What is Antimicrobial Resistance?
Antimicrobial Resistance can develop when microorganisms are treated with anti-microbial agents. These may cause the adaptation of bacteria such that they do not respond anymore to the used antibiotics. As a result other anti-microbial agents should be used for an effective treatment. If these alternative are still there ..
Antimicrobial resistance or AMR increasingly threatens the effective control of more and more infections caused by bacteria, viruses, fungi and parasites worldwide.
Risks of Antimicrobial resistance
How is the situation outside the Netherlands?
Problem of AMR much bigger abroad
As the Netherlands has a strict policy for the use of antibiotics, the resistance problem in the Netherlands is fortunately limited. This also applies, for example, to the Scandinavian countries. In Mediterranean countries, countries outside Europe such as Turkey and certainly in countries in Asia and Africa, the problem of resistance is substantially higher. The United States is also clearly struggling with the problem of resistance.
What do authorities do against AMR?
A large number of national and international authorities such as the WHO are strongly committed to better combating the resistance problem. The various programs and action plans mostly focus on:
- Preventing the arise of infections to the extent possible
- Limiting use of anti-microbial agents
- Preventing the spreading of resistant bacteria
- Rapid diagnosis of (resistant) micro-organisms
- Continued developmetn of new antibiotics and alternative treatments
What is antibiotic resistentance?
Antibiotics and other antimicrobial agents are indispensable in the fight against infectious diseases in humans and animals. The use of antibiotics however can lead to the formation of resistant bacteria. In the same way also other microorganisms such as viruses, yeasts, fungi and parasites can also become resistant. Resistance is caused by adaptation of the microorganism. This natural process leads to the bacterium losing its sensitivity to the antibiotic and growing unhindered. The resistance is passed on to subsequent generations of bacteria.
Can bacteria become resistant to multiple antibiotics?
Bacteria can become resistant to one, several or even all commercially available antibiotics. In that case one speaks of ‘superbugs’ that can no longer be combated with antibiotics. Occasionally a multiresistant bacterium pops up and may cause a threatening outbreak. Such multiresistant bacteria must clearly be prevented from further spreading.
What are the consequences of antibiotic resistance?
Resistant bacteria make easy-to-treat conditions such as bladder infections and pneumonia and also wound, blood and intestinal infections poorly treatable or even completely untreatable. Sometimes other antibiotics provide a good alternative. However such alternatives are not always available. In the case of multiresistant bacteria or superbugs, complex interventions such as cesarean sections, transplants and cancer treatments become difficult or even impossible.
Does resistance also occur in viruses, fungi and yeasts?
Resistance occurs not only in bacteria but also in viruses, fungi and yeasts and even in parasites. Consider, for example, the resistant malaria parasite that has become insensitive to the drug artemisinin. In this broad context we speak of AMR: Antimicrobial Resistance. AMR includes resistance in bacteria, viruses, fungi, yeasts and parasites.
How do resistant bacteria spread?
Resistant bacteria, as well as other resistant micro-organisms, mostly spread from men to men, via farm animals, through food and/or via the environment and water systems. Distribution may take place by touch, via the air and via the water. Consider, for example, the spreading of resistant bacteria via the sewer water.
Where do resistant bacteria occur?
Resistant bacteria basically occur in the same places as where non-resistant bacteria occur. The chance of having resistant bacteria is greater at places where antibiotics are being used. This applies, for example, to hospitals and animal farms where antibiotics are used. People, farm animals and companion animals can be unnoticed carriers of a resistant bacteria. These may also be further spread unnoticed. Resistant bacteria can also occur on and be spread via meat, fish, vegetables, garden, arable and dairy products. Furthermore, resistant bacteria are spread via waste water. This can also contaminate surface water. It is known that water not only spreads the resistant bacteria but also the antibiotics residues and their degradation products. These also can lead to new resistant bacteria.
What are the consequences of Antimicrobial Resistance?
AMR is a rapidly growing global problem that mainly manifests in Southern European countries, Africa, Asia and North and South America. The consequences of AMR are daunting:
- Increase in the number of deaths: every year in Europe 25,000 people are dying from the consequences of AMR [i]. Without further intervention, the global number may rise from 700,000 nowadays to 10,000,000 by 2050 [ii]. By then AMR may even become the number one cause of death.
- Reduced economic output due to increasing mortality (loss of work potential due to death) and morbidity (loss due to illness and care)
- Increasing costs such as direct costs (healthcare: research, treatment and hospitalization patients) and indirect costs (waiving of medical interventions, travel and trade). The ECDC has estimated that the antibiotic resistance problem as a whole in the EU leads to additional healthcare costs and productivity loss totaling € 1.5 billion per year. The economic impact worldwide until 2050 is estimated at 100 trillion USD.
What is the role of authorities?
International (WHO, FAO) and national (VWS, RIVM) authorities clearly call for cooperation:
- Better prevention (preventing the emergence and spread of AMR)
- Better monitoring and surveillance of AMR
- More effective control with new products: diagnostics, antibiotics and alternatives
What professionals are dealing with the resistance problem?
An increasing number of professionals is dealing with AMR be it in very different ways. Authorities, public institutions, research and knowledge institutions and thousands of public and private organizations are faced with the challenges of AMR.
Research has shown shows that over 50,000 professionals in the Netherlands are involved in AMR. Sectors where AMR plays a role include health (general practices, hospitals and nursing homes, dentists), food and feed, meat, fish, dairy, agriculture and horticulture, animal husbandry and animal health and the environment (water, soil and air).
[i] ECDC. The bacterial challenge: time to react. A call to narrow the gap between multidrug resistant bacteria in the EU and the development of new antibacterial agents. Stockholm: European Center for Disease Prevention and Control; 2009.
[ii] Review Antimicrobial Resistance; Tackling drug-resistant infections globally: final report and recommendations. May 2016