By Dr Amar Al-Salti, Consultant Anaesthesia and Pain Medicine at Sheikh Khalifa Medical City
The damaging effects of antimicrobial resistance are already manifesting themselves across the world. Antimicrobial-resistant infections currently claim at least 50,000 lives each year across Europe and the US alone, with many hundreds of thousands more dying in other areas of the world. It is no surprise, therefore, that antimicrobial resistance accounts for 700,000 deaths worldwide – rivalling the number of deaths caused by traffic accidents (1.2 million).
A global action plan on antimicrobial resistance was adopted by Member States at the 68th World Health Assembly and supported by the governing bodies of FAO and OIE in May and June 2015. The goal of the 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.
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 spread to others. New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases, resulting in prolonged illness, disability, and death.
Without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery become very high risk. Antimicrobial resistance increases the cost of health care with lengthier stays in hospitals and more intensive care required.
Antimicrobial resistance is putting the gains of the Millennium Development Goals at risk and also endangers achievement of the Sustainable Development Goals.
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 and fish.
Antimicrobial resistant-microbes are found in people, animals, food, and the environment. They can spread between people and animals, and from person to person. Poor infection control, inadequate sanitary conditions and inappropriate food-handling encourage the spread of antimicrobial resistance.
The economic picture is also bleak. Crucially, superbugs do not just cost millions of lives, but millions of dollars too. According to a global ‘Review in antimicrobial resistance’ in 2014, bacteria could cost a cumulative $100 trillion of economic output by 2050 if not contained urgently. Put simply, infectious diseases do not respect international borders or economic circumstances, and as the figures show, they are likely to trigger a monetary tsunami around the world if we do not tackle resistance.
What can be done?
With the world becoming more interconnected every day, countries need to work together to address this global issue, including setting guidelines for screening patients who carry resistant bacteria, educating HCPs to stick to prescribed courses of antibiotics and reducing the use of antibiotics in livestock. It’s also important for the public, government officials and HCPs to know how to monitor both big and small outbreaks, and report them. For example, Pfizer’s ATLAS (Antimicrobial Testing Leadership and Surveillance) tool is an interactive website that provides valuable resources for policy makers, those working in healthcare and the general public. It facilitates recording country-specific data on efficacy and resistance to antibiotic treatment.
Recently, experts on the subject including Dr Philippe Eggimann, Attending Physician at Lausanne University Hospital, Switzerland and Dr Zeina Kanafani, Assistant Professor of Medicine at American University, Beirut, discussed ways to address antimicrobial resistance in the region through education, policy and research, and touched on topics ranging from ‘improving outcomes of antifungal therapy’ to ‘current challenges in the field of anti-infectives’. During the event, experts agreed that antimicrobial stewardship is essential for the proper management of infections and can help in the preservation of the available antimicrobials. Assessment of patient risk factors helps identify patients at risk of contracting resistant pathogens.
Furthermore, international guidelines guide therapy but knowing local epidemiology is essential.
Defeating superbugs is no simple task, and requires collaboration, tenacity and innovation from all relevant parties. Timing is key to addressing the nature of these lethal bacteria – and working against superbugs’ multiplying clock can seem impossible. However, we must join forces and share knowledge and learnings in the war against superbugs. Through robust education methods, advanced science and solid team work, we can set a clear vision and significantly curb the issue once and for all.