fight against antimicrobial resistance

Antimicrobial Resistance Collaborative, “The Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis”, the Lancet, January 19, 2022 , https://doi.org/10.1016/S0140-6736(21)02724-0.

After two years of relentless talks about a pathogen ruling the world, over 52 million deaths occurred in this period, the Lancet Recently six other deadly pathogens (individually, or in combination with certain drugs) wreaked havoc in the world resulting in antimicrobial resistance (AMR) in 2019. A publication published at the end of January 2022 in the peer-reviewed journal estimated that 4.95 million deaths in 2019 were linked to bacterial antimicrobial resistance. Bacterial antimicrobial resistance occurs when the drugs used to treat the infection become less effective due to changes in the bacteria.

The first such comprehensive study on AMR globally, the paper by antimicrobial resistance collaborators, said AMR is a leading cause of death worldwide, with the highest number of deaths occurring in low-resource settings. “Understanding the burden of AMR and the key pathogen-drug combinations that contribute to it, particularly in the context of infection prevention and control programs, access to essential antibiotics, and research and development of new vaccines and antibiotics, are informed and location-specific.” Policy is important for decision making. “The authors have recommended.

large scale research

This study is an analysis of the AMR burden in 2019 for 204 countries and territories, 23 bacterial pathogens and 88 drug-pathogen combinations. They obtained data from multiple data sources – including published studies (microbiology data, in patient). data, data on multiple causes of death, and pharmaceutical sales data), and directly from collaborators in the Global Research on Antimicrobial Resistance Project, members of the Global Burden of Disease, Injury and Risk Factors collaborative network. Additionally, they calculated two counterfactual scenarios—one where all drug-resistant infections are replaced by susceptible infections, and second, a scenario where all drug-resistant infections are replaced by no-infections. The deaths and burden of AMR were estimated in these two scenarios, and served as a measure to inform the development of potential intervention strategies.

Among the six leading pathogens for resistance-associated deaths are E. coli, S. Aureus, K. pneumoniae, s. pneumoniae, a. baumannii and Pseudomonas aeruginosa. They accounted for 73.4% of deaths due to AMR, and have been identified by WHO as priority pathogens.

While the study was done in 2019, it is possible that the pandemic may have worsened the situation in terms of further escalating AMR levels. Dr. V. Ramasubramaniam, Senior Consultant, Department of Infectious Diseases, Apollo Hospitals, Chennai, points out that during the COVID-19 pandemic, the use of antibiotics increased. There was also a tendency to use antibiotics for patients on ventilators with fever. Secondly, due to the large number of patients during peak waves, the lack of appropriate infection control (as would be done in the case of patients with resistant bacteria) was made impossible. He explains that antibiotics are the only batch of drugs, used in one person, that can affect the rest of the community. When the gut biome is modified and excreted, it can contaminate land and water sources, thus further spreading resistant bacteria in the community.

“We have always known that the burden of AMR in the world was huge. If action was not taken it was not because of lack of data,” says Abdul Ghafoor, infectious disease specialist, Apollo Hospitals, and architect of the Chennai Declaration. “That’s because on a global scale, we’ve lost momentum.” India formulated its AMR policy in 2017, but only three states have launched a state action plan. According to official sources, 11 states are still working on a state action plan.

Action plan to control AMR

“We should apply the principles of COVID control to AMR control. The most effective strategy against COVID was deployed by? The public If you look at the global strategy, the public has been consistently kept out of the picture. We must involve the public, carpet bomb them with information and announce an AMR action plan that will get them under control. Another key strategy would be to ensure cleanliness and hygiene at all places. In a study we conducted among healthy volunteers, 14% of those carrying colistin-resistant bacteria in the gut that had a food source did not contract it in the hospital, Dr. Ghafoor said.

AMR, Reason Dr. Ramasubramaniam, is a classic case of ‘the tragedy of the common people’ where a perfect solution is elusive. “You have to use antibiotics, they are life saving. But there are many factors which affect such use like use of right drugs, right dosage/schedule to be followed, over the counter issue of antibiotics, farming and antibiotics used in some areas in poultry, as well as a lack of clear (by the medical community) incentives to follow guidelines and by the pharma industry to write prescriptions for antibiotics…”. The paper’s authors also make a strong case for improving sanitation around the world, as part of an intervention strategy to prevent infection. Community based programs that will improve sanitation, water and sanitation are essential along with implementing hospital based prevention programmes. This is especially important in low- and middle-income countries where the burden of AMR is highest and clean water and sanitation networks are hard to come by.

They also suggest that preventing infection through vaccination will automatically reduce the need for antibiotics. Currently, vaccines are available for only one of the six major pathogens (S. pneumoniae), but vaccine programs are reportedly ongoing for some others as well.

way forward

It is also important to reduce the exposure to antibiotics used in the agriculture sector and the poultry industry. In this context, Dr. Ghafoor points out that India’s move to ban the use of colistin in the poultry industry will go a long way in reducing the burden of AMR in the country.

Antibiotic management, or reducing the use of antibiotics unless absolutely necessary, is at the core of the fight against AMR. Dr. Ghafoor indicates strong community involvement in this aspect.

It is the hope of all allies who have waged the major war with bacterial antimicrobial resistance before and through the pandemic that this new data will provide immediate and innovative solutions to counter the single greatest burden that poses a major threat to global action. provides speed. for human health.