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 increased morbidity, mortality, and healthcare costs. AMR occurs when microorganisms develop mechanisms to survive and grow in the presence of antimicrobial drugs, making infections harder to treat 1. The misuse and overuse of antibiotics are the primary drivers of AMR, and healthcare-associated infections caused by multidrug-resistant organisms (MDROs) are a leading cause of morbidity and mortality worldwide 1.

Key Facts About AMR

• AMR is recognized by the World Health Organization (WHO) as a worldwide priority requiring urgent multisectoral action 1
• The most recent European Antimicrobial Resistance Surveillance Network (EARS-Net) report highlighted a substantial proportion of MDROs spreading in several European Union/European Economic Area (EU/EEA) countries 1
• More than one-half of the Escherichia coli and more than one-third of the Klebsiella pneumoniae isolates were resistant to at least one antimicrobial group 1
• Carbapenem-resistant Enterobacterales (CRE) represent a significant threat to healthcare systems in all EU/EEA countries 1

Combating AMR

• Healthcare providers should practice antimicrobial stewardship by prescribing antibiotics only when necessary, using the correct drug at the appropriate dose and duration, and following local resistance patterns 1
• Patients should take antibiotics exactly as prescribed, never share medications, and complete the full course even if feeling better
• Prevention strategies include proper hand hygiene, vaccination, infection control measures, and improved surveillance systems to track resistant organisms 1

Conclusion is not needed, and the answer is based on the most recent evidence 1

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.