worldwide efforts are moving in the right direction.
“It’s imperative that oncology professionals, advocates, patient groups, and cancer societies such as ASCO address the factors that contribute to the development and spread of antimicrobial resistance.”— Shalini Jayasekar Zurn, MSc
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To be successful, however, we also need to raise public awareness of the health consequences of antimicrobial resistance, especially as they relate to cancer care and patient outcomes. In 2019, UICC published a set of recommendations developed by our antimicrobial resistance and cancer care task force and other experts. The recommendations call for limiting the overuse of antibiotics through effective stewardship; implementing good infection prevention and control practices; designing a centralized surveillance system for patients with cancer to predict, prevent, and treat antibiotic-resistant infections; and integrating antimicrobial resistance strategies into national cancer control plans with adequate funding, among others. We have also published resources for how individuals and governments can increase their knowledge and awareness of antimicrobial resistance (www.uicc.org/what-we-do/thematic-areas/antimicrobial-resistance-amr/uiccs-actions-amr).
The UICC, along with WHO, and the Centers for Disease Control and Prevention, among other organizations, support World Antimicrobial Resistance Awareness Week. This global observance—marked each year from November 18 to 24—is to raise awareness and increase understanding of antimicrobial resistance.
Consequences of Antimicrobial Resistance on Patients With Cancer
In addition to the health consequences of antimicrobial resistance, please talk about the impact antimicrobial resistance has on health-care costs from increased hospital admissions, longer hospital stays and more intensive therapy, as well as on countries’ economies.
The rise of antimicrobial resistance is resulting in drug-resistant infections that are becoming more and more difficult to treat with standard antimicrobials. This leads to longer hospital stays and the need for more intensive and expensive therapies, which place a heavy cost burden on health-care systems, especially those in low- and middle-income countries, where shortages of essential medicines lead to patients receiving less effective or no treatment.
Hospitals must invest in more advanced medical interventions, such as second- and third-line antibiotics and intravenous formulations, which are more costly and often less readily available. Then, there is the need for specialized care in the intensive care unit, which adds to the strain on hospital resources, particularly in low-resource countries that simply don’t have the infrastructure or financial resources to treat these patients. Also, often these additional costs are passed on to patients who don’t have the financial means to pay for this care.
DISCLOSURE: Ms. Zurn reported no conflicts of interest.
REFERENCES
1. U.S. Department of Health and Human Services: Combating antimicrobial resistance. Available at www.hhs.gov/about/agencies/oga/global-health-security/antimicrobial-resistance/index.html. Accessed February 10, 2025.
2. Naghavi M, Vollset SE, Ikuta KS, et al: Global burden of bacterial antimicrobial resistance 1990–2021: A systematic analysis with forecasts to 2050. Lancet 404:1199-1226, 2024.
3. ReACT: Successful cancer treatment relies on effective antibiotics. Available at www.reactgroup.org/wp-content/uploads/2020/05/Successful_cancer_treatment_relies_on_effective_antibiotics_ReAct_Policy_Brief_May_2020_web.pdf. Accessed February 10, 2025.
4. Global Leaders Group on Antimicrobial Resistance: Annex to the GLG Report: Toward specific commitments and action in the response to antimicrobial resistance. April 4, 2024. Available at www.amrleaders.org/resources/m/item/annex-to-the-glg-report. Accessed February 10, 2025.
