ANTIMICROBIAL RESISTANCE AWARENESS
I’ve always known, even as a child, that I’d grow up to work in healthcare.
There was never a doubt about it, it was always so clear in my mind.
Which is ironic, considering the number of times I’ve considered dropping
out of med school in the last year, which is more times than I’d like to
count.
Which leads me to my opening- for someone who’s been certain about
working in a hospital their whole life, I was surprised to find out that I
knew astonishingly little about antimicrobial resistance and it’s
implications in our day and society, and its vital importance in healthcare.
So let’s start at the very beginning.
ANTIMICROBIAL RESISTANCE: WHAT IS IT ALL ABOUT?
Antimicrobial resistance occurs when microbes like bacteria, fungi,
parasites, etc evolve and change over time to a point where they don’t
respond to drugs or medicines, which make it difficult to treat such
infections, and thus, increasing the risk for increase in the spread of
disease.
According to WHO, “Antimicrobial resistance (AMR) threatens the effective
prevention and treatment of an ever-increasing range of infections caused
by bacteria, parasites, viruses and fungi”.
Not only does this feed into an ever-growing need to discover new drugs
that are effective, but also feeds into the vicious cycle of the spread of
pathogens.
Microorganisms that do develop a resistance against antimicrobials are
often termed as ‘superbugs’
AMR TYPES:
i) Intrinsic resistance- a natural characteristic that the microbe possesses
that makes it resistant to antimicrobials.
An example of this would be Enterococci bacteria being resistant to low
levels of aminoglycosides due to their thick peptidoglycan layer.
ii) Extrinsic resistance- A microbe that has previously encountered a drug
might develop a resistance to the same drug when exposed to it again.
This can be due to mutation by acquiring new genetic material.
A classic example of this is Methicillin-resistant Staphylococcus aureus
(MRSA) which is caused by a change in the bacterial DNA that alters the
penicillin binding protein (PBP). This change makes the PBP less effective
at binding to b lactam antibiotics, such as methicillin.
Interestingly, the most common type of AMR is exhibited by MRSA. They
start as small red bumps on the skin, and eventually progress into deep,
painful abscesses and boils, which are pus-filled masses under the skin.
HOW DID ANTIMICROBIAL RESISTANCE BECOME AN IMPORTANT
CONVERSATION?
The concept of AMR was first noted in the 1940 when Oxford researchers
Edward Abraham and Chain discovered an enzyme that could break down
penicillin in E.coli.
This was shortly after the discovery of penicillin in 1928 by Alexander
Fleming.
In 1961, multiresistant Staphylococcus aureus, including methicillin and
penicillin resistance started becoming more common.
By the 80’s, multiresistant Gram negative bacteria became more common,
particularly to penicillins and cephalosporins. In 1988, Vancomycin
resistant Enterococcus was discovered.
AMR Awareness
So clearly, we were in an obvious need for raising awareness amongst
both doctors and medical students in medicine, as well as the general
public.
World Antibiotic Awareness Week was first launched in 2015, and was re-
branded in 2020 as the World Antimicrobial Awareness Week (WAAW)
Thus, this year, the WAAW is being observed from 18 th November- 24th
November of 2024. It’s purpose is to improve knowledge about AMR and
reduce its impact.
AWARENESS IN HEALTHCARE:
Healthcare providers can help combat AMR by:
i) Complying with hospital infection control and antibiotic policies
ii) Proper waste disposal, especially of fecal matter which can contain
resistant microbes which can survive plumbing and splash onto people.
iii) Sterilization- taking proper aseptic precaution while handling surgery
equipment. Educating other healthcare providers about AMR and aseptic
practices
iv) Inculcating patients regarding treatment compliance
v) Educating patients about antibiotics
AWARENESS AMONG GENERAL PUBLIC:
i) Practice good hygiene- washing hands regularly, especially before and
after handling food, using the washroom, changing diapers, etc. Using a
handkerchief or tissue to cover coughs and sneezes.
ii) Use antibiotics properly- using them only as prescribed by the doctor,
not any more than required. Complete the course of the antibiotic that is
prescribed. Keep antibiotics out of reach of children, and only administer
the recommended and prescribed dosage to them.
iii) Get vaccinated
iv) Prepare food safely- use clean products, maintain a clean space and
kitchen
v) Talk to a healthcare professional regarding any doubts on antibiotics,
their dosages and requirements- a common misconception is that taking
antibiotics helps with viral diseases when it in fact, does not. And taking
antibiotics while one has a viral disease is unnecessary and slowly but
surely increases AMR within the body.
vi) Never take an antibiotic prescribed to someone else.
AN IMPORTANT CONVERSATION TODAY- AMR
In the key facts mentioned under a WHO article:
“AMR puts many of the gains of modern medicine at risk. It makes
infections harder to treat and makes other medical procedures and
treatments – such as surgery, caesarean sections and cancer
chemotherapy – much riskier.
In addition to death and disability, AMR has significant economic costs.
The World Bank estimates that AMR could result in US$ 1 trillion additional
healthcare costs by 2050, and US$ 1 trillion to US$ 3.4 trillion gross
domestic product (GDP) losses per year by 2030”.
Day by day, microbes are evolving, mutating. This poses a major issue in
our case because diseases are only ever growing. And the fact that now,
in this day and age, even though we have the resources and information
to create new drugs- it will never be enough because of the rampant
antimicrobial resistance amongst the individuals in our society.
And thus, the importance of AMR becomes evident: to prevent the spread
of all infection- or at least the ability to control them and keep them in
check. Regardless of the technological advances, change will only be
made possible if every single person, yes, every single person in our
community actively tries to do their part to make a change.
