What is Antimicrobial Resistance (AMR)?
AMR is an increase in the ability of microorganisms to survive, multiply and resist antimicrobial agents. It can affect all aspects of public health, including the treatment of infectious diseases such as HIV/AIDS, tuberculosis (TB), malaria, non-neurological conditions such as diarrhea and pneumonia, cancer treatment, and transplantation.
Even stronger antibiotics are becoming less effective as drug resistance spreads around the world, resulting in more difficult-to-treat infections, thereby increasing mortality. Newer, more effective antibacterial agents are desperately needed. However, unless the irrational and incomplete use of antibiotics is stopped, the newer antibiotics will suffer the same fate as the old ones.
Why is it a concern?
A huge concern in the public health sector emerges as the treatment options become insufficient due to the effect of AMR. These include infections caused by bacteria (such as tuberculosis), viruses (such as HIV/AIDS), fungi, parasites, and protozoa (such as malaria).
It is estimated that antimicrobial resistance could cause 10 million deaths per year by 2050 if no action is taken to address it.
This is because the infections caused by antimicrobial resistance are more difficult to treat and incur higher costs. Misdiagnoses and lack of awareness among people are adding to the increasing cost of treating AMR-associated illnesses.
An issue with certain antimicrobials in the future would not just be the side effects but also their inability to treat the illness they have been prescribed for. Bringing awareness has been a challenge because it's not easy to believe that the medicine that is taken for certain illnesses might actually be working against them. This is why Public education is the key to bringing change in people regarding false beliefs like ‘AMR does really exist’ or ’Every person suffering from cold and cough do not need to be addressed with immediate antibiotics’. In fact, this will only increase the required dose for the littlest of ailments.
How does AMR actually affect the public -
- Frequent infections - Antibiotics are used to treat bacterial infections, but there are many people who take them regularly without any benefits or indications.
It is reported that about 80% of antibiotics sold in US markets each year are for livestock use only; 20% for food production; 5% for human use; and 1% for veterinary use (Environmental Protection Agency). This shows that antibiotics are overused in livestock production, which leads to overuse in human medicine as well.
Undetected secondary bacterial infection further makes us believe the infection is something we can get away with easily.
Antimicrobial resistance causes secondary bacterial infection, which can be life-threatening for patients with compromised immune systems. For example, it contributes to infections that one can acquire during the treatment of another disease. It can also affect the health outcome of people in long-term care facilities as well as post-surgical infections such as surgical site infections (infections occurring at the incision site after surgery)
Infectious diseases have been on the rise globally over the past few decades due to increased global travel, migration, and trade. Infections caused by antibiotic-resistant bacteria are particularly concerning because they are more difficult to treat than regular bacteria. As a result, more people are dying from these infections than ever before.
2. Misdiagnosis as food poisoning - A recent paper published in JAMA Internal Medicine has shown that antimicrobial resistance is misdiagnosed as food poisoning by most physicians because the patient presents with symptoms such as vomiting and diarrhea.
The authors of this study hypothesize that this misdiagnosis occurs because physicians rely too heavily on the current diagnostic criteria for bacterial food poisoning, which primarily focuses on stool pathogens. This can lead to misdiagnosis if there are other contributing factors such as antimicrobial-resistant bacteria or poor hygiene practices that may be more important than the presence of certain organisms in the stool sample. This is complicated by further treating the condition with antibiotics most of the time.
3. Undernutrition- Undernutrition can be considered the result of the above two situations.
An increase in antimicrobial resistance and undernutrition are both health and economic concerns. In case of antimicrobial resistance, the effectiveness of antibiotics and other antimicrobials will decline over time. This can lead to frequent bacterial infections that cannot be treated with current drugs, leading to serious illnesses. This may further lead to an increase in the undernourished population both in hospitals and at home, thus making it difficult to treat known and unknown diseases.
Below is the representation of how undernutrition actually impacts and cycles back to AMR in a simple way.
Undernutrition and AMR
- An Infectious disease episode
- Various medicines and antibiotics taken
- Appropriate treatment, follow-up, and detections not done
- Lowered immunity
- Further increase in the risk of infections
- Repeated inappropriate management of the infection as an underlying AMR is not completely understood
It is reasonable to argue that better-nourished children are less susceptible to infectious diseases and thus require fewer antibiotics. In their paper 'Antibiotic resistance - the need for global solutions, Laxminarayan et al speculate that the effects of AMR are likely to be greater in vulnerable groups, including those who are malnourished. As a result, strategies with interventions to combat malnutrition and promote optimal nutrition as an upstream influence on infectious disease and AMR should be implemented.
Conclusion
The rise of antimicrobial resistance (AMR) is one of the most concerning global health issues today. It has been called a "colossal threat" by the World Health Organization, and it is estimated that by 2050, 10 million people will die each year due to AMR.
In addition to its health impact, AMR also has economic implications. The global cost of AMR rose from $16 billion in 2015 to $35 billion in 2016 and will likely increase to $80 billion per year by 2020. In addition to health care costs, research suggests that there may be a significant impact on productivity due to reduced work output or longer recovery time from illness.
Antimicrobial resistance is a complicated issue with numerous contributing factors. It is a major source of health concern, with direct and indirect costs to oneself and the community. Prevention remains the most effective tool for reducing infection spread and, thus, AMR. Along with the rational use of existing antimicrobial drugs, newer, effective compounds and diagnostic techniques are required. To combat the global spread of antimicrobial resistance- patients, prescribers, and other individuals must work together with international regulators and policymakers.
Read the article "An anecdote of antimicrobial resistance in the surgical ward" here