A new World Health Organization (WHO) report reveals that more than half of life-threatening bacterial infections are becoming resistant to treatment. According to this data, despite the innovations in modern medicine, health systems are still vulnerable and need prompt action. We approached several microbiology experts in this regard to learn their opinions on life-threatening infections. Read the insights below.
- According to the WHO, high levels of resistance to treatment are reported in bacteria such as Klebsiella pneumonia and Acinetobacter baumannii spp which require treatment with last-resort antibiotics such as carbapenems.
- According to experts, some of the factors that have caused this rise in resistance may include inappropriate prescription practices, inadequate patient education, limited diagnostic facilities, and the unauthorized sale of antimicrobials among others.
- Antimicrobial resistance is a global public health challenge that can be controlled through the rational use of antibiotics.
DevelopmentAid: What are the main causes and consequences of the rise in life-threatening infections?
“The causes of antimicrobial resistance (AMR) in developing countries are complex and may be rooted in the practices of healthcare professionals and the behavior of patients towards the use of antimicrobials, as well as supply chains of antimicrobials in the population. Some of these factors may include inappropriate prescription practices, inadequate patient education, limited diagnostic facilities, the unauthorized sale of antimicrobials, the lack of appropriate functioning drug regulatory mechanisms, and the non-human use of antimicrobials such as in animal production. (James A. Ayukekbong, 2017). The main cause of antibiotic resistance is antibiotic use. When we use antibiotics, some bacteria die but resistant bacteria can survive and even multiply. The overuse of antibiotics makes resistant bacteria more common. The more we use antibiotics, the higher the chance that bacteria will become resistant to them. To make matters worse, many drugs that have contributed to decreasing the mortality rates associated with numerous infectious diseases are declining in efficacy (Naylor et al., 2018). The rise of AMR is one of the biggest threats of twenty-first-century medicine and the leading cause of therapeutic failure in the field of infectious diseases (Bloom and Cadarette, 2019). Increased antimicrobial resistance is the cause of severe infections, complications, longer hospital stays, and increased mortality.”
“In humans, the bacteria are often present in parts of the digestive tract where they do not cause problems most of the time. Within the hospital or healthcare set-up on the other hand, Klebsiella pneumonia are causative agents of several types of healthcare-associated acquired infections such as pneumonia, bacteremia, septicemia infections, wound or surgical site infections, and meningitis. These infections mostly occur amongst severely ill patients with highly compromised immune systems that require special needs for the care and treatment for other conditions. Contributing factors to AMR of Klebsiella pneumonia, as well as Acinetobacter baumannii, Acinetobacter baylyi, and Acinetobacter lwoffii sets of bacteria include natural or biological causes such as selective pressure, mutations and gene transfers as well as societal pressures such as inappropriate use of antibiotics, inadequate diagnostics, hospital use (heavier use of antibiotics), and agricultural use (addition of antibiotics to agricultural feed that promotes AMR) with the resultant antimicrobial resistance to these critical life-saving agents.”
“While 50% of AMR levels being resistant may be true globally, according to the WHO report, the figure may be higher in developing countries where the use of antibiotics is lax. In many developing countries, antibiotics may be bought freely over-the-counter, without a prescription from a qualified physician. Thus, the right dosage may not be taken and, even when prescribed, the dosage regimen may not be followed. Today, people talk about the world being a global village and as such any resistance in any part of the world can easily be taken to another part as people travel from one country to the other. The consequences are enormous as the infections that the resistance organisms cause may be more severe. Antimicrobial resistance may also lead to higher medical costs as well as prolonged hospital stays. It can also lead to increased mortality.”
“The global market and supply chain of antibiotics lacks transparency. This situation is taking advantage of poorly enforced regulations in low and middle-income countries which come with enormous challenges to national and global surveillance systems and the authority of nation-states. Other causes are the unlimited use of antibiotics and self-medication as well as poor infection prevention and control practices in constrained healthcare settings. A consequence of antimicrobial resistance that comes at a higher cost is a looming pandemic.”
DevelopmentAid: What should the international community do in this regard?
“Antimicrobial resistance is a global public health challenge that has been accelerated by the overuse of antibiotics worldwide. Most of the AMR are related to bacteria, and the infections are typically nosocomial. Unlike pandemic threats, the proliferation rate of resistant pathogens is slow; however, they have expanded worldwide (Bloom and Cadarette, 2019). The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene for both humans and animals; poor infection and disease prevention and control in healthcare facilities and farms and poor access to quality, affordable medicines and the lack of hand hygiene, respiratory and cough hygiene, personal protective equipment (PPE), the safe management of care equipment, bed linen, and blood and body fluid spillages. We need to improve medication concepts, not take an antibiotic for a virus, not save an antibiotic for the next time one gets sick. Take antibiotics exactly as prescribed and do not skip doses and never take an antibiotic prescribed for someone else. Encourage and promote the uptake of vaccinations and immunizations to protect patients from preventable infections. Unfortunately, the development of effective antimicrobial agents is a much slower and complex process compared to the spread of AMR. Consequently, the current options in the treatment of AMR are limited. One of the main alternatives to conventional antibiotics is the use of antibody antibiotic conjugates (AACs).”
“The fight against antimicrobial resistance has to be approached from a collective perspective and the responsibility shared according to the WHO’s One Health Approach. Antimicrobial resistance to bacteria and the Acinetobacter and Klebsiella pneumonia species that develop the ability to outwit the natural selective pressures or societal pressures to the very antibiotics designed to kill them result in the growth of these microorganisms in their presence. Addressing these threats calls for consented efforts and continued aggressive action plans such as the One Health Approach. Notwithstanding this wider approach, in the particular case of preventing the spread of the Klebsiella pneumonia and Acinetobacter baumannii species between healthcare workers and patients and vice versa, it is imperative for healthcare workers to follow established and specific infection control precautionary measures as outlined in the “Guidelines for Isolation Precaution: Preventing Transmission of Infectious Agents in Healthcare Settings” (2007). These precautions may include strict adherence to hand hygiene and wearing gowns and gloves when accessing wards where patients with Klebsiella and Acinetobacter baumannii-related illnesses are located. Healthcare facilities must also follow strict cleaning procedures to prevent the spread of bacteria.”
“Antimicrobial resistance can be controlled through the rational use of antibiotics. Similarly, the early detection of infections and susceptibility testing before prescribing are all ways of controlling resistance. The use of vaccinations and immune modulators as well as medicinal plants or their derivatives can help to decrease the emergence of resistance. It is advised that antibiotics should only be used when prescribed by a certified physician.”
“Innovative technologies to produce new antibiotics can help to curb the resistance. Limiting the use of antibiotics by intensifying education regarding antimicrobial resistance and the appropriate use of antibiotics, enforcement of the laws regulating the purchase and use of antibiotics (both in humans and animals), and strengthening the healthcare systems (especially in LMICs) are necessary steps. Collaborative efforts in the fight against antimicrobial resistance should be enhanced leaving no country behind. This should be done to strengthen surveillance systems and to monitor the trajectories of antibiotics in the global south in terms of their inception and consumption. Antimicrobial-resistant infections know no borders and are a threat to our common future.”
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