What is Antimicrobial Resistance (AMR)?

AMR is a growing problem that threatens healthcare professionals' ability to effectively prevent and treat an ever-increasing range of infections caused by bacteria, parasites, viruses, and fungi.1,2

 

AMR develops when microorganisms are able to overcome the effects of the antimicrobial therapeutics that would have previously killed them or prevented their growth.1,3,4

 

An example of this is when bacteria develop antibiotic resistance, which emerges when bacteria develop characteristics that allow them to survive exposure to the antibiotics used to treat bacterial infections, eventually making the antibiotics ineffective for treatment.5

How does antibiotic resistance develop?

 

info cards

Figure adapted from https://www.cdc.gov/antibiotic-use/community/images/HowAntibioticResistanceHappens.jpg

Why should we be concerned?

According to the Centers for Disease Control and Prevention (CDC), antibiotic resistance contributes to at least 2.8 million antibiotic-resistant infections and 35,000 deaths each year in the United States (US).1 However, according to recent estimates, up to 153,000 people in the US may die annually due to multi-drug resistant infections.9

 

For example, methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae are considered leading causes of bacterial skin infections and community-acquired pneumonia, respectively, and have developed resistance to many clinically relevant antibiotics.1

 

In addition, antibiotic resistance of Clostridioides difficile has contributed to the spread of C. difficile in the healthcare setting.10 During 2017, around 223,900 people in the US required hospital care for C. difficile infection and at least 12,800 people died as a result.1

 

AMR has the potential to affect any person at any stage of life and jeopardizes the efficacy of many aspects of modern healthcare. Without effective antibiotics, many medical interventions such as joint replacements, cancer therapy, organ transplants and treatment of chronic diseases will be less safe and effective. The need for action to combat a developing global health crisis is imperative.1-3

Bacteria causing AMR

Images reproduced from the Centers for Disease Control and Prevention Public Health Image Library.

What can be done?

There is no excuse for inaction. The AMR crisis is already here and change is overdue.1,3,4

 

Despite efforts and actions taken in recent decades, the trends in AMR show no signs of slowing down.4,11

 

The problem of AMR is multifaceted. To address it will require widespread change, including a shift in agricultural practice, improved antibiotic use and prescribing, increased patient education and the implementation of appropriate global surveillance systems.1,3,4

 

Each of us must play our part.

Increase AMR awareness1,3

  • Expand public awareness
  • Raise the level of awareness among professional and occupational groups who use or prescribe antibiotics
  • Improve awareness and education in patients who are prescribed antibiotics

Increase responsible antibiotic use1,3,12

  • Adopt antimicrobial stewardship programs
  • Improve prescribing practice and optimize therapeutic regimen
  • Promote utilization of rapid diagnostics
  • Reduce unnecessary use of antimicrobials in agriculture and their dissemination into the environment

Increase monitoring and tracking1,3

  • Increase surveillance of drug resistance
  • Benchmark antimicrobial consumption

Support development of 
new therapeutics1,3,12

  • Promote development and use of vaccines
  • Increase development of alternative antimicrobials

Improve infection control and prevention1,3,12

  • Implement effective sanitation, hygiene and infection prevention measures

Action to halt the evolution and spread of antimicrobial-resistant organisms, coupled with sustained innovation in the research and development of novel antimicrobials, is vital if we are to maintain an effective repertoire of antimicrobials to treat infection.13

 

The following resources provide additional information:

 

Centers for Disease Control and Prevention:

Antibiotic Resistance Threats in the United States (2019)
Core Elements of Antibiotic Stewardship (2019)

World Health Organization:

Antimicrobial Resistance: Global Report on Surveillance (2014)

Review on Antimicrobial Resistance:

Tackling Drug-Resistant Infections Globally: Final Report and Recommendations (O’Neill, 2016)

References

  1. Centers for Disease Control and Prevention. 2019. Antibiotic resistance threats in the United States. Available from: https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf (accessed September 30 2020).
  2. World Health Organization. 2014. Antimicrobial resistance: global report on surveillance. Available from: https://iris.who.int/bitstream/handle/10665/112642/9789241564748_eng.pdf?sequence=1&isAllowed=y (accessed September 30 2020).
  3. Review on Antimicrobial Resistance. 2016. Tackling drug-resistant infections globally: final report and recommendations. Available from: https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf (accessed September 30 2020).
  4. Dadgostar P. Antimicrobial resistance: implications and costs. Infect Drug Resist. 2019;12:3903–3910.
  5. World Health Organization. 2020. What is antimicrobial resistance? Available from: https://www.who.int/features/qa/75/en/ (accessed September 30 2020). 
  6. Hawkey P. The origins and molecular basis of antibiotic resistance. BMJ. 1998;317:657–660.
  7. Aslam B. Antibiotic resistance: a rundown of a global crisis. Infect Drug Resist. 2018;11:1645–1658. 
  8. Rolain J-M. Do we need new antibiotics. Clin Microbiol Infect. 2016;22:408–415. 
  9. Burnham JP. Re-estimating annual deaths due to multidrug-resistant organism infection. Clin Infect Dis. 2018;40:112–113.
  10. Spigaglia P. Recent advances in the understanding of antibiotic resistance in Clostridium difficile infection. Ther Adv Infect Dis. 2016;3:23–42.
  11. World Health Organization. 2020. Antimicrobial resistance. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance (accessed September 30 2020).
  12. Ventola CL. The antibiotic resistance crisis: part 2: management strategies and new agents. P T. 2015;40:344–352.
  13. Annunziato G. Strategies to overcome antimicrobial resistance (AMR) making use of non-essential target inhibitors: a review. Int J Mol Sci. 2019;20:1–25.
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