Antimicrobial resistance (AMR) is resistance of a microorganism to an antimicrobial medicine to which it was originally sensitive. Resistant organisms (they include bacteria, fungi, viruses and some parasites) are able to withstand attack by antimicrobial medicines, such as antibiotics, antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist increasing risk of spread to others. The evolution of resistant strains is a natural phenomenon that happens when microorganisms are exposed to antimicrobial drugs, and resistant traits can be exchanged between certain types of bacteria. The misuse of antimicrobial medicines accelerates this natural phenomenon. Poor infection control practices encourages the spread of AMR.
The researchers note that antibiotic resistance causes an estimated minimum of two million illnesses and 23,000 deaths per year, and one of the most urgent threats is Clostridium difficile, which causes an estimated minimum of 250,000 illnesses and 14,000 deaths per year. The estimated costs of antibiotic resistance could be as high as $20 billion in direct costs and $35 billion in indirect costs such as lost productivity. Antibiotic use is the most important factor leading to antibiotic resistance, with up to 50 percent of antibiotics prescribed inappropriately. The spread of resistant strains from person to person or from non-human sources is also a major factor in antibiotic resistance. The four core actions to combat antibiotic-resistant infection are prevention of infections and of the spread of resistance; tracing resistant bacteria; improving antibiotic use; and promoting the development of new antibiotics.
The use of antibiotics in agriculture is also a huge problem. It is estimated that more than half of the antibiotics in the United States are used in the production of animal food. The pigs and cows and chickens who receive these antibiotics develop resistant bacteria themselves and the humans who eat them (or drink their milk, or eat their eggs) ingest the same antibiotics the animals get, increasing their risk to bacterial resistance. (It’s important to remember that people don’t develop resistance to antibiotics. Rather, it’s the bacteria that cause infections in people that become resistant.) The U.S. Food and Drug Administration (FDA) understands the problem:
The U.S. Food and Drug Administration today is implementing a plan to help phase out the use of medically important antimicrobials in food animals for food production purposes, such as to enhance growth or improve feed efficiency. The plan would also phase in veterinary oversight of the remaining appropriate therapeutic uses of such drugs.
Certain antimicrobials have historically been used in the feed or drinking water of cattle, poultry, hogs, and other food animals for production purposes such as using less food to gain weight. Some of these antimicrobials are important drugs used to treat human infection, prompting concerns about the contribution of this practice to increasing the ability of bacteria and other microbes to resist the effects of a drug. Once antimicrobial resistance occurs, a drug may no longer be as effective in treating various illnesses or infections.
Because antimicrobial drug use in both humans and animals can contribute to the development of antimicrobial resistance, it is important to use these drugs only when medically necessary. The plan announced today focuses on those antimicrobial drugs that are considered medically important (i.e., are important for treating human infection) and which are approved for use in feed and water of food animals.
In the video below, Dr. Karl Klose clearly explains the mechanisms by which bacteria become resistant, leading to the “global crisis” of antimicrobial resistance he says we now face:
The key to solve any problem is first to become aware and educated. Pediatricians are well aware that we are part of the problem and more judicious use of antibiotics is required of us (and all physicians). More and more parents understand the concept of resistance and are more likely to ask us “why” when we prescribe antibiotics for their children. Although there has been some reluctance to change agricultural practices in the U.S., there are now plans in place to allow those changes to take place. The crisis may be global, but its solution lies with you and me.
Watch the informative-yet-frightening PBS Frontline episode “Hunting the Nightmare Bacteria” here.