Causes Of Antimicrobial Resistance
Microbes, such as bacteria, viruses, fungi, and parasites, are living organisms that evolve over time. Their primary function is to reproduce, thrive, and spread quickly and efficiently. Therefore, microbes adapt to their environments and change in ways that ensure their survival. If something stops their ability to grow, such as an antimicrobial, genetic changes can occur that enable the microbe to survive. There are several ways this happens.
Mechanism Of Bacterial Resistance Mediated By Different Factors
Antibiotic resistance is a global problem and poses a major threat to human and animal health. Driven by conditions such as selective pressure of antibacterial drugs, spontaneous mutation, recombination and horizontal gene transfer, the unreasonable use of antibiotics has led to the increasing resistance of bacteria to antibiotics. The resistance of bacteria to antibacterial drugs is caused by genetic variation of different mechanisms. The increase in human health risks associated with antimicrobial resistance has prompted us to study the development mechanism of drug resistance, and in-depth exploration of the factors related to the spread of resistance genes in order to take necessary measures to reduce the growing threat. The resistance mechanisms of bacteria to antibiotics, heavy metals and biocides are introduced as follow.
What Is Antibiotic Resistance And How To Prevent It
In this article:
The unnecessary treatment with antibiotics can result in nonbeneficial effects of therapy while still being susceptible to the medications adverse effects.
Antibiotics exert their effects by disrupting bacterial composition depending on the agents mechanism of action, which can lead to adaptations and openings for the bacteria to evade and emerge into new mutant strains that are then resistant to the current therapy. Bacterial resistance occurs from four known mechanisms: intrinsic resistance, acquired resistance, genetic change, and DNA transfer.
Improper usage of antibiotics may result in the advancement of a resistant strain that can then be transmitted to others who may then acquire the mutant drug-resistant strain.
Thirty percent of antibiotics prescribed in outpatient settings in 2015 were unnecessary and avoidable, accounting for 47 million antibiotic courses, of which 50% are for acute respiratory infections, which are the leading cause of unnecessary use.
Antibiotic resistance prevention measures can be exerted at all levels of society to minimize improper and excessive antibiotic use and minimize the spread of resistance.
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Antibiotic Versus Antimicrobial Resistance
Distinguishing between antibiotic and antimicrobial resistance is important.
- Antibiotic resistance refers to bacteria resisting antibiotics.
- Antimicrobial resistance describes the opposition of any microbe to the drugs that scientists created to kill them.
It is possible for AMR to develop in bacteria, but it can also originate in fungi, parasites, and viruses. This resistance could affect people with Candida, malaria, HIV, and a wide range of other conditions.
Microbes can become resistant to drugs for both biological and social reasons.
Antibiotic Resistance Questions And Answers
Antibiotic resistance is one of the greatest public health challenges of our timefew treatment options exist for people infected with antibiotic-resistant bacteria.
Visit CDCs Antibiotic Resistance website for more information, including fact sheets describing some of these answers and how CDC is taking a One Health approach to combat this threat.
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Global Research And Development Priority Setting For Amr
In 2017, to guide research and development into new antimicrobials, diagnostics and vaccines, WHO developed the WHO priority pathogens list. It will be updated in 2022. On an annual basis, WHO reviews the pre-clinical and clinical antibacterial pipelines to see how the pipeline is progressing with respect to the WHO priority pathogens list. A critical gap remains in research and development, in particular for antibacterial targeting of the gram-negative carbapenem resistant bacteria.
What Accelerates The Emergence And Spread Of Antimicrobial Resistance
AMR occurs naturally over time, usually through genetic changes. Antimicrobial resistant organisms are found in people, animals, food, plants and the environment . They can spread from person to person or between people and animals, including from food of animal origin. The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials lack of access to clean water, sanitation and hygiene for both humans and animals poor infection and disease prevention and control in health-care facilities and farms poor access to quality, affordable medicines, vaccines and diagnostics lack of awareness and knowledge and lack of enforcement of legislation.
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How Antibiotic And Antifungal Use Affects Resistance
Antibiotics and antifungals save lives, but their use can contribute to the development of resistant germs. Antimicrobial resistance is accelerated when the presence of antibiotics and antifungals pressure bacteria and fungi to adapt.
Antibiotics and antifungals kill some germs that cause infections, but they also kill helpful germs that protect our body from infection. The antimicrobial-resistant germs survive and multiply. These surviving germs have resistance traits in their DNA that can spread to other germs.
Comparison With Expert Opinion
A previous exercise had been undertaken previously with nine experts in antimicrobial resistance who practice in disparate fields, from molecular biology through to translational antimicrobial resistance research, clinical infection practice and veterinary medicine. This panel undertook a two-round Delphi process to similarly rank the perceived contribution of each factor as a cause of global antimicrobial resistance and in addition also ranked the contributory scientific evidence for each factor, and the potential population affected . The results from the public poll related to the relative contribution of factors towards AMR were compared and contrasted to these expert results to explore any divergence.
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How To Slow Antibiotic Resistance
We can help to slow down antibiotic resistance by:
- not asking for antibiotics to treat viral infections, including colds and flu
- taking antibiotic doses as prescribed and only when you need them
- cleaning your hands regularly and keeping toilets clean, this makes it harder for superbugs to spread
Using antibiotics in the right way will help them remain effective.
What Causes Antibiotic Resistance
These factors often contribute to antibiotic resistance:
- Overuse of antibiotics: Taking antibiotics when theyre not needed or helpful contributes to antibiotic resistance. For instance, most cases of pharyngitis are viral. Antibiotics wont help. Even bacterial ear infections often improve without antibiotics.
- Misuse of antibiotics: Bacteria take advantage of any opportunity to multiply. If you forget to take a medicine for a day , stop treatment too soon, or use incorrect antibiotics , bacteria start reproducing. As they multiply, they can change . Mutated bacteria become increasingly more resistant to a medicine.
- Agricultural use: Bacteria in animals can also become antibiotic resistant. An estimated 80% of antibiotic use in the United States is for livestock.
- Spontaneous resistance: Sometimes, the genetic makeup of a bacterium changes or mutates on its own. The antibiotic doesnt recognize this newly changed bacterium and cant target it the way it should. Or the change helps the bacteria fight off the medicines effects.
- Transmitted resistance: You can pass a contagious drug-resistant bacterial infection to someone else. That person now has an infection that wont respond to an antibiotic. Again, we can usually find a treatment, but time has passed and the now resistant bacteria may be harder to treat.
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Antibiotic Resistance And Factors For It
Antibiotic & Antibiotic Resistance
Antibiotic: any of various chemical substances,produced by various microorganisms, esp. fungi, or made synthetically and capable of destroying or inhibiting the growth of microorganism.
People may exhibit allergic reactions to antibiotics, but they are not resistant to them. It is the bacteria themselves, not the infected host, which become resistant.
Antibiotic Resistance: the ability of bacteria and other microorganisms to withstand an antibiotic to which they
were once sensitive
Tolerance of micro-organisms to inhibitory action of antibiotics.
Resistance to antibiotics is a biological phenomenon that can be accelerated by a variety of factors, including human practices.
Resistance Can be: Drug Tolerance, Drug Destruction, Drug Impermeability, Cross resistance.
Antibiotic Resistance Is A Serious Worldwide Problem
The monetary cost of treating antibiotic resistant infections worldwide is estimated to be many billions of dollars per year.
According to the researchers : the resistance to antibiotics is increasing at a faster pace than it can be controlled.
Since antibiotic resistance can pass from bacterium to bacterium and resistant bacterial infections can pass from
person to person. Thus, antibiotic use and antibiotic resistance can eventually affect an entire community.
Factors Affecting Antibiotic Resistance
Forget to take medication
Amr Increases When We Use Antibiotics
The main cause of antibiotic resistance is antibiotic use. When we use antibiotics, some bacteria die but resistant bacteria can survive and even multiply. The overuse of antibiotics makes resistant bacteria more common.
The more we use antibiotics, the more chances bacteria have to become resistant to them. This means that antibiotics wont work when we need them in the future. If we decrease antibiotic use, the antibiotics may again become effective at killing bacteria.
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How Can I Protect Myself And My Family From Antibiotic Resistance
No one can completely avoid getting an infection, but there are additional steps you can take to protect yourself and your family.
Protect yourself and your family from antibiotic resistance by
- doing your best to stay healthy and keep others healthy,
- cleaning hands,
- staying home when sick, and
- getting recommended vaccines, such as the flu vaccine.
Taking antibiotics only when they are needed is an important way you can protect yourself and your family from antibiotic resistance. Talk to your doctor about the best treatment if you are sick. Never pressure your doctor to prescribe an antibiotic.
When antibiotics arent needed, they wont help you, and their side effects could still cause harm. Ask your doctor or pharmacist about steps you can take to feel better when an antibiotic isnt needed.
If your doctor decides an antibiotic is the best treatment when you are sick:
- Take the antibiotic exactly as your doctor tells you.
- Do not share your antibiotic with others.
- Do not save them for later. Talk to your pharmacist about safely discarding leftover medicines.
- Do not take antibiotics prescribed for someone else. This may delay the best treatment for you, make you even sicker, or cause side effects.
- Talk with your doctor and pharmacist if you have any questions about your antibiotics.
Spread Of Resistant Bacteria
Resistant bacteria spread via many routes. Different factors influence spread depending on the setting. Poor hygiene, poor sanitation, and poor infection control are three interconnected key factors contributing to the spread of resistant bacteria in health care facilities, in farms and in the community.
Bacteria know no boundaries and international traveling and trade help disseminate resistant bacteria across the world. Animals for food production are transported across borders and groceries are exported from most parts of the world, and the bacteria follow along. This contributes to the complexity of the antibiotic resistance problem and underpins the fact that it is a global issue. It does not matter where a resistant bacterium forms. If it is successful and increases in numbers it may quickly spread to other parts of the world in our globalized society.
Here follows an overview including an introductory video of some of the ways resistant bacteria can spread. For more information, see the selected resources at the bottom of the page, or read more in How did we end up here?
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Why Should I Care About Antibiotic Resistance
Antibiotic resistance can affect any person, at any stage of life. People receiving health care or those with weakened immune systems are often at higher risk for getting an infection.
Antibiotic resistance jeopardizes advancements in modern health care that we have come to rely on, such as joint replacements, organ transplants, and cancer therapy. These procedures have a significant risk of infection, and patients wont be able to receive them if effective antibiotics are not available.
Aside from healthcare, antibiotic resistance also impacts veterinary and agriculture industries.
Studying Resistance In The Environment
Most bacterial species do not cause disease and are not associated with clinical breakpoint concentrations. Accordingly, environmental microbiologists most often define resistance as a decreased susceptibility to an antibiotic compared with other strains of the same species. As most species of environmental bacteria are difficult to culture with standard methods, environmental microbiologists, more often so than clinical microbiologists, also tend to study ARGs rather than resistant bacteria. It is important to appreciate the differences, particularly because the genetic context and host of the detected ARGs in most instances remain unknown. Linking ARGs to their hosts and/or mobile genetic element is often critical, both for assessing risks for evolution and transmission, and for predicting the resistance situation in the clinic from sewage analyses.
Shotgun metagenomics can be used to detect and quantify ARGs, with the main advantage over PCR being that any ARG present in available databases can be identified, also in retrospect. The chief disadvantage, even with short reads, is the limitation in sensitivity. Quantitative PCR arrays can be a good compromise between coverage and sensitivity. Analyses of other genetic elements or genes, such as the integrase of class 1 integrons, can often provide a good surrogate for the overall presence of anthropogenic pollution, including resistant bacteria in polluted environments,.
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Poor Hygiene And Infection Prevention And Control
Poor hygiene and poor infection prevention and control can:
- provide more opportunity for resistant bacteria and other germs to spread
- make more people sick and increase the need for antibiotics.
Hand hygiene is the most important way of preventing the spread of infections including antibiotic resistant infections.
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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World Antimicrobial Awareness Week
WAAW was previously called World Antibiotic Awareness Week. Since 2020, it has been called World Antimicrobial Awareness Week. This reflects the broadened scope of WAAW to include all antimicrobials including antibiotics, antifungals, antiparasitics and antivirals. 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 policy makers 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. This was changed to Antimicrobials: Handle with Care in 2020.
Causes Of Antibiotics Resistance
Antibiotic resistance is caused by:
- overuse of antibiotics – some antibiotics don’t work anymore for some infections
- bacteria growing, changing and spreading very fast – some antibiotics no longer work well for some infections
- antibiotics killing our ‘good’ bacteria as well as our ‘bad’ bacteria – this means superbugs can grow and take over
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The Environment Reflecting The Clinic
Although the environment contributes to the problem of antibiotic resistance, both during the evolution of resistance and as a transmission route, it can also provide means to manage it. Environmental microorganisms, including both fungi and bacteria, have been a source for many novel candidate antibiotic molecules, thereby advancing drug development. In addition, there is continuous and widespread environmental emission of human- and animal-associated bacteria through different waste streams. Analysing the abundance and pattern of resistance in the environmental microbiota could therefore provide an opportunity to predict the regional resistance situation,,,,, and indirectly also provide indications of historical antibiotic use. This overlaps with the main objectives of classic, clinical resistance surveillance, which is critical for guiding empirical treatment, for evaluating interventions, and for identifying regional and temporal trends of resistance.
Table 1 Comparison of sewage-based resistance surveillance with traditional clinical resistance surveillance
Superbugs And Antibiotic Resistance
Superbugs are strains of bacteria that have developed resistance to many different types of antibiotics.
They are becoming an increasing cause of disability and death across the world.
The spread of superbugs is a problem because:
- they spread easily to others – in particular to people taking antibiotics
- it can be hard to find a safe and effective antibiotic to fight a superbug infection
- there is a risk that new superbugs may emerge that cannot be treated by any existing 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.