Trends in Antimicrobial Resistance

Antimicrobial resistance (AMR) is a rising public health concern around the world, and antibiotic usage is increasingly being identified as the primary selective pressure generating this resistance. However, the global trend in antibiotic resistance in response to antibiotic intake remains unknown. The authors collected national resistance data on specific resistant pathogens considered priority by the World Health Organisation (WHO) and antibiotic consumption data for 61 countries in order to assess global trends in antibiotic resistance of those common bacterial pathogens and their association with antibiotic consumption.

//www.sciencedirect.com/science/article/abs/pii/S0304389422018362

1. Chakraborty M, Sardar S, De R, Biswas M, Mascellino MT, Miele MC, et al. Current Trends in Antimicrobial Resistance Patterns in Bacterial Pathogens among Adult and Pediatric Patients in the Intensive Care Unit in a Tertiary Care Hospital in Kolkata, India. Antibiotics (Basel, Switzerland) [Internet]. 2023 Feb 24 [cited 2023 Aug 3];12(3):459. Available from: //pubmed.ncbi.nlm.nih.gov/36978325/#:~:text=from%20adult%20patients%20were%20found

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Antimicrobial resistance is driven by multiple factors. Resolving the threat to human and animal health presented by drug-resistant infections remains a societal challenge that demands close collaboration between scientists and citizens. 

Antibiotics are the “magic bullets” for fighting against bacteria and are considered as the most remarkable medical discovery of the 20th century. The introduction of antibiotics has changed the therapeutic paradigm and continues to save millions of lives from bacterial infections. Microbes have developed acquired antimicrobial resistance (AMR) to many drugs due to high selection pressure from increasing use and misuse of antibiotics over the years. The transmission and acquisition of AMR occur primarily via a human-human interface both within and outside of healthcare facilities. A huge number of interdependent factors related to healthcare and agriculture govern the development of AMR through various drug-resistance mechanisms. The emergence and spread of AMR from the unrestricted use of antimicrobials in livestock feed has been a major contributing factor. The prevalence of antimicrobial-resistant bacteria has attained an incongruous level worldwide and threatens global public health as a silent pandemic, necessitating urgent intervention. Therapeutic options of infections caused by antimicrobial-resistant bacteria are limited, resulting in significant morbidity and mortality with high financial impact. The paucity in discovery and supply of new novel antimicrobials to treat life-threatening infections by resistant pathogens stands in sharp contrast to demand. Immediate interventions to contain AMR include surveillance and monitoring, minimizing over-the-counter antibiotics and antibiotics in food animals, access to quality and affordable medicines, vaccines and diagnostics, and enforcement of legislation. An orchestrated collaborative action within and between multiple national and international organizations is required urgently, otherwise, a postantibiotic era can be a more real possibility than an apocalyptic fantasy for the 21st century (Md Abdus Salam et al., 2023)

Multiple drivers are contributing to the development and dissemination of antimicrobial resistance globally, creating a major concern for both human and animal health. Antimicrobial-resistant infections are more difficult to treat, leading to treatment failure and complications on top of huge financial costs to individuals and to the community. Prudent use of antibiotics with appropriate dosage and duration is among the most important means to reduce the selective pressure required for the emergence of resistant organisms. Strict practice of infection prevention and control measures in all healthcare facilities is a vital step in controlling the spread of MDR organisms (Pulia et al., 2018).

References 

Preventing antimicrobial resistance is a collective duty we all share. This phenomenon leads to almost 5 million deaths annually, primarily fuelled by the inappropriate and excessive use of antimicrobial agents in both human and animal contexts.

It poses a significant risk of getting to an era where even minor infections were incurable. Awareness among community is very crucial to minimise the future unhealthy circumstances. 

Source: //www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

According to estimates from the US Centre for Disease Control and Prevention, at least 23,000 people die and over two million suffer from AMR annually.India is predicted to have a crude infectious illness death rate of 416.75 per 100,000 people, which is twice the US rate. There is a significant amount of multi-resistant enterobacteriaceae and 41% of methicillin-resistant Staphylococcus aureus, according to the Indian Network for Surveillance of Antimicrobial Resistance. Few investigations have documented multi-drug resistance in 3.4% of isolates of Salmonella typhi, as well as resistance to ciprofloxacin (37.9%), azithromycin (7.3%), and nalidixic acid (96.7%). The majority of V. cholerae O1 isolates, according to research conducted in India, are resistant to ciprofloxacin, ampicillin, furazolidone, and tetracycline, among other widely used antibiotics(Patwardhan & Unnikrishnan Payyappalli, 2018).

Ayurveda strategies against antimicrobial resistance

The world looks into One health approach in the context of AMR, Ayurveda can be considered in the scenario as it also approaches holistically, considering humans, animals,animal ,plant and their interactive environments.

These can be grouped into three major objectives, including

1) Decrease the disease transmission
2) Reduce the use of antibiotics.
3) Proper care after antibiotic use

These approaches will be helpful to  achieve
 Source reduction
 Weakening the mode of transmission
 Strengthening the host 

Prevention via Ayurveda can be primordial and primary: a. Dinacharya, - daily regimen to be followed by an individual; b. Ritucharya, - seasonal regimen to be followed by an individual. c. Samshodhana: seasonal cleansing of the individual
d. Adhaaraniya Vegas: non- Non- retention of the natural urges e. Rasayanas: Intake of Rasayanas f. Sattvavijaya: Improving mental strength with the help of Yoga and Dhyana 

Curative treatments for microbes are possible with various drugs.

Convalescent care by rejuvenating drug group like "Rasayana(Radhakrishnan, 2021)

Reference:

//doi.org/10.1016/j.jaim.2018.05.002 ‌" target="_blank" rel="noopener">Patwardhan, B., & Unnikrishnan Payyappalli. (2018). Ayurveda and anti-microbial resistance. Journal of Ayurveda and Integrative Medicine. //doi.org/10.1016/j.jaim.2018.05.002 ‌

//www.ijhsr.org/IJHSR_Vol.11_Issue.1_Jan2021/IJHSR10.pdf ‌" target="_blank" rel="noopener">Radhakrishnan, A. (2021). Antimicrobial Resistance (AMR): An Ayurvedic Insight. International Journal of Health Sciences and Research (Www.ijhsr.org), 11, 1. //www.ijhsr.org/IJHSR_Vol.11_Issue.1_Jan2021/IJHSR10.pdf ‌

Antibiotic resistance has become a serious issue in the treatment of nosocomial infections.The culture and sensitivity pattern of clinical isolates from blood, urine, sputum, endotracheal tube (ET) aspirate, and central line catheter insertion site swabs were studied.Culture positive rates among adults and children patients were 37% and 40%, respectively. Proteus spp., Acinetobacter baumannii, and Pseudomonas spp (Adult patients were shown to be resistant to third generation (100%) and fourth generation cephalosporins (79%), beta-lactams (74%), fluoroquinolones (74%), and carbapenems (89%). Other non-fermenters recovered from both adult and pediatric patients exhibited strong resistance to all antibiotic classes employed in this study) have been found to be antibiotic resistant. ICU data Enterococcus spp. exhibited greater than 90% resistance to ampicillin and more than 75% resistance to fluoroquinolones. Antibiotic-resistant ESKAPE bacteria (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pose a global threat to human health and the health-care system. A frequent study of antimicrobial resistance patterns is imperative for antibiotic stewardshipin combatting the devastating effect of the MDR bacteria in critically ill patients. MDR bacterial infections are on an upward trend in both adult and pediatric intensive care units, leading significant treatment challenges. This is a severe public health problem since these antibiotic classes are the most commonly used to treat nosocomial infections.

Reference:

Chakraborty, M., Sardar, S., De, R., Biswas, M., Maria Teresa Mascellino, Maria Claudia Miele, Biswas, S., & Anita Nandi Mitra. (2023). Current Trends in Antimicrobial Resistance Patterns in Bacterial Pathogens among Adult and Pediatric Patients in the Intensive Care Unit in a Tertiary Care Hospital in Kolkata, India. Antibiotics, 12(3), 459–459. //doi.org/10.3390/antibiotics12030459

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