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Antimicrobial resistance

Two petri dishes with antibiotic resistance tests
Antibiotic resistance tests: Bacteria are streaked on dishes with white disks, each impregnated with a different antibiotic. Clear rings, such as those on the left, show that bacteria have not grown—indicating that these bacteria are not resistant. The bacteria on the right are fully resistant to three of seven and partially resistant to two of seven antibiotics tested.[1]

Antimicrobial resistance (AMR) occurs when microbes evolve mechanisms that protect them from the effects of antimicrobials (drugs used to treat infections).[2] All classes of microbes can evolve resistance to the point that one or more drugs used to fight them are no longer effective. Fungi evolve antifungal resistance, viruses evolve antiviral resistance, protozoa evolve antiprotozoal resistance, and bacteria evolve antibiotic resistance. Together all of these come under the umbrella of antimicrobial resistance.

Microbes resistant to multiple antimicrobials are called multidrug resistant (MDR) and are sometimes referred to as superbugs.[3] Although antimicrobial resistance is a naturally occurring process, it is often the result of improper usage of the drugs and management of the infections.[4][5]

Antibiotic resistance is a major subset of AMR, that applies specifically to bacteria that become resistant to antibiotics.[2] Resistance in bacteria can arise naturally by genetic mutation, or by one species acquiring resistance from another.[6] Resistance can appear spontaneously because of random mutations, but also arises through spreading of resistant genes through horizontal gene transfer. However, extended use of antibiotics appears to encourage selection for mutations which can render antibiotics ineffective.[7] Antifungal resistance is a subset of AMR, that specifically applies to fungi that have become resistant to antifungals. Resistance to antifungals can arise naturally, for example by genetic mutation or through aneuploidy. Extended use of antifungals leads to development of antifungal resistance through various mechanisms.[8]

Clinical conditions due to infections caused by microbes containing AMR cause millions of deaths each year.[9] In 2019 there were around 1.27 million deaths globally caused by bacterial AMR.[10] Infections caused by resistant microbes are more difficult to treat, requiring higher doses of antimicrobial drugs, more expensive antibiotics, or alternative medications which may prove more toxic. These approaches may also cost more.[4][5]

The prevention of antibiotic misuse, which can lead to antibiotic resistance, includes taking antibiotics only when prescribed.[11][12] Narrow-spectrum antibiotics are preferred over broad-spectrum antibiotics when possible, for effectively and accurately targeting specific organisms is less likely to cause resistance as well as side effects.[13][14][15] For people who take these medications at home, education about proper use is essential. Health care providers can minimize the spread of resistant infections by use of proper sanitation and hygiene, including handwashing and disinfecting between patients, and should encourage the same of every patient, visitor, and family member.[16]

Rising drug resistance is caused mainly by use of antimicrobials in humans and other animals and the spread of AMR strains between the two.[11] Growing resistance has also been linked to releasing inadequately treated effluents from the pharmaceutical industry, especially in countries where bulk drugs are manufactured.[17] Antibiotics increase selective pressure in bacterial populations, killing vulnerable bacteria; this increases the percentage of resistant bacteria, which continue growing. Even very low levels of antibiotic can give resistant bacteria an advantage in growing and reproducing faster than vulnerable bacteria.[18] Similarly, the use of antifungals in agriculture increases selective pressure in fungal populations, causing antifungal resistance.[8] As resistance to antimicrobials becomes more common there is a much greater need for alternative treatments. Calls for new antimicrobial therapies have been issued, but there is very little development of new drugs and consequently little innovation in the process of researching potential candidates for them.[19]

Antibiotic resistance is increasing globally due to increased prescribing and dispensing of antibiotic drugs in developing countries.[20] Estimates are that 700,000 to several million deaths worldwide result annually from antibiotic resistance, so it continues to pose a major public health threat.[21][22][23] Each year in the United States, at least 2.8 million people become infected with antibiotic-resistant bacteria, at least 35,000 of them die, and US$55 billion is spent on all their health care costs and lost productivity.[24][25] According to the World Health Organization (WHO) estimates, 350 million deaths could be caused by AMR by 2050.[26] By then, the yearly death toll will be 10 million, according to a United Nations report.[27]

Public calls for global collective action to address the threat include proposals for international treaties on antimicrobial resistance.[28] The burden of worldwide antibiotic resistance is not completely identified, but low-and middle- income countries with weaker healthcare systems are more affected, with mortality being the highest in sub-Saharan Africa.[10][12] During the COVID-19 pandemic, priorities changed, and action against AMR slowed because scientific and government focus moved to the more pressing problem of SARS-CoV-2 research.[29][30] At the same time, the threat of AMR increased.[31]

  1. ^ Kirby-Bauer Disk Diffusion Susceptibility Test Protocol Archived 26 June 2011 at the Wayback Machine, Jan Hudzicki, ASM
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  17. ^ "Impacts of Pharmaceutical Pollution on Communities and Environment in India" (PDF). Nordea. February 2016. Archived (PDF) from the original on 20 May 2017. Retrieved 1 May 2018.
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  21. ^ Dramé O, Leclair D, Parmley EJ, Deckert A, Ouattara B, Daignault D, et al. (August 2020). "Antimicrobial Resistance of Campylobacter in Broiler Chicken Along the Food Chain in Canada". Foodborne Pathogens and Disease. 17 (8): 512–520. doi:10.1089/fpd.2019.2752. PMC 7415884. PMID 32130036.
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