The Threat of Antimicrobial Resistance

Facts on Antimicrobial Resistance:

1. AMR is a global health and development threat. It requires urgent multisectoral action in order to achieve the Sustainable Development Goals (SDGs).
2. WHO has declared that AMR is one of the top 10 (actually the third) global public health threats facing humanity.
3. Lack of clean water and sanitation and inadequate infection prevention and control promote the spread of microbes, some of which can be resistant to antimicrobial treatment.
4. As we have seen, AMR is a natural phenomenon but the use/ misuse/ excessive use of antimicrobials causes pressure on microorganisms which leads to rapid or faster development of resistance to used antimicrobials. 
5. The cost of AMR to the economy is significant. In addition to death and disability, prolonged illness results in longer hospital stays, the need for more expensive medicines, and financial challenges for those impacted.
6. Without effective antimicrobials, the success of modern medicine in treating infections, including during major surgery and cancer chemotherapy, would be at increased risk.
7. Even without taking antimicrobials, you can get infected with an antimicrobial-resistant pathogen. It means that everyone has a role to play to slow down the spread of AMR pathogens.
8. Although this course is for healthcare students/professionals on the human side, livestock, and the environment significantly contribute to the increase and spread of AMR pathogens. Therefore, a One Health approach (to be covered in other chapters) is necessary to curb this trend. Did you know that 1 in 5 resistant infections are caused by pathogens from food and animals?  Did you know that the rate of resistance to ciprofloxacin, an antibiotic commonly used to treat urinary tract infections, varied from 8.4% to 92.9% for Escherichia Coli and from 4.1% to 79.4% for Klebsiella pneumoniae in countries reporting to the Global Antimicrobial Resistance and Use Surveillance System (GLASS).
9. Microorganisms can pass resistance genes to their offspring (vertical transmission) or even to other members of the same species or different species in the environment via horizontal gene transfer (conjugation, transformation, and transduction).
10. Previous predictions estimated that by the year 2050, if no adequate actions are taken, the annual death rate due to AMR would reach 10 million people worldwide and cost USD 100 trillion (Burki, 2018). However, a recent paper showed that in 2019, 1.3 million people died and these deaths were directly attributable to antibiotic resistance. The deaths attributable to AMR were higher than deaths associated with HIV/AIDS, breast cancer, and malaria (Murrary et al., 2022). 

11. A considerable number of people, including educated ones, confuse antimicrobial resistance with antibiotic resistance. Sometimes both terminologies are used interchangeably but they are different (Check the list of given terminologies).

12.  AMR affects both developed and developing countries. AMR is a public health challenge with extensive health, economic, and societal implications. 

The threat caused by AMR

Source: UN-Environment Program

Globally, AMR poses a significant threat to modern medicine (Nisabwe et al., 2020) and it is regarded as an underappreciated pandemic (Laxminarayan, 2022). A Global AMR burden estimate study reported 1,27 million deaths attributable to bacterial AMR in 2019, which was higher than the deaths attributable to HIV and Malaria (Murray et al., 2022). Apart from deaths, AMR is associated with long hospitalizations, and the use of second/third-line antimicrobials which are expensive for poor individuals (Gahamanyi et al., 2020; Laxminarayan, 2022). Without effective antimicrobials, processes like surgery, organ transplantation, and cancer treatment would become even riskier (Cook & Wright, 2022). Furthermore, the use of antimicrobials, particularly the broad-spectrum antimicrobials, negatively affects the gut microbiome and thus giving way to the predominance of AMR pathogens. 

Currently, almost all clinically used antimicrobials, including colistin, the final weapon in the armament safeguarding humans from deadly gram-negative infections, resistance to almost all antimicrobials have been reported. Furthermore, internationally, the threat to public health from the exponential progression of multi-drug resistance (MDR), extensive drug resistance (XDR), and pandrug resistance (PDR) gram-negative microorganisms has become critical (Dhingra et al., 2020). The discovery of new antimicrobials is not satisfactory compared to the increased rates of AMR pathogens (Bisi-Johnson et al., 2017). Pharmaceutical companies are afraid of not making a profit before the emergence of resistance to any antimicrobial put on the market and severely restricting sales of the drug resulting in a nearly dry pipeline for new drugs (Dhingra et al., 2020; Cook & Wright, 2022).

Without effective antimicrobials, we are heading towards a pre-antibiotic era in which all achievements made in the prevention and control of communicable diseases will be reversed. Common infections and minor injuries that have been treatable for decades may once again kill millions. Resistance to antibiotics will make complex surgeries and management of several chronic illnesses like cancer, extremely difficult.