Looming threat of antimicrobial resistance

Imagine a world where a minor surgery or a brief hospitalisation could turn into a potentially life-threatening condition due to the lack of effective drugs to treat infections! This catastrophic prediction was made by Dr Alexander Fleming in 1945, during his speech on receiving the Nobel Prize for discovery of penicillin and the likely danger of developing resistance to this life-saving antibacterial drug.

AMR or Antimicrobial Resistance is a silent global pandemic where bacteria, viruses, fungi and parasites adapt over time and develop resistance mechanisms to currently available medicines, thereby rendering treatment ineffective; increasing the severity of illness and number of deaths. As resistant organisms are found in humans, animals, food and the environment, it is imperative to understand and quantify the role played by each of these sectors in the global emergence and spread of AMR. According to a recently published report from the Global Research on AntiMicrobial resistance (GRAM) project, an estimated 4.95 million people suffered from at least one drug-resistant infection and AMR directly caused 1.27 million deaths in 2019.

The COVID-19 pandemic has worsened the global AMR crisis on multiple fronts – due to a sudden surge and indiscriminate use of antibiotics, and diversion of critical investments to tracking and monitoring infection control practices. Due to the fear of acquiring infections with drug-resistant pathogens, broad-spectrum antibiotics were used for a prolonged duration in hospitalised patients with moderate to severe COVID-19 despite the lack of evidence of a bacterial infection. Without point-of-care diagnostic tools, which can reliably differentiate bacterial pneumonia from severe COVID-19 disease, the use of antibiotics is likely to continue.

The last decade saw a dramatic rise in AMR, attributable to ESKAPE -- an acronym for: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species. Today, we are in the midst of a crisis with limited treatment options and paucity of new antibiotics in the development pipeline. A lack of incentives for sustainable drug development has fuelled the exodus of big pharmaceutical players from this space.

The ongoing COVID-19 pandemic has highlighted the criticality of human-animal-environment interface and its direct impact on the emergence of zoonotic outbreaks, the necessity to promote and sustain biodiversity and the global adoption of agricultural and veterinary best practices with minimal use of antimicrobials in farming. A multi-pronged strategy embracing the “One Health” approach, which engages multiple players involving humans, animal and environmental health sectors, is important to devise mechanisms to tackle the dual pandemics of AMR and COVID-19.

A concerted global response to tackle COVID-19 to develop vaccines and new treatment modalities built through international partnership, global funding and political commitment provides a success framework and precedence to address the looming threat of AMR. Furthermore, timely investments in strengthening primary health care infrastructure, real-time AMR surveillance, data sharing and enduring global partnerships are essential for bridging the current knowledge gaps and supporting regional readiness to identify and thwart the emergence of new drug resistant pathogens across the globe.

What is needed is a significant investment in the development of affordable and reliable diagnostic tools to detect drug-resistant pathogens in real-time. This will guide clinical decision-making on the right antibiotic and the duration of treatment with current antibiotics and preserve the longevity of new antibiotics to be launched in the market.

Lastly, investment in sustained education and active engagement with the society is crucial to highlight and enable participation in this battle against AMR.

(The writer is Senior VP at Bugworks Research Pvt Ltd)