Antimicrobial resistance
AMR: preventing the next pandemic
After years of excessive and sometimes inappropriate use of antimicrobials, an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi are no longer susceptible to the common medicines used to treat them. Simon Aylen discusses the history and challenges of antimicrobial resistance (AMR) and the strategies we can employ to control and contain this global threat.
Prior to 1900, infectious diseases were the leading cause of death worldwide, particularly pneumonia, influenza, and tuberculosis (TB).1 However, the successful implementation of public health initiatives, the introduction of vaccines, and the development of antimicrobial compounds, such as penicillin, greatly diminished the mortality rate from infectious diseases. The discovery of penicillin by Alexander
Fleming in 1928 marked the start of the golden age of antibiotic discovery. This period lasted until the 1970s, and in fact most of the drugs we commonly use today were discovered solely within the 1950s.2
Since then, antibiotics have
significantly increased human health and lifespan by supporting modern life-saving medical procedures such as cancer chemotherapy, advanced surgery, and organ transplants, in addition to curing deadly infectious diseases like tuberculosis and pneumonia. However, the widespread use of these drugs for decades has spawned a new generation of antibiotic-resistant strains (aka ‘superbugs’). Due to this, treatment options for common infections are fast running out and AMR now presents a major health issue globally, with a high proportion of resistance reported within both the healthcare setting and the general community.3
Consequently, routine surgery and
many immune-suppressing cancer treatments could soon become simply too dangerous to perform due to the risk of infection.
The cause of AMR On the molecular level, AMR is essentially a natural phenomenon where bacteria respond to their environment just like any organism, mutating and evolving to protect themselves against the toxic compounds to which they are exposed. Notably, the number of bloodstream infections (BSI) had increased by 17% between 2015 and 2019, with a 32% increase in the estimated number of antibiotic resistant BSI.
This has been primarily driven by the Gram- negative bacterial species Escherichia coli and Klebsiella pneumoniae and the Gram-positive bacterial genera Enterococcus spp.3
Although,
trends in some key pathogens have varied between 2020 and 2021, due to the multifactorial effects of the COVID-19 pandemic, reported cases of antibiotic-resistant bacterial strains are still generally increasing year on year.3,4 Providing a highly insightful view of the situation within the UK, a report by the UK Health Security Agency highlights how antibiotic prescribing and resistance throughout the UK has changed over recent years.4
The English
Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report shows that although AMR is on the increase, antibiotic prescribing throughout the UK has decreased since its peak in 2014.
The Global Antimicrobial Resistance and Use Surveillance System (GLASS) published by the World Health Organization (WHO) has also recently reported high rates of resistance against antibiotics used to treat common bacterial infections on a global scale.5
For
example, the rate of resistance to ciprofloxacin, an antibiotic commonly used to treat urinary tract infections, varied from 8.4% to 92.9% for Escherichia coli and from 4.1% to 79.4% for Klebsiella pneumoniae in countries reporting to GLASS.
Action Required As common infections begin to pose a serious threat to life, the WHO has listed AMR as one of the top 10 global public health threats facing humanity. The first comprehensive assessment of the global burden of bacterial AMR showed
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