On April 27, 2020, the Journal of Antimicrobial Chemotherapy published data from the international Survey of Antibiotic Resistance (SOAR), conducted in 16 countries from 2015 to 2017. One of the seven articles was devoted to the results of the SOAR study in Ukraine in 2016–2017*.

Rising antibiotic resistance, which reduces treatment options for dangerous infections, is one of the greatest threats to human health in history. Due to the declining effectiveness of antibiotics, dangerous infectious diseases such as pneumonia, tuberculosis, gonorrhea, and salmonellosis are becoming increasingly difficult to treat. According to the U.S. Centers for Disease Control and Prevention (CDC), the number of antibiotic-resistant infections has increased by 30% since 2013, from 2 million to 2.6 million cases.

According to the Interagency Coordination Group on Antimicrobial Resistance (IACG), drug-resistant diseases already cause at least 700,000 deaths globally each year. If the situation continues unabated, up to 10 million people worldwide could fall victim to antibiotic resistance by 2050, meaning one person will die every three seconds due to antibiotic resistance. The increasing number of bacteria detected that are resistant to the reserve antibiotic (colistin) is also alarming, indicating a high likelihood of the rapid spread of diseases that are generally untreatable with available antibacterial drugs.

The rise of antimicrobial resistance is a pressing issue for Ukraine. According to the Ukrainian Ministry of Health, one in two residents taking antibiotics does not actually need antibacterial therapy, and one in three believes these drugs are effective against viral infections. The availability of antimicrobials, coupled with low public awareness of the dangers of antibiotic resistance and disregard for antibiotic therapy guidelines, could lead to a catastrophe in the near future.

Given the scale of the problem and the global threat posed by antibiotic resistance to human health, this issue is on the radar of the UN, the G7, the G20, and the WHO. In Ukraine, the National Action Plan to Combat Antimicrobial Resistance was approved in March 2019. It sets out steps to ensure the rational use of antimicrobials in human medicine, veterinary medicine, and the food industry in accordance with international practices.

An important part of this process is the international Survey of Antibiotic Resistance (SOAR), initiated by GSK in 2002 in countries across the Middle East, Africa, Latin America, Asia-Pacific, and the CIS. Ukraine joined the study in 2011.

Results of the SOAR study in 2014–2016: SOAR Antimicrobial Resistance Survey in Ukraine and Slovakia

The SOAR study focuses on determining the susceptibility of key community-acquired respiratory tract infection pathogens , Streptococcus pneumoniae and Haemophilus influenzae , to antibacterial drugs. It is worth noting that lower respiratory tract infections, which cause 3.2 million deaths annually, are the third most common cause of death globally, according to the WHO. Furthermore, community-acquired respiratory tract infections are the most common reason for antibacterial prescriptions, meaning antibiotics are often used irrationally in the treatment of these conditions.

In Ukraine, SOAR was and remains the only large-scale international project providing information on the antibiotic resistance of the main pathogens causing community-acquired respiratory tract infections. During the third phase of the SOAR study in 2016–2017, microbial strains for analysis were isolated from patients at the Treatment and Diagnostic Center of the Medical Academy (Dnipro) and the National Institute of Phthisiology and Pulmonology (Kyiv). The susceptibility of the isolated microorganisms to antibacterial agents most commonly used in clinical practice for community-acquired upper and lower respiratory tract infections was tested at an independent laboratory in the UK. The obtained data were analyzed according to three recognized and standardized reference points: Clinical and Laboratory Standards Institute (CLSI), European Committee on Antimicrobial Susceptibility Testing (EUCAST, Switzerland) and pharmacokinetics/pharmacodynamics (PK/PD).

According to the results of the 2016-2017 SOAR study in Ukraine, 100% of Streptococcus pneumoniae strains were susceptible to amoxicillin clavulanate, amoxicillin, and reserve drugs (fluoroquinolones) according to CLSI criteria. Among the third-generation cephalosporins analyzed in the study, 98% of Streptococcus pneumoniae strains were susceptible to ceftriaxone, 83% to cefpodoxime and cefdinir (CLSI criteria), and 77% to cefixime (PK/PD criteria). The activity of all three analyzed macrolides against Streptococcus pneumoniae in Ukraine continues to decline and is 78% for azithromycin, 77% for clarithromycin and erythromycin (CLSI criteria). In the analysis of susceptibility of Haemophilus influenzae, an increase in the number of beta-lactamase-producing microorganisms resistant to unprotected penicillins is noteworthy compared with previous stages of the SOAR study.

This stage of the study showed a further increase in resistance of Streptococcus pneumoniae and Haemophilus influenzae to most of the antibiotic molecules studied, which clearly underlines the importance of rational use of antibacterial drugs in Ukraine and, in particular, taking into account local susceptibility indicators in clinical practice.

Since 2016, data from the SOAR study have been used to develop and implement local antibacterial treatment protocols for community-acquired upper and lower respiratory tract infections, which helps curb the level of antibiotic resistance in the region.

Based on materials from the press service of GSK in Ukraine

* Results from the Survey of Antibiotic Resistance (SOAR) 2016–17 in Ukraine: data based on CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Journal of Antimicrobial Chemotherapy, 2020, 75, Issue Supplement_1: i100–i111. https://academic.oup.com/jac/article/75/Supplement_1/i100/5824465