Antimicrobial resistance has gained notoriety as one of the most pressing public health issues the world faces today. It is occurring everywhere in the world, compromising our ability to treat infectious diseases, as well as undermining many other advances in health and medicine.
The treatment for patients with antimicrobial resistant infections is costlier, requires additional testing and expensive drugs to treat. In the US the estimated number of illnesses caused by antimicrobial resistance is more than 2 million per year, with approximately 23,000 deaths; in Europe its 25,000 (2).
A hands on solution
One of the objectives of the World Health Organization (WHO) Global Plan on Antimicrobial Resistance is to reduce infections by improving hygiene, sanitation, and infection prevention. The most effective and efficient means of infection prevention in the community and healthcare settings is hand hygiene. Successful infection control programs are based upon this. Through proper hand hygiene, staying home when sick, sneezing/coughing into one’s sleeve all play an important part in reducing the spread of infections in the community and healthcare settings. If we can limit the incidence of infections that require antibiotics, we can use them a bit more prudently. Through education about the importance of proper hand hygiene in the community and healthcare settings can reduce transmission of microbes which include resistant ones.
The process of resistance
How does antibiotic resistance happen in the first place? First, you have many bacteria present and a few are resistant to the drug that is being used to kill it. The antibiotic kills the bad and good. But without the “good” bacteria to protect our bodies, the few drug resistant ones are allowed to proliferate. These in turn often referred to as superbugs, can give their resistant properties to other bacteria and they in turn can grow and multiply. The simple fact that we use antimicrobials is enough to cause resistance. We repeat the above scenario over and over again. Resistance occurs naturally in microbes through genetic changes that change their sensitivities to different drugs.
Bacteria adapt in one of two ways. When an external pressure (such as an antibiotic) is in the environment, bacteria can develop genetic mutations that would allow the next generation of bacteria to thrive even in the presence of that external pressure. These random genetic mutations can give rise to strains of bacteria that are resistant to previously effective therapies. Secondly, when bacteria come in close proximity with one another, bacteria can exchange portions of their genetic material (known as plasmids) between each other—conferring resistance to previously susceptible strains. The way to prevent antibiotic resistance rests on the premise of judiciously using antibiotics to prevent bacteria from mutating and becoming resistant strains (6). We accelerate this process through misuse and overuse of these drugs. As antibiotics were first discovered and used, resistance to those antibiotics soon followed. “It doesn’t take very long for bacteria to figure out how to outsmart us,” said Dr. Robert Weinstein, chairman of Division of Infectious Diseases at Stroger Hospital of Cook County. “The more you use it, the faster you lose it (6).”
The illustration below shows how we, animals, and our environment all contribute to the increase in resistance. “They can spread between people and animals, and person to person. Poor infection control, inadequate sanitary conditions and inappropriate food-handling encourage the spread (7).”
Resistance to “last-line” drugs are becoming common in all countries. The list of resistant microbes just keeps growing. Klebsiella pneumonia, E.coli, Gonorrhea, MRSA, are all showing resistance to last-line antibiotics. Tuberculosis is not a new disease. But over the years it has become resistant to the two first line drugs used to treat all cases of Tb.
In September of 2016, the U.N. convened a special meeting of the General Assembly to discuss this health issue. This is just the fourth time a health crisis rose to a “high-level” meeting status. The others included HIV/AIDS, noncommunicable diseases, and Ebola. The issue of antimicrobial resistance and how we can set global targets for reducing antimicrobial infections needs a global approach as we see that it is happening everywhere. The member states reaffirmed their commitment to develop plans to address this, based on the WHO’s Global Action Plan on Antimicrobial Resistance.
At the Sixty-eight World Health Assembly in May 2015, the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance, including antibiotic resistance, the most urgent drug resistance trend. The goal of the draft global action plan is to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them.
To achieve this goal, the global action plan sets out five strategic objectives:
- To improve awareness and understanding of antimicrobial resistance
- To strengthen knowledge through surveillance and research
- To reduce the incidence of infection
- To optimize the use of antimicrobial agents
- To develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
This has never been more important to the heath care setting as it is now. This problem of resistance is not an isolated issue to a country or region, but one that has caught the world’s attention and policy-makers have issued a call to action to make hand hygiene a priority. This is truly a global issue which is going to need a multifactor approach to halt, but we all can all be part of the solution.
- A brief history of the antibiotic era: lessons learned and challenges for the future. https://doi.org/10.3389/fmicb.2010.00134
- Antibiotic-Resistant Bacteria and the World’s Peril. https://blogs.scientificamerican.com/guest-blog/antibiotic-resistant-bacteria-and-the-world-s-peril/
- Achieving global targets for antimicrobial resistance. http://science.sciencemag.org/content/early/2016/08/17/science.aaf9286
- Antibiotic resistance is the quintessential One Health issue. http://trstmh.oxfordjournals.org/content/early/2016/07/27/trstmh.trw048.full
- Staving off Superbugs- The Battle Against Antibiotic Resistance. http://chicago-mosaic.medill.northwestern.edu/antibiotic-resistance-superbugs/
- Antimicrobial Resistance. http://www.who.int/mediacentre/factsheets/fs194/en/
- Global Action Plan on Antimicrobial Resistance. http://www.who.int/antimicrobial-resistance/publications/global-action-plan/en/
- General Assembly of The United Nations. http://www.un.org/pga/71/2016/09/21/press-release-hl-meeting-on-antimicrobial-resistance/
About the Author
Lisa A. Mack MS, MPH is an Epidemiologist and Communicable Disease Investigator. In addition, she is a certified HIV counselor and tester in a county sexually transmitted disease (STD) clinic. She received a Master of Science degree (Epidemiology) from the University of Massachusetts-Amherst, School of Public Health and a Master of Public Health degree (Epidemiology) from Columbia University, Mailman School of Public Health. Her interests include emerging pathogens, HAIs, infection control, and drug resistance. Germs are Groovy.