Antimicrobial resistance: A looming global threat

BY DR. SYED MUDASIR ANDRABI

Antimicrobial resistance, or AMR, is regarded as one of the most important public health concern to the health of people, animals, and plants as well as to food security and economic growth”.

Antimicrobials are a crucial component of modern life. However, the more humans misuse them, the more the microbial world adapts. “Antibiotic resistance” refers to the reduction or elimination of antibiotic effectiveness caused by bacterial mutations or the acquisition of new genes. In broader way “antimicrobial resistance” encompasses drug resistance to diseases caused by a variety of pathogens, including bacteria, viruses, parasites, and fungi. It is getting harder and sometimes impossible to treat infections in people, animals, and plants. Antimicrobial resistance (AMR) is becoming a serious public health issue.

Resistance develops naturally, but negligent practices in drug supply, use, or misuse around the world are quickly increasing the prevalence of difficult-to-treat diseases in both human and animals. Since antibiotic-resistant bacterial strains are more difficult to treat and frequently necessitate prolonged therapy, antibiotic resistance places a significant burden on healthcare systems. In the worst-case scenario, a strain develops resistance to every drug and poses a severe threat to global health. The strategy for new and more effective antibiotics is not well-provided, and if nothing is done, the world may soon lose the simplest way to treat diseases and keep people healthy and alive.

The World Health Organization (WHO) predicts that by 2050, there may be up to 10 million annual deaths, which is comparable to other worst diseases like cancer. If left uncontrolled, AMR could reduce GDP by US$3.4 trillion yearly and will push about 24 million people into extreme poverty over the course of the next ten years. AMR is a global concern, and all nations are exposed to its risks. It has a close relationship with pollution, inadequate sanitation, lack of hygiene, and poverty. AMR is therefore more detrimental to low-income and lower-middle-income countries.

AMR can be addressed by employing the ‘One Health’ concept, which acknowledges the interdependence of human, animal, plant, and environmental health. Combating AMR will require all hands on deck, including those from the government, civic society, international organizations and private sector.

Evidence suggests that the environment plays a major role in the development, transmission and spread of superbugs. Superbug prevention and management strategies should focus on avoiding and controlling chemical and biological contamination from the pharmaceutical, agricultural, healthcare, and municipal wastes. Solid discharge regulation, improved wastewater treatment, re-aligning incentives to limit antimicrobial use, and more corporate accountability in the private sector are all changes that can be made to lower the risk of superbugs.

Antibiotics are widely used in animal husbandry practices to encourage growth and prevent infections in cattle and poultry, which contribute to the development of resistant bacteria that are then transmitted to people through the food chain. Hence posing a threat to food security and jeopardizing the food’s availability and safety.

Collaboration between the public and private sectors, academia, human and animal health will be necessary to address antibiotic resistance effectively. Due to a significant lack of information on the scope, epidemiology, and economic effects of antibiotic resistance as well as the scarcity of diagnostic and therapeutic options, the global community is left with few resources to combat this global challenge.

The development of innovative drugs and diagnostics must be encouraged. Stewardship of current antibiotics in human and agricultural settings must also be improved. Systems for identifying, diagnosing, and tracking resistance must also be strengthened to ensure that reporting is prompt, precise, and transparent. We must mobilize high-level political engagement, financial resources, and technical experience, with a focus on the needs and desires of individual countries.

Political support worldwide is growing for addressing the serious threat posed by antibiotic resistance. Through the Trans-Atlantic Taskforce on Antimicrobial Resistance (TATFAR), which was founded in 2009 by President Obama and his European colleagues to strengthen collaboration on combatting resistance, the United States has supported ongoing discussions with the European Union. In terms of promoting robust technical interactions, facilitating openness, and identifying best practices, TATFAR provides as a useful paradigm for international collaboration on antibiotic resistance. The G8 Science Ministers acknowledged that drug resistance is a “major health security challenge of the 21st century” in June 2013 and reaffirmed the critical role that science plays in solving issues like AMR. Recognizing the gravity of the situation, the World Health Assembly approved the Global Action Plan on AMR in 2015 as part of a trilateral collaboration between the World Health Organization, the Food and Agricultural Organization, and the World Organization for Animal Health.

The Union Ministry of Health and Family Welfare announced India’s National Action Plan (NAP) for AMR in April 2017. The NAP’s goals include raising awareness, boosting surveillance, strengthening infection prevention and control, research, and development, supporting investments, and collaborating to combat AMR.

Strategic outlines to combat AMR

8 Use antibiotics judiciously in healthcare and agriculture to prevent the emergence of resistance and extend the lifetime of effective antibiotics.

8 Increasing surveillance in the “One-Health” strategy, which encourages the integration of environment, public health, food, and veterinary diseases. The proper data sharing, improvement and coordination of the current surveillance systems can lead to improved detection. Regional and national laboratory networks can be very helpful in this direction.

8 It is crucial to use novel and quick diagnostic tools to find and characterize resistant microorganisms. The WHO has endorsed several current AMR monitoring systems, including GLASS (Global Antimicrobial Resistance and Use Surveillance System), which use conventional microbiological techniques to monitor pathogens from clinical isolates, assess their susceptibility to antibiotics, and sequence their entire genomes before entering the information into an AMR database. The effectiveness of such monitoring systems might be greatly increased by incorporating the most recent developments, such as metagenomics, for the detection, identification, and confirmation of AMR genes. Additionally, the development of electrochemical protocols and paper-based biosensors for the detection of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp). Real Time PCR detections and the addition of aptamer-quantum dots-based fluorescence biosensors could be more beneficial.

8 We must encourage the development of novel and next-generation antibiotics, vaccines, and alternate therapies to tackle AMR. Exploring antimicrobial peptides/bacteriocins and nano-formulation of phytochemicals as potential antimicrobial alternatives in combating antibiotic resistance could be game changers.

8 Establishing comprehensive and cohesive structures for national-level planning, governance, law and regulation, as well as systems for coordination and cooperation.

8 Establishing worldwide guidelines for the microbiological markers of AMR that can be extracted from environmental samples and utilized to inform risk reduction decisions.

8 Government should strengthen capacity building to detect antimicrobial drivers under One Health Approach. It is necessary to construct regional or district-level detection centres with effective networking.

Way Forward

AMR can be effectively handled by employing the “One Health” concept, which acknowledges the interdependence and intimate connections between the health of people, animals, plants, and the environment. This strategy has already been used by many nations, and their national action plans on AMR now incorporate environmental-related elements. By implementing “One Health” response to AMR, we can not only help society’s risk and burden of AMR, but also resolve the global crisis.

Dr. Syed Mudasir Andrabi, Prof. & Head, Animal Biotechnology, FVSc & AH, SKUAST-K. He can be reached at: mudasirbio@gmail.com