What is Antimicrobial Resistance (AMR)?

From the Guidelines

Antimicrobial resistance (AMR) is a major public health concern that requires immediate attention and action to prevent and control the spread of multidrug-resistant organisms (MDROs) and reduce morbidity, mortality, and healthcare costs. According to a recent study published in the International Journal of Antimicrobial Agents 1, AMR is one of the leading threats to human health, and the misuse and overuse of antibiotics are the main drivers of the emergence and spread of AMR. The study highlights that healthcare-associated infections caused by MDROs, including Gram-positive bacteria and Gram-negative bacilli, are a leading cause of morbidity and mortality, as well as increased healthcare costs worldwide.

Some of the key challenges in managing AMR include:

• Limited treatment options for MDRO infections, often requiring the use of last-resort antibiotics with high toxicity or poor efficacy
• The alarming increase in carbapenem resistance in several species, including Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii
• The need for antimicrobial stewardship and responsible use of antibiotics to slow the spread of AMR
• The importance of prevention strategies, such as proper hand hygiene, vaccination, safe food handling, and infection control measures, to reduce the risk of infection and transmission of MDROs.

The European Antimicrobial Resistance Surveillance Network (EARS-Net) report cited in the study 1 highlights the substantial proportion of MDROs spreading in several European Union/European Economic Area (EU/EEA) countries, with more than one-half of Escherichia coli and more than one-third of Klebsiella pneumoniae isolates resistant to at least one antimicrobial group. Therefore, it is essential to prioritize antimicrobial stewardship, infection control, and prevention strategies to combat AMR and reduce the risk of MDRO infections.

From the FDA Drug Label

The bactericidal action of ciprofloxacin results from inhibition of the enzymes topoisomerase II (DNA gyrase) and topoisomerase IV, which are required for bacterial DNA replication, transcription, repair, and recombination The mechanism of action of fluoroquinolones, including ciprofloxacin, is different from that of penicillins, cephalosporins, aminoglycosides, macrolides, and tetracyclines; therefore, microorganisms resistant to these classes of drugs may be susceptible to ciprofloxacin and other quinolones. The answer to the introduction of AMR is that ciprofloxacin's mechanism of action is different from other classes of antimicrobials, and therefore, microorganisms resistant to other classes may still be susceptible to ciprofloxacin.

• Key points about ciprofloxacin's mechanism of action include:
  • Inhibition of topoisomerase II (DNA gyrase) and topoisomerase IV
  • Different mechanism of action compared to other antimicrobials
  • Potential for susceptibility in microorganisms resistant to other classes of drugs 2

From the Research

Definition and Scope of AMR

• Antimicrobial resistance (AMR) is a phenomenon where microorganisms such as bacteria, fungi, viruses, and parasites become resistant to antimicrobial treatments, allowing them to survive within the host 3, 4.
• AMR is a global public health problem that requires a global solution, with the potential to cause enormous human and economic costs if left unaddressed 4, 5.
• The emergence and spread of AMR are driven by factors such as the overuse and misuse of antimicrobials, particularly antibiotics, as well as the lack of implementation of infection prevention and control hygiene measures 3, 6.

Causes and Consequences of AMR

• The prominent cause contributing to the current AMR crisis is the overuse and misuse of antimicrobials, particularly the inappropriate usage of antibiotics 3, 5.
• The consequences of failure to adequately address AMR are profound, with estimations of a return to the pre-antibiotic era, where everyday infections could be potentially life-threatening 3, 6.
• AMR is responsible for around 700 thousand deaths worldwide per year, and it is estimated that without proper control and action, AMR will result in enormous human and economic costs, including 10 million deaths per year by 2050 4, 6.

Strategies to Address AMR

• The "One Health Approach" is a system that incorporates a multidisciplinary effort to achieve the best possible health outcome by acknowledging the clear connections between humans, animals, and their shared environment 3.
• International governmental organizations, including the UN's 17 Sustainable Development Goals (SDGs), are working to address the problem of antibiotic resistance 3, 4.
• Public awareness and health literacy of lay audiences are crucial in the fight against AMR, and a coordinated effort to address this threat to global health is essential 3, 7.
• Strategies to combat AMR include surveillance and monitoring, minimizing over-the-counter antibiotics and antibiotics in food animals, access to quality and affordable medicines, vaccines, and diagnostics, and enforcement of legislation 6, 7.