The Challenge of Antimicrobial Resistance (AMR)

What is antimicrobial resistance?

Antimicrobial resistance happens when microorganisms (such as bacteria, fungi, viruses, and parasites) change when they are exposed to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics).
Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.
As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spreading to others.

What accelerates the emergence and spread of antimicrobial resistance?

Antimicrobial resistance occurs naturally over time, usually through genetic changes.
However, the misuse and overuse of antimicrobials is accelerating this process.
In many places, antibiotics are overused and misused in people and animals, and often given without professional oversight.
Examples of misuse include when they are taken by people with viral infections like colds and flu, and when they are given as growth promoters in animals or used to prevent diseases in healthy animals.
Antimicrobial resistant-microbes are found in people, animals, food, and the environment (in water, soil and air).
They can spread between people and animals, including from food of animal origin, and from person to person.
Poor infection control, inadequate sanitary conditions and inappropriate food-handling encourage the spread of antimicrobial resistance.

Why in news?

Based on estimates from 204 countries and territories, the Global Research on Antimicrobial Resistance (GRAM) report published in the Lancet provides the most comprehensive estimate of the global impact of AMR so far.

Major Findings

Its headline finding is that as many as 4.95 million deaths may be associated with bacterial AMR in 2019.
Estimates included in the paper show that AMR is a leading cause of death globally, higher than HIV/AIDS or malaria.
Eg: In South Asia, over 389,000 people died as a direct result of AMR in 2019 with the death rate being the highest in Western sub-Saharan Africa, at 27.3 deaths per 100,000 and lowest in Australasia, at 6.5 deaths per 100,000.
The six leading pathogens for deaths associated with resistance were Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa which were responsible for 3.57 million deaths associated with AMR in 2019.
One pathogen–drug combination, methicillin-resistant S aureus, caused more than 100,000 deaths attributable to AMR in 2019, while six more each caused 50 000 – 100,000 deaths.

Major Implications of the study

Common infections such as lower respiratory tract infections, bloodstream infections, and intra-abdominal infections are now killing hundreds of thousands of people every year because bacteria have become resistant to treatment which includes historically treatable illnesses, such as pneumonia, hospital-acquired infections, and foodborne ailments.
In 2019, one in five global deaths attributable to AMR occurred in children under the age of five – often from previously treatable infections.
AMR is threatening the ability of hospitals to keep patients safe from infections and undermining the ability of doctors to carry out essential medical practice safely, including surgery, childbirth and cancer treatment since infection is a risk following these procedures.
Out of the seven deadliest drug-resistant bacteria, vaccines are only available for two (Streptococcus pneumoniae and Mycobacterium tuberculosis).
While all seven of the leading bacteria have been identified as ‘priority pathogens’ by the World Health Organization (WHO) only two have been a focus of major global health intervention programmes S. pneumoniae (primarily through pneumococcal vaccination) and M. tuberculosis.

Way Forward

A greater action towards monitoring and controlling infections, globally, nationally and within individual hospitals.
Access to vaccines, clean water and sanitation ought to be expanded.
Being “more thoughtful” about our use of antimicrobial treatments – expanding access to lifesaving antibiotics where needed, minimizing use where they are not necessary to improve human health and acting according to WHO recommendations on the same.
Increase funding for developing new antimicrobials and targeting priority pathogens such as K. pneumoniae and E. coli and ensuring that they are affordable and accessible to most of the world.

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