The increasing prevalence of antimicrobial resistance (AMR) is responsible for a significant increase in morbidity and mortality rates, as well as a subsequent increase in overall healthcare costs.
The etiology of AMR is multifaceted, and its consequences pose an impact across the globe. To adequately address AMR, it is necessary to take a One Health approach with integrated actions across human, animal, and environmental health sectors. AMR develops across the animal, human, and environment triangle or niche and there is interlinked sharing of pathogens in this triad. The plausible causes of AMR include overuse and misuse of antibiotics in animals (food, pets, and aquatic) and humans, antibiotics sold over-the-counter, increased international travel, poor sanitation/hygiene, and release of non-metabolized antibiotics or their residues into the environment through manure/feces. These factors contribute to selection pressure for the emergence of AMR in the community.
AMR has emerged as one of the principal public health problems of the 21st century that threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses, and fungi no longer susceptible to the common antimicrobial agents. The burden of AMR is especially urgent regarding antibiotic resistance in bacteria. Antibiotic resistance is a phenomenon resulting from the natural evolution of bacteria. Nonetheless, human activities accelerate the pace at which bacteria develop and spread resistance. The success of modernized medicine, namely organ transplantation, cancer therapy, management of preterm babies, or major surgeries, might not have been possible without effective antibiotic treatment to control for bacterial infections.
Healthcare workers should be aware of their role and responsibility for maintaining the effectiveness of current and future antimicrobials. They can fight this battle by:
- enhancing infection prevention and control;
- prescribing and dispensing antimicrobials only when they are truly needed;
- prescribing and dispensing the right antimicrobial(s) to treat the illness and
- controlling the source of infection when it is needed.
By optimizing the use of antibiotics, clinicians improve patient outcomes and minimize the chances of AMR.
The preferred means of improving antibiotic stewardship should involve a comprehensive program that incorporates collaboration between various specialties within a healthcare institution including infectious disease specialists, hospital pharmacists, clinical pharmacologists, administrators, epidemiologists, infection prevention and control specialists, microbiologists, surgeons, anesthesiologists, intensivists, and pivotal stewardship team members such as the surgical and intensive care nurses in our hospitals.
There is now a substantial body of evidence that effective teamwork in healthcare contributes to improved quality of care. Leading international organizations, acknowledge that collaborative practice is essential for achieving a concerted approach to providing care that is appropriate to meet the needs of patients, thus optimizing individual health outcomes and overall service delivery of health care. The use of such approaches reinforces the concept that each one brings with them their particular expertise and is responsible for their respective contributions to patient care.
Actions against AMR should focus firstly on local needs and national plans because each country is different. However, resistance is everyone’s problem and all countries have a role in solving the problem. The countries that have crafted inclusive national plans have been successful in controlling AMR. These approaches include cautious use of antibiotics, surveillance of antibiotics by employing the One Health approach, advancement of health care setup, restricted drug promotion, consistent disease control strategies, and stewardship plans. On the other hand, these strategies demand patience and time to be organized. Furthermore, these require a comprehensive endorsement from the government authorities with ample funds. However, AMR poses a global challenge. No single country, however effective it is at containing resistance within its boundaries, can protect itself from the importation of AMR through travel and trade. Working alone is not sufficient and international partnerships to seek global solutions to tackle AMR are mandatory. By collaborating, there are opportunities for disseminating the best approaches for prevention and management. The global nature of AMR calls for a global response, both in the geographic sense and across the whole range of sectors involved. Nobody is exempt from the problem.
Public health education and changes in behavior are critical. The current COVID-19 pandemic shows that despite all of our medical advances, we remain incredibly vulnerable to infections for which we have no treatment options. However, it shows that we can make massive changes in short time frames if sufficiently motivated.
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Massimo Sartelli