The Growing Concern of Antimicrobial Resistance

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Few will have heard that it is coming up. With Breast Cancer Awareness month just behind us, and “Movember” in full swing (also Lung Cancer Awareness and Diabetes month, for those keeping track), most people are unaware that November 17-23 is Antibiotic Awareness Week. The campaign, launched by the Public Health Agency of Canada, centers on the growing concern surrounding antibiotic resistance, both in Canada and globally. And, while it does not involve fun-runs, mustaches, or ice buckets, this is also a cause that deserves our attention.

A recent report from the Government of Canada suggests that, each year, more than 18,000 hospitalized patients acquire infections resistant to antimicrobials, with deaths related to Clostridium difficile alone increasing five-fold in the past decade. Studies have demonstrated increasing rates of resistance to commonly used antimicrobials in numerous microorganisms, including Staphylococcus aureus, Shigella, Salmonella, and Streptococcus pneumoniae (CCAR, 2009). Meanwhile, conservative estimates suggest the economic burden of antimicrobial resistance on the Canadian healthcare system could be as high as 200 million CAD (CCAR, 2009). Antimicrobial is not a new problem, but the convergence of improper use, globalization of food and travel, and emerging microbes have exacerbated the problem. Antimicrobial resistance is, in the words of the World Health Organization, “a crisis which threatens to rob the world of opportunities to treat or cure many infectious diseases”.

So, what is causing this problem and how can it be addressed? First, one of the main drivers of resistance is overuse of antibiotics. Every time we expose a microbe to an antibiotic, there is a chance that it will survive, becoming resistant and passing this trait on to the next generation. Thus, on of the best ways to improve the situation is by scaling up disease prevention efforts and improving prescription practices (CDC, 2013). Successful prevention efforts reduce demand for antibiotics, decreasing microbe-drug exposure. Meanwhile, conservative estimates suggest that approximately half of antimicrobials used in Canada alone are inappropriately prescribed. Antimicrobial stewardship is meant to not only limit inappropriate drug use, but to optimize antimicrobial selection, dosing, route, and duration to maximize benefits while minimizing unintended consequences. Moreover, while these measures can slow and even reverse resistance trends, there is also the need for increased investment in development of new antibiotics. For instance, in March 2008, there were only 15 potential investigational antimicrobials with new mechanisms of action, and only five had progressed to stage III testing or beyond. Lastly, antibiotic use in animals, which accounts for approximately 88% of antibiotic use by volume in Canada, must be reduced.

While these measures may be unpalatable to some, we should also consider the cost of inaction. While hoping to avoid sensationalism and hyperbole, it is not too difficult to imagine a doomsday scenario. Imagine a case where, as a result of rampant antimicrobial resistance, the world plunges back into the pre-antibiotic era. Modern medical procedures, such as nearly any surgical procedure, are predicated on antibiotics, and can no longer be safely conducted. A cut on your finger is potentially fatal in the absence of treatment to control invasive bacteria. Treatments for common diseases dwindle, as once relatively harmless infections become life-threatening.

While this is an extreme scenario, the reality is that antimicrobial resistance is a problem, and it is growing. So, maybe sometime next week, take a moment to think about how you can be a smarter user of antibiotics, and what role you can play in limiting the spread of antimicrobial resistance.

References

Canadian Committee on Antimicrobial Resistance (CCAR). (2009).      Pan-Canadian Stakeholder Consultations on Antimicrobial Resistance. Public Health Agency of Canada: Ottawa, ON.

Centers for Disease Control and Prevention. (2013). Antibiotic Resistance Threats in the United States, 2013. US Department of Health and Human Services: Atlanta, GA.

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Patrick Saunders-Hastings

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