WHAT EXACTLY ARE ANTIMICROBIALS?
Antimicrobials are medications that are used to prevent and treat infections in humans, animals, and plants. They include antibiotics, antivirals, antifungals, and antiparasitics.
WHAT PRECISELY IS ANTIMICROBIAL RESISTANCE?
Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi, and parasites evolve and no longer respond to antibiotics, making infections more difficult to treat and increasing the risk of disease spread, severe illness, and death. Antibiotics and other antimicrobial medicines become ineffective as a result of drug resistance, and infections become increasingly difficult or impossible to treat.
WHY IS ANTIMICROBIAL RESISTANCE A PROBLEM ALL ACROSS THE WORLD?
- The emergence and spread of drug-resistant pathogens that have acquired new resistance mechanisms, leading to antimicrobial resistance, continue to threaten our ability to treat common infections.
- Especially alarming is the rapid global spread of multi- and pan-resistant bacteria (also known as “superbugs”) that cause infections that are not treatable with existing antimicrobial medicines such as antibiotics.
- Furthermore, a lack of access to quality antimicrobials remains a major issue.
- Antibiotics are becoming increasingly ineffective as drug resistance spreads globally leading to more difficult-to-treat infections and death.
- Without effective tools for the prevention and adequate treatment of drug-resistant infections and improved access to existing and new quality-assured antimicrobials, the number of people for whom treatment is failing or who die of infections will increase.
WHAT CAUSES ANTIMICROBIAL RESISTANCE TO EMERGE AND SPREAD MORE QUICKLY?
- AMR occurs naturally over time, usually through genetic changes.
- Antimicrobial-resistant organisms are found in people, animals, food, plants, and the environment (in water, soil, and air).
- The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials; lack of access to clean water, sanitation, and hygiene (WASH) for both humans and animals; poor infection and disease prevention and control in healthcare facilities and farms; poor access to quality, affordable medicines, vaccines and diagnostics; lack of awareness and knowledge; and lack of enforcement of legislation.
DRUG RESISTANCE IN BACTERIA
- For common bacterial infections, including urinary tract infections, sepsis, sexually transmitted infections, and some forms of diarrhea, high rates of resistance against antibiotics frequently used to treat these infections have been observed worldwide, indicating that we are running out of effective antibiotics.
- Klebsiella pneumoniae are common intestinal bacteria that can cause life-threatening infections.
- This indicator monitors the frequency of bloodstream infections due to two specific drug-resistant pathogens: methicillin-resistant Staphylococcus aureus (MRSA); and E. coli resistant to third-generation cephalosporins (3GC).
DRUG RESISTANCE IN VIRUSES
- Antiviral drug resistance is an increasing concern in immunocompromised patient populations, where ongoing viral replication and prolonged drug exposure lead to the selection of resistant strains.
- Levels of pretreatment HIVDR (PDR) to non-nucleoside reverse-transcriptase inhibitors (NNRTIs) among adults initiating first-line therapy exceeded 10% in the majority of the monitored countries in Africa, Asia and Latin America.
- WHO’s HIV drug resistance program is monitoring the transmission and emergence of resistance to older and newer HIV drugs around the globe.
DRUG RESISTANCE IN MALARIA PARASITES
- Artemisinin-based combination therapies (ACTs) are the recommended first-line treatment for uncomplicated P. falciparum malaria and are used by most malaria-endemic countries.
- In the WHO Western Pacific Region and in the WHO South-East Asia Region, partial resistance to artemisinin and resistance to a number of the ACT partner drugs has been confirmed in Cambodia, Lao People’s Democratic Republic, Myanmar, Thailand, and Viet Nam through studies conducted between 2001 and 2019.
- However, further spread of resistance to artemisinin and ACT partner drugs could pose a major public health challenge and jeopardize important gains in malaria control.
DRUG RESISTANCE IN FUNGI
- Many fungal infections have existing treatability issues such as toxicity, especially for patients with other underlying infections (e.g. HIV).
- Drug-resistant Candida Auris, one of the most common invasive fungal infections, is already widespread with increasing resistance reported to fluconazole, amphotericin B, and voriconazole as well as emerging caspofungin resistance.
- WHO is undertaking a comprehensive review of fungal infections globally and will publish a list of fungal pathogens of public health importance, along with an analysis of the antifungal development pipeline.
THE NECESSITY OF CONCERTED ACTION
- The One Health approach brings together multiple sectors and stakeholders engaged in human, terrestrial and aquatic animal and plant health, food and feeds production, and the environment to communicate and work together in the design and implementation of programs, policies, legislation, and research to attain better public health outcomes.
- Greater innovation and investment is required in operational research, and in the research and development of new antimicrobial medicines, vaccines, and diagnostic tools especially those targeting the critical gram-negative bacteria such as carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii.
- The launch of the Antimicrobial Resistance Multi-Partner Trust Fund (AMR MPTF), the Global Antibiotic Research & Development Partnership (GARDP), the AMR Action Fund, and other funds and initiatives could fill a major funding gap.
ANTIMICROBIAL RESISTANCE GLOBAL ACTION PLAN (GAP)
- Globally, countries committed to the framework set out in the Global Action Plan1 (GAP) 2015 on AMR during the 2015 World Health Assembly and committed to the development and implementation of multisectoral national action plans.
- To ensure global progress, countries need to ensure the costing and implementation of national action plans across sectors to ensure sustainable progress.
- Prior to the endorsement of the GAP in 2015, global efforts to contain AMR included the WHO global strategy for containment of Antimicrobial Resistance developed in 2001 which provides a framework of interventions to slow the emergence and reduce the spread of AMR.
WORLD ANTIMICROBIAL AWARENESS WEEK (WAAW)
- Held annually since 2015, WAAW is a global campaign that aims to raise awareness of antimicrobial resistance worldwide and encourage best practices among the general public, health workers, and policymakers to slow the development and spread of drug-resistant infections.
- The Tripartite Executive Committee decided to set all future WAAW dates as 18 to 24 November.
- The overarching slogan used for the last 5 years was “Antibiotics: Handle with Care.”