Antimicrobial Use

Antimicrobial Resistance

World Health Organization
(Excerpted from Fact sheet N°194, updated April 2015)

What is antimicrobial resistance?
Antimicrobial resistance is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it.

Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g. antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.

The evolution of resistant strains is a natural phenomenon that occurs when microorganisms replicate themselves erroneously or when resistant traits are exchanged between them. The use and misuse of antimicrobial drugs accelerates the emergence of drug-resistant strains. Poor infection control practices, inadequate sanitary conditions and inappropriate food-handling encourage the further spread of antimicrobial resistance.

What is the difference between antibiotic and antimicrobial resistance?
Antibiotic resistance refers specifically to the resistance to antibiotics that occurs in common bacteria that cause infections. Antimicrobial resistance is a broader term, encompassing resistance to drugs to treat infections caused by other microbes as well, such as parasites (e.g. malaria), viruses (e.g. HIV) and fungi (e.g. Candida).

Why is antimicrobial resistance a global concern?
New resistance mechanisms emerge and spread globally threatening our ability to treat common infectious diseases, resulting in death and disability of individuals who until recently could continue a normal course of life.

Without effective anti-infective treatment, many standard medical treatments will fail or turn into very high risk procedures.

Antimicrobial resistance kills
Infections caused by resistant microorganisms often fail to respond to the standard treatment, resulting in prolonged illness, higher health care expenditures, and a greater risk of death.

As an example, the death rate for patients with serious infections caused by common bacteria treated in hospitals can be about twice that of patients with infections caused by the same non-resistant bacteria. For example, people with MRSA (methicillin-resistant Staphylococcus aureus, another common source of severe infections in the community and in hospitals) are estimated to be 64% more likely to die than people with a non-resistant form of the infection.

Antimicrobial resistance hampers the control of infectious diseases
Antimicrobial resistance reduces the effectiveness of treatment; thus patients remain infectious for a longer time, increasing the risk of spreading resistant microorganisms to others. For example, the emergence of Plasmodium falciparum multidrug resistance, including resistance to ACTs in the Greater Mekong subregion is an urgent public health concern that is threatening global efforts to reduce the burden of malaria.

Although MDR-TB is a growing concern, it is still largely under-reported, compromising control efforts.

Antimicrobial resistance increases the costs of health care
When infections become resistant to first-line drugs, more expensive therapies must be used. A longer duration of illness and treatment, often in hospitals, increases health care costs as well as the economic burden on families and societies.

Antimicrobial resistance jeopardizes health care gains to society
The achievements of modern medicine are put at risk by antimicrobial resistance. Without effective antimicrobials for prevention and treatment of infections, the success of organ transplantation, cancer chemotherapy and major surgery would be compromised.

Resistance in bacteria
WHO’s 2014 report on global surveillance of antimicrobial resistance revealed that antibiotic resistance is no longer a prediction for the future; it is happening right now, across the world, and is putting at risk the ability to treat common infections in the community and hospitals. Without urgent, coordinated action, the world is heading towards a post-antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill.

What accelerates the emergence and spread of antimicrobial resistance?
The development of antimicrobial resistance is a natural phenomenon. However, certain human actions accelerate its emergence and spread. The inappropriate use of antimicrobial drugs, including in animal husbandry, favours the emergence and selection of resistant strains, and poor infection prevention and control practices contribute to further emergence and spread of antimicrobial resistance.

Need for concerted actions

Antimicrobial resistance is a complex problem driven by many interconnected factors. As such, single, isolated interventions have little impact. Coordinated action is required to minimize emergence and spread of antimicrobial resistance.

The Centers for Disease Control and Prevention informed in 2015 that in the United States at least 23,000 people die each year as a direct result of antimicrobial resistance infections. The number of deaths in Europe is estimated as greater than 25,000 per year.

Antimicrobial Use graphic from International Livestock Research Institute. Fair use for noncommercial educational purposes. ILRI is a non-profit-making and non-governmental organization with headquarters in Nairobi, Kenya, and a second principal campus in Addis Ababa, Ethiopia. ILRI works in Africa, South and Southeast Asia, and China. It  works at the crossroads of livestock and poverty, bringing high-quality science and capacity-building to bear on poverty reduction and sustainable development.

Cartoon below from Lunatic Laboratories. Licensed under a Creative Commons Attribution-NonCommercial NoDerivs 3.0 Unported License. Lunatic Labs is a certified velociraptor-free workplace.

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