Antimicrobial resistance: action to combat the rising microbial challenges

Abstract

Antimicrobial therapy transformed medical practice from a merely diagnosis-focused approach 80 years ago to a treatment-focused approach, saving millions of lives in the years to follow. Today, numerous medical advances made possible by effective antibiotics are being threatened by the relentlessly rising rates of bacteria resistant to all currently available antibiotics. This phenomenon is a consequence of antibiotic misuse, which exerts undue selective pressure on micro-organisms, combined with defective infection control practices that accelerate their spread. Its impact on societies worldwide is immense, resulting in loss of human life and money. An alarming pattern of resistance involving multidrug-resistant and sometimes pandrug-resistant Gram-negative bacteria is currently emerging. In response to the global public health threat posed by antimicrobial resistance (AMR), a number of national and international actions and initiatives have been developed in recent years to address this issue. Although the optimally effective and cost-effective strategy to reduce AMR is not known, a multifaceted approach is most likely to be successful. It should include actions aiming at optimising antibiotic use, strengthening surveillance and infection control, and improving healthcare worker and public education with regard to antibiotics. Research efforts to bring new effective antibiotics to patients need to be fostered in order to negate the consequences of the current lack of antimicrobial therapy options. A holistic view of AMR as well as intersectoral collaboration between human and veterinary medicine is required to best address the problem.

Introduction

Around eight decades ago, the ground-breaking discovery that substances produced by fungi or bacteria can inhibit the growth of other bacteria revolutionised medical practice, transforming it from merely a diagnosis-focused approach to a treatment-focused approach. These substances, later named antibiotics, were used for the treatment of innumerable cases of infection, which were the leading cause of death at the time. In the years to follow, millions of lives have been saved due to substantial reductions in mortality achieved with antibiotic therapy [1].

Eighty years later, antibiotic effectiveness is seriously threatened by the relentlessly rising resistance of bacteria to all currently available antibiotics, a reality with immense consequences on societies worldwide. The naturally occurring phenomenon of antimicrobial resistance (AMR) is distorted by antibiotic overuse and misuse, exerting undue selective pressure on micro-organisms. Despite early warnings, including those of Sir A. Fleming, antibiotics have suffered years of misuse. In 1945, Sir Fleming stated ‘…the microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred out… In such cases the thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism. I hope this evil can be averted’ [2]. Spread of selected resistant bacteria is accelerated by inadequate infection control practices. Moreover, the pharmaceutical industry's interest in research and development of new antimicrobials is seriously declining owing to the increased cost and complexity involved in this process as well as the fact that recommendations urging restrictive antimicrobial use are viewed as disincentives [3], [4]. So if antibiotics are rapidly becoming ineffective, what can be done to reverse this course?