A continuous surge in antimicrobial resistance

Antimicrobial resistance (AMR) is the 21st-century global public health problem. AMR occurs when microbes, such as bacteria, viruses, fungi and parasites stop responding to antimicrobial medicines. Because of the high rate of antibiotic overuse that leads to alterations in the bacterium itself, bacterial AMR poses the greatest concern. AMR is predicted to cause 10 million deaths annually by 2050, according to The Review on Antimicrobial Resistance, a UK government program [1]. WHO and other organizations acknowledge that a promptly coordinated worldwide strategy is necessary to fight AMR, even though they do not agree with this estimate. For this reason, statistics about the present global burden of bacterial AMR and its regional patterns are needed. Future generations will see the emergence of increasingly deadly infections that are incurable if effective management is not implemented. This article sheds light on global trends and developments pertaining to antimicrobial resistance in bacteria. 

                                                                                            Dr Vikrant Kumar

All India Institute of Medical Sciences, New Delhi

Global trends of antimicrobial resistance 

A research that was published in The Lancet estimates that 4.9 million deaths worldwide in 2019 were related to bacterial AMR [2]. It further states that the worldwide burden of bacterial AMR was caused by three infectious syndromes: bloodstream infections, intra-abdominal infections, and lower respiratory and thoracic infections. Six pathogens (E coli, Staphylococcus aureus, K pneumoniae, S pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) were responsible for majority of the deaths linked to AMR. 

Image caption: Mortality rate due to bacterial resistance to antibiotics in 2019. Source: Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis [2]

Antimicrobial resistance in India

India has one of the highest incidences of AMR worldwide and is an emerging hub for bacterial AMR. AMR’s burden in India is mostly caused by over-the-counter availability of drugs, unrestricted and excessive human use, antibiotic use in poultry and agriculture, public ignorance, and shortcomings in national surveillance and monitoring of AMR. Antimicrobial resistance in India is further exacerbated by inadequate use of diagnostics, overcrowding that increases the risk of cross-infections, over prescription by physicians, and inadequate health infrastructure. The Indian Council of Medical Research (ICMR) annual report on the antimicrobial resistance research and surveillance network (2022) stated that E. coli, which causes meningitis, pneumonia, bacteremia, abdominal and pelvic infections, urinary tract infections, and infections, has become less susceptible to major antibiotics [3].  According to the data, E. Coli resistance to piperacillin-tazobactam climbed from 35% to 56% between 2017 and 2022, while resistance to ceftazidime increased from 18% to 23% and resistance to ciprofloxacin from 12% to 19%. S. aureus has also shown a noticeable upward trend in antibiotic resistance over time against clindamycin and cefoxitin. Similar trends were reported for Klebsiella pneumoniae, a causative agent of pneumonia, bloodstream infections, and meningitis. K. pneumoniae’s sensitivity to imipenem decreased gradually during the previous six years, falling from 59% in 2017 to 42% in 2022. There has been a modest and inconsistent drop in meropenem susceptibility for K. pneumoniae. Nearly, 88% of the Acinetobacter baumannii isolates were resistant to carbapenems and left with limited treatment options. Against A. baumannii, piperacillin/tazobactam, cefepime, ceftazidime, amikacin and levofloxacin showed limited activity. When it comes to hospital-acquired infections, Pseudomonas aeruginosa infections are becoming a major concern, especially in patients who are very sick or have compromised immune systems. P. aeruginosa cause post-surgery infections in the blood, lungs (pneumonia), and/ or other body parts. These bacteria persistently find a new way to evade the effects of the antibiotics and become resistant to the treatment. The growth of drug-resistant bacteria is the main reason for the higher mortality rates. During 2017 to 2022, an increasing resistance was observed in P. aeruginosa against the majority of antibiotics- ceftazidime (41.2% to 43.6%), cefepime (46.1% to 48.1%), imipenem (40.5% to 51.1% ), meropenem (47.9% to 54.1% &), amikacin (51.4% & 60.4%), gentamicin (44.4% to 48.2%), tobramycin (50.1% to 65.8%), ciprofloxacin (35.9% to 38.5%) and levofloxacin (33.3% to 42.6%).

Image Caption: Trends of antibiotic resistance among major bacterial strains from 2017-2022. Source: Annual report on antimicrobial resistance research and surveillance network (2022), ICMR [3]

Conclusive Remarks

The use of antibiotics is a cornerstone of modern medicine. The emergence and spread of bacteria resistant to drugs threatens our ability to treat common illnesses and perform life-saving procedures. Antibiotic resistance is a major global health issue that decreases the efficacy of traditional treatments against common bacterial infections. The abuse and overuse of antibiotics in humans, animals, and plants are the main factors contributing to the formation of drug-resistant diseases. AMR affects all important sects a country leading to social and economic burden. Its primary causes are poverty and inequality, with low- and middle-income countries being most affected. The present AMR crisis highlights the urgent need for improved antimicrobial practices and broader surveillance coverage on a worldwide scale. In addition, awareness programs by local governments can help in reducing the cases of antibiotic abuse.

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