Monday, November 28, 2022

How To Slow Antibiotic Resistance

What Does Antibiotic Resistance Mean For You Your Family And The Community

Slowing the spread of Antimicrobial Resistance (AMR)

Antibiotic resistance is a major concern because it means some infections will become more difficult, and sometimes impossible, to treat. If you or someone in your family develop an antibiotic-resistant infection:

  • you may have the infection for longer
  • you may be more likely to have complications from the infection
  • you could remain infectious for longer and pass your infection to other people.

Infections caused by antibiotic-resistant bacteria are harder to treat, usually last longer, often result is longer stays in hospital and are associated with more complications. In serious cases they can cause death. Doctors have to use to less conventional antibiotics or a combination of different antibiotics to treat these infections. These are usually more costly and can have more-serious side effects. In New Zealand, the occurrence of antibiotic-resistant bacteria is increasing. Examples of antibiotic-resistant bacteria include:

  • Methicillin-resistant Staphylococcus aureus a group of bacteria that are resistant to commonly used penicillin-like antibiotics
  • Extended spectrum beta-lactamases chemicals produced by some bacteria that prevent certain antibiotics from working.
  • Vancomycin-resistant enterococci a group of bacteria that are resistant to the antibiotic vancomycin.

Transmission Of Antibiotic Resistant Bacteria In Hospitals

The common ways in which bacteria can be passed from person to person include:

  • contact with contaminated hands of hospital staff
  • contact with contaminated surfaces such as door handles, over-bed tables and call bells
  • contact with contaminated equipment, such as stethoscopes and blood pressure cuffs.

Why Is Antimicrobial Resistance A Global Concern

The emergence and spread of drug-resistant pathogens that have acquired new resistance mechanisms, leading to antimicrobial resistance, continues to threaten our ability to treat common infections. Especially alarming is the rapid global spread of multi- and pan-resistant bacteria that cause infections that are not treatable with existing antimicrobial medicines such as antibiotics.

The clinical pipeline of new antimicrobials is dry. In 2019 WHO identified 32 antibiotics in clinical development that address the WHO list of priority pathogens, of which only six were classified as innovative. Furthermore, a lack of access to quality antimicrobials remains a major issue. Antibiotic shortages are affecting countries of all levels of development and especially in health- care systems.

Antibiotics are becoming increasingly ineffective as drug-resistance spreads globally leading to more difficult to treat infections and death. New antibacterials are urgently needed for example, to treat carbapenem-resistant gram-negative bacterial infections as identified in the WHO priority pathogen list. However, if people do not change the way antibiotics are used now, these new antibiotics will suffer the same fate as the current ones and become ineffective.

The cost of AMR to national economies and their health systems is significant as it affects productivity of patients or their caretakers through prolonged hospital stays and the need for more expensive and intensive care.

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Have Attitudes To Amr Changed

Sally Davies, UK Special Envoy on antimicrobial resistance: I am actually a doctor and has always been a problem. It was predicted by Fleming when he won his Nobel prize that bugs would develop resistance to antibiotics and people would die as a result. It’s natural selection.

And I still remember looking after patients through my career where the microbiologists would come and say, ‘this patient has a bacterium that is resistant to the standard treatment – now you need to swap to a different treatment.’

That was fine. The problem that has arisen is that we are running out of antibiotics and the pipeline’s rather empty. And just to give you an example of this, of the 26 antibiotics in the clinical pipeline active against priority pathogens at WHO, only seven fulfil at least one criteria of innovation. And not putting enough money into it. So just under 10 billion into cancer research and only 132 million into antibiotics research.

And what I found as Chief Medical Officer, and it first really hit me in 2013, was the technical people, our microbiologists, knew of this problem – antimicrobial resistance, AMR – and how it was rising, not just resistance in bacteria, but HIV, TB, malaria, all infections. And yet they weren’t managing to get a policy focus and action on it.

I think we’ve steadily raised awareness, but not fast enough and not good enough.

Robin Pomeroy: You were talking there about a global treaty. What were you referring to?

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Who Is At Higher Risk For Food Poisoning

U.S. Action to Combat Antibiotic Resistance

Those at higher risk include adults aged 65 and older, children younger than 5 years, people who have health problems or take medicines that lower the bodys ability to fight germs and sickness, and pregnant women. These groups are at risk for severe symptoms or complications from food poisoning, including illnesses caused by antibiotic resistant bacteria.

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Never Share Antibiotics With Others

Antibiotics you are prescribed may not work for your family/whnau member, friend or neighbours illness. They might not need antibiotics at all. If they do, they might need a different dose or type of antibiotic. They may have an allergy or another condition or be taking other medicines that mean your antibiotics are not suitable. Using antibiotics when they are not needed, or taking the wrong antibiotic, exposes bacteria to antibiotics unnecessarily, which encourages antibiotic resistance.

Only Use Antibiotics For An Infection Caused By Bacteria

Antibiotics are effective against infections caused by bacteria. They don’t work against infections caused by viruses such as the common cold and the flu. Having green or yellow-coloured mucous, phlegm or snot isnt always a sign of a bacterial infection. Read more about snot and sputum. Symptoms such as cough, sore throat, earache and fever don’t always mean that you have a bacterial infection. While some people with these symptoms will need antibiotics, most people wont because the infection can be caused by viruses. In those cases, the infection will get better without antibiotics.

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Global Action Plan On Antimicrobial Resistance

Globally, countries committed to the framework set out in the Global Action Plan1 2015 on AMR during the 2015 World Health Assembly and committed to the development and implementation of multisectoral national action plans. It was subsequently endorsed by the Governing Bodies of the Food and Agriculture Organization of the United Nations and the World Organisation for Animal Health . To ensure global progress, countries need to ensure 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.

Cdc Report Underscores Urgency Of Threat Need To Maintain Fight Against Superbugs

Combating Antibiotic Resistance: Infection Prevention & Control

People in the United States contend with more than 2.8 million antibiotic-resistant infections a yearand more than 35,000 die as a result, according to new data from the Centers for Disease Control and Prevention. The agencys Antibiotic Threats in the United States, 2019an update of its first analysis in 2013 of antibiotic resistance in the U.S.outlines the top 18 resistant pathogens and evaluates progress in the fight against superbugs.

The report shows important advances made over the past six yearsparticularly in the decline of six types of resistant infectionsbut it also highlights the continued severity of the superbug threat and the urgent need to preserve the effectiveness of the antibiotic stockpile and spur innovation of new types of antibiotics.

Here are five priorities for combating antibiotic resistance in 2020:

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Drug Resistance In Bacteria

For common bacterial infections, including urinary tract infections, sepsis, sexually transmitted infections, and some forms of diarrhoea, high rates of resistance against antibiotics frequently used to treat these infections have been observed world-wide, indicating that we are running out of effective antibiotics. For example, the rate of resistance to ciprofloxacin, an antibiotic commonly used to treat urinary tract infections, varied from 8.4% to 92.9% for Escherichia coliand from 4.1% to 79.4% for Klebsiella pneumoniae in countries reporting to the Global Antimicrobial Resistance and Use Surveillance System .

Klebsiella pneumoniae are common intestinal bacteria that can cause life-threatening infections. Resistance in K. pneumoniae to last resort treatment has spread to all regions of the world. K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, and infections in newborns and intensive-care unit patients. In some countries, carbapenem antibiotics do not work in more than half of the patients treated for K. pneumoniae infections due to resistance.

Resistance to fluoroquinolone antibiotics in E. coli, used for the treatment of urinary tract infections, is widespread.

There are countries in many parts of the world where this treatment is now ineffective in more than half of patients.

Antibiotic / Antimicrobial Resistance

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Promoting Research On New Anti

Development of novel anti-infectious approaches should not be considered the only strategy to prevent increasing resistance to antibiotics. However, it is essential to explore original and new anti-infectious approachesfor example, to encourage research on vaccines . There are also clear advantages to focusing on antibiotic therapy, that is, to address specifically the microorganism responsible for infection rather than to eliminate a large proportion of the bacterial flora of the patient. This allows the advantage of the barrier effect exerted by the resident indigenous bacteria that oppose colonization and invasion by exogenous microorganisms.

In addition, development of new animal-growth promoters that do not display cross-resistance with antibiotics used as therapy for human infections and evaluation of their efficacy could help lead to discontinuation of the use of antibiotics as additives to animal feed.

Antibiotic Resistance Food And Food Animals

What you need to know about antibiotics

The American food supply is among the safest in the world, but people can still get food poisoning by eating contaminated foods. Some food poisoning is caused by antibiotic-resistant bacteria. Symptoms of infection with antibiotic-resistant bacteria are like other food poisoning symptoms, which can be mild to life-threatening and include diarrhea, nausea, and vomiting.

Antibiotics are medicines that kill or stop the growth of bacteria. Antibiotic resistance happens when bacteria develop the ability to survive or grow despite being exposed to antibiotics designed to kill them.

Antibiotics save lives, but any time antibiotics are used, they can contribute to the development and spread of antibiotic resistance. Antibiotic resistance spreads to bacteria through people, animals, and the environment. Improving antibiotic use, including reducing unnecessary use, can help stop resistance from spreading.

Learn what CDC is doing to help stop antibiotic-resistant infections from food and animals, and how you can protect yourself and your family.

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Drug Resistance In Malaria Parasites

The emergence of drug-resistant parasites poses one of the greatest threats to malaria control and results in increased malaria morbidity and mortality. Artemisinin-based combination therapies are the recommended first-line treatment for uncomplicated P. falciparum malaria and are used by most malaria endemic countries. ACTs are a combination of an artemisinin component and a partner drug. 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 Peoples Democratic Republic, Myanmar, Thailand, and Viet Nam through studies conducted between 2001 and 2019. This makes selecting the right treatment more challenging and requires close monitoring.

In the WHO Eastern Mediterranean Region, P. falciparum resistance to sulfadoxine-pyrimethamine led to artesunate-sulfadoxine-pyrimethamine failures in some countries, necessitating a change to another ACT.

In Africa, evidence has recently been published showing emergence of mutations linked to partial artemisinin resistance in Rwanda. So far, ACTs that have been tested remain highly efficacious. 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.

Treating Animals With Antibiotics

Until 2017, U.S. farmers could give animals antibiotics to make animals grow faster or gain weight. This practice has advantages for farmers, who can bring their meat to market faster. In an effort to limit antibiotic use to medical treatment, the FDA released guidance in 2013 that effectively phased out antibiotics in animal feed and water to promote growth.

But antibiotics can still be used to prevent disease in animals. There’s all kinds of real or made-up justifications for routine disease prevention, says Lance Price, co-director of George Washington Universitys Antibiotic Resistance Action Center, and then the way the dosing is described, it is, in some cases, exactly like growth promotion. So it’s low doses every day, indefinitely.

Organizations including the World Health Organization recommend minimizing both this practice and administering antibiotics to promote growth, because treating animals before they get sick contributes to antibiotic resistance.

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Overuse Of These Medicines In Livestock Can Affect Humans Too

If youre buying a pack of ground turkey in the meat aisle, you might already know what to check for: Meat thats priced well, looks fresh and isnt past its expiration date. But what you might not consider are that these turkeys may have consumed antibiotics and that this could affect you.

Excess use of antibiotics in livestock and in humans fuels antibiotic resistance: the process by which bacteria evolve to outsmart our best weapons against them. These bacteria are sometimes known as superbugs, which, despite their sci-fi nickname, are a very real threat to human health.

These bacteria can spread to humans from animals and cause illnesses that become increasingly hard to treat over time. According to a review study from 2017, drug-resistant infections kill 23,000 Americans each year and society’s antibiotic practices are largely to blame.

Animal antibiotic use and how much it contributes to the problem of drug resistance is still debated, especially in the U.S. But organizations like the World Health Organization , the U.S. Food and Drug Administration , and the American Veterinary Medical Association have acknowledged the need for responsible antibiotic use in livestock.

Spread Of Germs & Resistance Mechanisms

Global antibiotic overuse is like a ‘slow motion train wreck’

To survive, germs develop defense strategies against antibiotics called resistance mechanisms. DNA tells the germ how to make specific proteins, which determine the germs resistance mechanisms. Bacteria and fungi can carry genes for many types of resistance.

When already hard-to-treat germs have the right combination of resistance mechanisms, it can make all antibiotics ineffective, resulting in untreatable infections. Alarmingly, antibiotic-resistant germs can share their resistance mechanisms with other germs that have not been exposed to antibiotics.

This table gives a few examples of defense strategies used to resist the effects of antibiotics.

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Applying Our Knowledge Of Evolution

Evolutionary theory predicted that bacterial resistance would happen. Given time, heredity, and variation, any living organisms will evolve when a selective pressure is introduced. But evolutionary theory also gives doctors and patients some specific strategies for delaying even more widespread evolution of antibiotic resistance. These strategies include:

  • Dont use antibiotics to treat viral infections.Antibiotics kill bacteria, not viruses. If you take antibiotics for a viral infection , you will not kill the viruses, but you will introduce a selective pressure on bacteria in your body, inadvertently selecting for antibiotic-resistant bacteria. Basically, you want your bacteria to be antibiotic virgins, so that if they someday get out of hand and cause an infection that your immune system cant handle, they can be killed by a readily available antibiotic.
  • Avoid mild doses of antibiotics over long time periods.If an infection needs to be controlled with antibiotics, a short-term, high-dosage prescription is preferable. This is because you want to kill all of the illness-causing bacteria, leaving no bacterial survivors. Any bacteria that survive a mild dose are likely to be somewhat resistant. Basically, if you are going to introduce a selective pressure , make it so strong that you cause the extinction of the illness-causing bacteria in the host and not their evolution into resistant forms.
  • Antibiotic Resistance: How To Prevent The Next Public Health Emergency

    Emma H. Yee, Steven S. Cheng, Grant A. Knappe, and Christine A. Moomau | MIT Science Policy Review

    Article Summary

    Antibiotics are a vital component of global health. By killing or inhibiting the growth of bacteria, antibiotics treat infections like pneumonia, staph, and tuberculosis.By preventing infections, they enable major medical procedures such as surgeries and chemotherapy. However,bacteria are becoming increasingly resistant to current antibiotics, causing an estimated 34,000 deaths annually in the US. Left unchecked, antibiotic resistance will have major public health consequences, causing over 5 million deaths each year by 2050. Major causes of this crisis are the misuse of existing antibiotics and the slow development of new antibiotics. To incentivize responsible use, governments and institutions are initiating education programs, mandating comprehensive hospital antibiotic stewardship programs, and funding the development of rapid diagnostics. To bring new antibiotic drugs to market, the US government and other non-governmental organizations are funding scientific research toward antibiotic development.Additional incentives are being pursued to improve the commercial viability of antibiotic development and protect drug developers from the unique challenges of the antibiotic market. With diligent efforts to improve responsible use and encourage novel antibiotic drug discovery, we can decrease the global disease burden, save money, and save lives.

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