From the Guidelines
Antimicrobial resistance (AMR) is one of the most pressing global health threats today, causing approximately 1.27 million deaths worldwide each year and contributing to nearly 5 million deaths, making it imperative to address this issue to prevent a potential future where common infections become untreatable with existing medications. AMR occurs when bacteria, viruses, fungi, and parasites evolve to resist the effects of medications designed to kill them, making infections harder to treat and increasing the risk of disease spread, severe illness, and death 1. The importance of addressing AMR cannot be overstated, as it is caused primarily by the overuse and misuse of antimicrobial drugs in humans, animals, and agriculture.
Causes and Consequences of AMR
The overuse and misuse of antimicrobial drugs in humans, animals, and agriculture are well-established key drivers of AMR 1. Inappropriate use of antibiotics, such as using them when none are needed or using the wrong antibiotic at the wrong dose, for the wrong duration, and by the wrong route, is a common problem concerning between 30% and 50% of all antibiotic prescriptions 1. The COVID-19 pandemic has aggravated the widespread and inappropriate use of antibiotics, even though SARS-CoV-2 is a virus and infrequently complicated by bacterial superinfections 1.
Combating AMR
To combat AMR, healthcare providers should prescribe antibiotics only when necessary, using the correct drug, dose, and duration. Patients should take antibiotics exactly as prescribed, never share medications, and practice good hygiene to prevent infection spread. In agriculture, limiting antimicrobial use in healthy animals and improving sanitation in food production is essential. Our future depends on developing new antimicrobials, implementing better diagnostic tools to identify resistant infections quickly, and establishing global surveillance systems to track resistance patterns 1.
Global Surveillance and Action
The World Health Organization (WHO) has declared AMR as one of the top 10 global public health threats facing humanity, and it is essential to strengthen the knowledge and evidence base around AMR through increased research and surveillance 1. A comprehensive approach to infections across the surgical pathway, including a One Health approach, is required urgently to address the rising threat of AMR 1. Every hospital worldwide should utilize the existing resources to create an effective multidisciplinary team for combating AMR.
Key Recommendations
- Prescribe antibiotics only when necessary, using the correct drug, dose, and duration.
- Limit antimicrobial use in healthy animals and improve sanitation in food production.
- Develop new antimicrobials and implement better diagnostic tools to identify resistant infections quickly.
- Establish global surveillance systems to track resistance patterns.
- Practice good hygiene to prevent infection spread and never share medications.
Without immediate action, we risk entering a post-antibiotic era where minor infections could once again become deadly, routine medical procedures become high-risk, and the economic burden on healthcare systems becomes unsustainable 1.
From the Research
Importance of Antimicrobial Resistance (AMR)
- AMR is a serious threat to global public health, increasing morbidity and mortality, and associated with high economic costs due to its healthcare burden 2.
- Infections with multidrug-resistant (MDR) bacteria have substantial implications on clinical and economic outcomes 2.
- The indiscriminate use of antibiotics, such as during the COVID-19 pandemic, will heighten bacterial resistance and ultimately lead to more deaths 2.
Role of Antimicrobial Stewardship (AMS)
- AMS is an organizational or system-wide healthcare strategy designed to promote, improve, monitor, and evaluate the rational use of antimicrobials to preserve their future effectiveness 2.
- AMS practices, principles, and interventions are critical steps towards containing and mitigating AMR 2.
- A multifaceted approach, including prescriber education, formulary restriction, prior approval, streamlining, antibiotic cycling, and computer-assisted programs, is necessary to improve antibiotic use 3.
Community Healthcare Providers' Perceptions on AMR
- Healthcare providers are vital to reducing AMR, and their perceptions and experiences around the issue must be explored 4.
- Community nurses and physicians perceive that both environmental and human causes contribute to AMR, and that guidelines, patient and provider education, and top-down and bottom-up initiatives can facilitate reducing AMR 4.
- Barriers to addressing AMR include patient demands, physician pressures and fears, and systemic overworking of physicians 4.
Strategies for Antimicrobial Stewardship
- Education of healthcare providers is emphasized, and a rationale is provided with regard to the health, safety, and financial benefits that can be obtained from an ASP 5.
- Programs for optimal use, including a prospective audit and feedback strategy and preauthorization procedure, can be effective in reducing AMR 5.
- Targeted interventions, such as improving empirical ceftriaxone prescription in lower respiratory tract infections and urinary infections, can significantly reduce the inappropriate empirical use of ceftriaxone 6.