By Dr. Mohammad Iqbal Yatoo
Antimicrobial resistance (AMR) is considered as one of the ten global public health and development threats that humanity is facing. It is a critical One Health concern with implications for human, animal, plant, and environmental health.
AMR occurs when microorganisms such as bacteria, viruses, parasites or fungi become resistant to antimicrobial treatments to which they were previously susceptible. Antimicrobials – antibiotics, antivirals, antifungals and antiparasitics – are substances widely used to prevent and treat infections in humans, aquaculture, livestock, and crop production. Their effectiveness is now in jeopardy because a number of antimicrobial treatments that once worked no longer do so because microorganisms have become resistant to them. Microorganisms that develop resistance to commonly used antimicrobials are referred to as superbugs.
So antimicrobial resistance is the ability of microorganisms to become increasingly resistant to antimicrobials to which they were susceptible. Microbial pathogens develop resistance against antimicrobial drugs making them ineffective for treatment of infections. Antimicrobial drugs are commonly used for curing infections caused by microbial pathogens. Inability of antimicrobials to cure infections due to resistance problems can cause havoc in the public healthcare system.
Antimicrobial resistance threatens human and animal health and welfare, the environment, food and nutrition security and safety, economic development, and equity within societies. AMR poses serious threats to pandemic prevention, preparedness, and response. It could make antimicrobials ineffective and useless and can kill more than 10 million people by 2050. Nearly 250000 people are dying annually in the European Union and 700000 globally due to AMR and more likely causing more deaths than cancer in future.
AMR could cause a loss of $1 trillion dollars in the global economy and a surge of 1.2 trillion dollars in annual health expenditure by 2050 sinking the global GDP by 1.1–3.8%. The cost of treatment is rising due to ineffectiveness of antimicrobial treatment by AMR. In the EU alone it is estimated that AMR costs EUR 1.5 billion annually in healthcare costs and productivity losses.
AMR disproportionately affects low- and middle-income countries. The World Bank estimates that an additional 24 million people would be forced into extreme poverty by 2030 if no action is taken on AMR today. As per estimates by 2050, AMR may pose economic crises similar to the 2008 financial crisis. AMR threatens sustainable development goals of United Nations, especially targets for good health and well-being (Goal 3).
Understanding the basis of AMR is of utmost importance. Devising interventions that can support antimicrobials and can help in overcoming the menace of AMR will be needed in the future.
There are many causes of AMR of both natural and manmade origin, latter being the main cause incited by unregulated use or misuse of antimicrobials in animals, humans and agriculture, application of antimicrobials in animals as prophylactics or feed additives and use of antimicrobials in animals destined for human use. Societal pressure, inappropriate use of antimicrobials, inadequate diagnostics, and hospital use coupled with agricultural use of antimicrobials aid in development of AMR. The application of antimicrobials is central to resistance development both in animals, humans and the environment. Unrestricted use, under dosage, overuse and inappropriate use of antimicrobials in animals and humans predisposes to AMR. Antimicrobial consumption will increase in animals by 99% in 2030 and in humans by 13%. There was a significant surge in the global consumption of antibiotics (increased by 65%, 21.1–34.8 billion DDDs (defined daily doses) during 2000 to 2015, which was mainly driven by low- and middle- income countries. India is the largest consumer of antibiotics (12.9 × 109 units (10.7 units/person)) followed by China (10.0 × 109 units (7.5 units per person)). BRICS countries (Brazil, Russia, India, China, and South Africa) have shown 76% of the overall rise in antibiotic use during the decade 2000 to 2010. Among BRICS countries 23% of the rise in the retail antibiotic sales was attributed to India, while around 57% of the increase in the medical sector was in China. The rise in antibiotic use has multifaceted reasons but unregulated systems and ineffectiveness being of prime importance. This further aggravates the problem of AMR as constant exposure of pathogens to antimicrobials results in resistance.
Natural selection and mutation helps microbial pathogens to develop this resistance which is transmitted from one generation to another. This selection process is exacerbated by humans through inappropriate use of antimicrobials, poor hygiene conditions and practices in healthcare settings or in the food chain facilitating the transmission of resistant microorganisms. This all results in loss of effectiveness of antimicrobials and ultimately uselessness. The initial antimicrobial resistance is believed to be through random gene transfer events by bacteriophage-driven transduction. Development of resistance against antimicrobial drugs due to selection of resistant microbes was followed by horizontal transfer of genes among microbial species producing resistant phenotypes. Despite discovery of novel antimicrobials, microbes kept developing resistance through different mechanisms. With the advent of new antimicrobials from 1950 to 1970, AMR could not be noticed on that large scale however continuous use of the same antimicrobials and less or no discovery of newer antimicrobials for a long time led to crises of AMR. FDA has approved only 17 new systemic antibiotics and 1 related biologic in the last 12 years (2010-2022). Only 1 in 30 drugs reach clinical trials or testing in people phase and even if approved they are reserved for severe infections only with restricted use. So there is pressure of utilising already available antimicrobials which results in development of resistance.
Microbes have developed resistance to multiple drugs (MDR) and there is also Extended-Spectrum Drug Resistance (XDR) and Pandrug Resistance (PDR). The ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) are the notable bacterial pathogens having developed antimicrobial resistance. Similarly Candida auris fungus, human immunodeficiency virus and Plasmodium falciparum parasite are other examples of resistant microbial pathogens.
Understanding the basis and mechanisms of resistance is of utmost importance for devising interventions and curtailing the menace of AMR. Devising techno interventions that could support antimicrobials and help in combating AMR are the need of the hour and requirements for safeguarding the future. This involves efforts at regional, national and global levels. The main approaches that should be under focus include judicious and limited use of antimicrobials in animals, regular screening of antimicrobials for AMR, development of novel antimicrobials, alternatives to antimicrobials, monitoring and surveillance of AMR, awareness and outreach on AMR, collaborations at national and international levels and implementing the initiatives of one health.
Considering the importance and need for combating AMR, quadripartite joint secretariat on antimicrobial resistance was constituted with global organisations including World Health Organisation (WHO), Food and Agriculture Organization of the United Nations (FAO), the UN Environment Programme (UNEP) and the World Organisation for Animal Health (WOAH) to drive multi-stakeholder engagement in AMR.
The United Nations General Assembly in 2022 resolved to hold a UNGA High-level Meeting on AMR in 2024 which will be an opportunity to commit to clear and new targets and practical steps to address AMR. This event will allow Heads of Government and State, Government Ministers and political leaders the opportunity to discuss effective approaches to addressing AMR at a local, national and global level with regards to funding, policy development and international and multi-sectoral collaboration.
On a similar pattern, Sher E Kashmir University of Agricultural Sciences and Technology of Kashmir (SKUAST-K) is organizing JK Agri-Med Science Congress (2023-2024) from 27 to 29th February 2024 involving experts from Agriculture and allied sciences and medical sciences with the aim of convergence of expertise in agricultural and medical science in order to discuss and focus on the issues and challenges that the bioeconomy and healthcare will be facing in future including antimicrobial resistance.
The author is Assistant Professor, FVSc and AH Shuhama Principal Investigator of SERB, DST and BIRAC projects on infectious diseases of livestock
Views expressed in the article are the author’s own and do not necessarily represent the editorial stance of Kashmir Observer. The opinions and observations are of the author and not of the institute he works for
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