Dr Farooq Ulla Khan, ICU Consultant, Mahaveer Jain Hospital, Bengaluru highlights that the consequences of AMR are dire. Infections that were once easily treatable with antibiotics are becoming increasingly difficult, and sometimes impossible, to cure. This leads to increased mortality rates, as patients succumb to infections that their bodies can no longer fight
We live in an era of medical marvels. Diseases that once decimated populations are now treatable, often curable. Yet, a silent pandemic threatens to unravel this progress, pushing us towards a post-antibiotic era where common infections could once again become life-threatening. This silent threat is Antimicrobial Resistance (AMR), and its consequences are far-reaching, impacting patients, doctors, and hospitals alike. The gravity of this threat is evident in the alarming statistics: in 2021 alone, 1.14 million people died directly from AMR.[1]
AMR occurs when microorganisms like bacteria evolve to resist the drugs designed to kill them. This resistance develops primarily due to the overuse and misuse of antimicrobials, particularly antibiotics. Imagine a battlefield where soldiers (antibiotics) are deployed against an enemy (bacteria). Initially, the soldiers are successful, eliminating most of the enemy. However, a few resistant bacteria, possessing genetic mutations that protect them from the antibiotic, survive. These resistant bacteria then multiply, creating a new army impervious to the original weapon.
The overuse of antibiotics in human healthcare is a major driver of AMR. Often, antibiotics are prescribed for viral infections like the common cold or flu, against which they are ineffective. This unnecessary exposure provides an opportunity for bacteria within the body to develop resistance. Similarly, resistance can also develop when patients don’t complete their full course of prescribed antibiotics, a common form of misuse. When treatment is stopped prematurely, even if symptoms subside, some bacteria may survive and develop resistance to the antibiotic.
Beyond human healthcare, the widespread use of antibiotics in agriculture and animal farming plays a significant role in the rise of AMR. Antibiotics are often used in these settings not to treat infections, but as growth promoters in livestock. This practice exposes vast populations of bacteria to antibiotics, accelerating the development and spread of resistance. These resistant bacteria can then enter the human food chain through contaminated meat or produce, further exacerbating the problem.
The consequences of AMR are dire. Infections that were once easily treatable with antibiotics are becoming increasingly difficult, and sometimes impossible, to cure. This leads to increased mortality rates, as patients succumb to infections that their bodies can no longer fight. The severity of this crisis varies globally, with some regions facing greater challenges than others. For instance, when comparing AMR-related deaths across 204 countries, India ranks 60th, measured by age-standardised mortality rate per 100,000 population.[2]
Even when infections can be treated, recovery times are significantly longer, requiring extended hospital stays and placing a greater burden on healthcare systems. The economic costs associated with AMR are also substantial, including the cost of developing new antibiotics, longer hospital stays, and lost productivity.
Doctors are on the front lines of this battle, facing the frustration of dwindling treatment options and the heartbreaking task of informing patients that effective antibiotics are no longer available. They are forced to resort to older, less effective drugs, or combinations of drugs, which often carry significant side effects. The constant pressure to stay ahead of evolving resistance patterns and the emotional toll of witnessing the devastating impact of AMR on patients can be overwhelming.
Hospitals are significantly impacted by AMR and must take decisive action through comprehensive stewardship programs. The increased prevalence of resistant infections leads to longer hospital stays, higher healthcare costs, and a greater strain on resources. Modern healthcare facilities must implement strict Antibiotic Stewardship Policies, with a particular emphasis on Restricted Antibiotic Programs. These programs typically categorise antibiotics into different tiers, with certain broad-spectrum and last-resort antibiotics requiring special authorisation before prescription. Hospitals must also invest heavily in infection prevention and control measures, including robust surveillance systems, regular staff training, and state-of-the-art diagnostic capabilities.
Effective Antibiotic Stewardship Programs typically follow a structured approach. For example, many hospitals implement a “traffic light” system for antibiotic prescription: green for unrestricted antibiotics, amber for those requiring consultation with infectious disease specialists, and red for restricted antibiotics that need senior approval and regular review. This system is supported by mandatory documentation of the indication, duration, and review dates for all antibiotic prescriptions. Additionally, hospitals must maintain dedicated infection prevention teams responsible for surveillance, monitoring antibiotic resistance patterns, and ensuring compliance with hygiene protocols.
Addressing the challenge of AMR requires a multi-pronged approach, with Antibiotic Stewardship at its core. Healthcare facilities must prioritise the implementation of restricted antibiotic policies and invest in comprehensive infection prevention measures. This includes proper hand hygiene infrastructure, regular environmental cleaning, active surveillance for resistant organisms, and advanced diagnostic capabilities to ensure targeted antibiotic use. We need to promote responsible antibiotic use in human healthcare, reduce the use of antibiotics in agriculture and animal farming, and invest in the development of new antibiotics and alternative therapies. Public awareness campaigns are crucial to educate people about the risks of AMR and the importance of responsible antibiotic use. International collaboration is also essential to coordinate efforts and share best practices in combating this global threat.
The silent pandemic of AMR threatens to return us to a pre-antibiotic era where common infections become deadly once again. The time to act is now. We must work together – patients, doctors, hospitals, governments, and the agricultural industry – to preserve the effectiveness of these life-saving drugs and protect future generations from the devastating consequences of antimicrobial resistance.
References
[1] https://www.healthdata.org/research-analysis/health-risks-issues/antimicrobial-resistance-amr#
[2] https://www.healthdata.org/sites/default/files/2023-09/India.pdf
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