Antimicrobial resistance (AMR), also known as antibiotic resistance, poses a major threat to public health as the burden of drug-resistant infections escalates. Conditions that could previously be treated with first-line medication are now becoming more difficult to treat as is the case with drug-resistant tuberculosis (TB).
AMR has emerged as a bigger killer in Africa than malaria, HIV or TB. According to a Lancet study, in 2019, around 1.05 million deaths were associated with bacterial AMR and 250,000 deaths were directly attributable to bacterial AMR in the WHO African region.
Yoliswa Sobuwa spoke with Dr Caroline Maluleka, Acting Head of the Centre for Healthcare Associated Infections, Antimicrobial Resistance and Mycoses (CHARM) at the National Institute for Communicable Diseases (NICD) about the impact of AMR on the treatment of a wide range of diseases, putting lives at risk and straining the health system.
What is AMR and what impact does it have on public health?
Antimicrobial resistance occurs when organisms such as bacteria, viruses, fungi, and parasites resist the effects of medications. This makes common infections harder to treat, which increases the risk of spreading diseases.
The medications used to treat these infections are called antimicrobials. The most common type of antimicrobials we are well aware of are antibiotics. When antibiotics are over-used they can create bacteria that are harder to kill.
AMR impacts public health because there is a higher death rate from untreatable infections. And patients have longer stays in hospitals since the infection isn’t cleared as easily.
What is the potential long-term impact of AMR on the health system?
Without sufficient effort to combat AMR, we may suffer from an overburdened healthcare infrastructure and the serious economic consequences of a reduced workforce.
Common infections and medical procedures become riskier, raising mortality rates and reducing patients’ quality of life.
Resistant infections lead to longer hospital stays and expensive treatments, straining national healthcare budgets.
AMR impairs breakthroughs in medicine, complicating procedures and limiting treatment options for critical conditions. Untreatable infections could lead to global health emergencies, increasing insecurity and political instability.
What are the primary drivers?
AMR is an inevitable occurrence because organisms evolve all the time.
However, many human activities speed up the process by adding pressure to the evolutionary process.
The most important drivers of AMR are the overuse and misuse of antimicrobials in human health and animal agriculture, poor monitoring and regulation of antimicrobial use, poor sanitation, hygiene, infection control and inadequate diagnostics.
From the environmental perspective, poor waste management and antimicrobial pollution from manufacturing sites are important drivers for the spread of diseases.
What are the key pathogens driving the rise of AMR and why are they so resilient to treatment?
The World Health Organisation (WHO) has highlighted several bacterial and fungal pathogens causing the greatest number of deaths worldwide and for which newer treatments are required urgently.
These pathogens are known as the WHO fungal priority pathogens and bacterial priority pathogens. In general, these organisms are able to resist current treatments and are also able to survive for long periods of time in the healthcare environment.
The priority pathogens are classified based on the urgency of the need for new medications as critical, high and medium.
How does AMR affect treatment outcomes for common infections such as pneumonia, urinary tract infections and sepsis?
Urinary tract infections and pneumonia can usually be treated with oral medication as outpatients. As the organisms become more resistant, the only treatment options may be those that must be given via intravenous lines (drip).
This means that the patient has to be admitted to the hospital instead of taking the treatment from home.
AMR affects the treatment of sepsis by requiring expensive, last-resort antimicrobials or less effective and toxic antimicrobials.
This can result in severe side effects of the medication and difficulty clearing the infection.
How does AMR affect vulnerable populations?
Vulnerable populations including the elderly, children and those with chronic diseases often have weaker immune systems and greater healthcare needs.
This means they usually have a higher exposure to antimicrobials compared to the general population.
These vulnerable populations are therefore more susceptible to infections and tend to have higher mortality, longer hospital stays, and worse complications of the infections.
What are the other most effective strategies for preventing the spread of AMR?
Preventing the spread of AMR in healthcare settings requires several strategies. It is also important to remember that everyone has a role to play in combating AMR.
The strategies include infection prevention and control measures such as good hand-washing practices and disinfecting hospital equipment and surfaces.
Antimicrobial stewardship programmes are a critical way to make sure antimicrobials are prescribed appropriately and are not misused or overused.
It is also important to monitor the resistance trends and track the emergence of new resistance mechanisms using surveillance. Education and training cannot be overstated and is a very important aspect of AMR prevention.
Education is not limited to healthcare professionals but also to patients and families as well as the general public.
How can healthcare professionals, policymakers and the public create a more coordinated response to AMR?
AMR is a multidisciplinary issue involving the health, agriculture and environmental sectors.
For a sustainable effort in addressing AMR, it is so important that there is coordination between these groups.
These groups need to work together to strengthen surveillance, infection prevention and control and promote responsible use of antimicrobials. It is also important that they advocate for equitable access to diagnostics and treatments.
They must also advocate for policy enforcement. – Health-e News
Source:
health-e.org.za
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