What is antimicrobial resistance?
Antimicrobial resistance (AMR) occurs when microorganisms (e.g. bacteria, viruses, fungi and parasites) evolve in response to exposure to antimicrobial medicines (including antibiotics, antivirals, antifungals, antimalarials and anthelmintics etc). Antimicrobial-resistant microbes are often termed 'superbugs' and are not affected by medicines usually used to treat the infection. This means that infections persist which may cause further complications to the patient as well as increase the risk of spread to others.
Why is this a concern?
AMR threatens the effective prevention and treatment of a ever widening range of infections and is becoming an increasingly serious threat. Antimicrobial drug resistance can: compromise common surgical procedures including caesarean, organ transplantation and hip replacements; affect the success of cancer chemotherapy; and complicate the fight against diseases such as HIV and malaria. This means that currently preventable or treatable situations become very high-risk and result in an increased likelihood of worse clinical outcomes, disability and death.
In addition, the cost of healthcare for patients with drug-resistant microbial infections is also higher due to prolonged illness and lengthier hospital stays, additional medical tests and more intensive care and the use of more expensive drugs.
What causes AMR?
AMR does occur naturally over time, however this process is being accelerated due to the overuse and misuse of antimicrobial medicines and poor hygiene standards. Antimicrobials should only be used following professional advice and not as a 'quick fix'. For example, antibiotics will have no impact on viral infections such as the common cold or the flu, and are also overused in animals and fish as a method of promoting growth. Antimicrobial resistant-microbes can be found in people, animals, food and the environment and can easily spread from one to another. Poor hygiene standards, unsanitary conditions and unsafe food-handling can all increase the spread of the drug resistant microbes.
Examples of AMR
All sorts of microorganisms can become resistant to antimicrobial medicines and cause infections with an increased cause for concern, with some of the most common including:
MRSA
- One of the most well-known 'superbugs' is methicillin-resistant Staphylococcus aureus (MRSA), a bacterial strain resistant to the first-line antibiotics that are used to treat the infection. MRSA is particularly prevalent in healthcare settings and is a common cause of severe infections. Patients are estimated to be 64% more likely to die from an infection caused by MRSA than a non-resistant strain of Staphylococcus aureus.
Tuberculosis
- The World Health Organisation (WHO) estimated that there were approximately 480,000 new cases of multi-drug resistant tuberculosis (MDR-TB) in 2015 alone. This strain of bacteria that causes TB is resistant to the two most powerful anti-TB drugs and treatment causes for MDR-TB infection are much longer and less effective than those cause by non-resistant strains. Extensively drug-resistant TB (XDR-TB) is a form of MDR-TB that is resistant to at least four of the core anti-TB drugs and has so far been reported in 117 countries.
Malaria
- There are currently 5 countries in which resistance to the first-line treatment for Plasmodium falciparum (the parasite that causes malaria) has been reported. In addition, along the Cambodian-Thailand border P. falciparum has become resistant to almost all available antimalarials. The risk of multi-drug resistant P. falciparum emerging in other regions is increasing and would pose challenging public health concerns.
Is AMR a worldwide problem?
Yes, AMR is an increasingly serious threat to global public health. Drug-resistant microbes are present in every country and new resistance mechanisms are emerging and spreading globally. AMR is a complex, interconnected problem and response to this threat requires a coordinated, multifaceted approach from government sectors and societies across the globe. This includes: increased investment and innovation in the research and development of new antimicrobial medicines, vaccines and diagnostic tools; national and global action plans and collaboration for the prevention and management of AMR.
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