Antimicrobial resistance is threatening global health security
When medicines become resistant, even curable diseases are at risk of becoming incurable

Shobha Shukla / Bobby Ramakant *

Antimicrobial resistance occurs when Microbes such as bacteria, viruses, fungi, and parasites no longer respond to medicines. This makes common infections harder to treat and increases the risk of disease spread, severe illness and death. That is why India and other countries worldwide are observing 18-24 November as World Antimicrobial Awareness Week.

Thomas Joseph, World Health Organization (WHO)’s head of Antimicrobial Stewardship and Awareness said that “Antimicrobial resistance is undermining a century of progress in medicine - infections that were previously treatable and curable with our drugs are becoming (or at risk of becoming) incurable (as medicines are not working against infections). Even common infections are becoming risky and a problem.

Surgeries are becoming risky. Cause of antimicrobial resistance is found in the behaviour of human beings who are misusing or overusing antimicrobials. We must ensure that when we are sick we are only taking antimicrobials on medical advice and medical supervision.”

Keep the healthcare facilities clean: use medicines responsibly and appropriately

Irresponsible and inappropriate use of antimicrobials (antibiotics, antifungals, antivirals or antiparasitics) is not justified to compensate for failure of ensuring standard infection control practices.

Dr Kamini Walia, Scientist at the Indian Council of Medical Research (ICMR), Ministry of Health and Family Welfare, Government of India, is currently leading the setting up of antimicrobial surveillance network across the country.

“Antimicrobial resistance is a direct result of excessive use of antimicrobials which is mostly done to compromise for poor infection control practices. Now we have a big burden of drug resistance in the community as well as drug-resistant nosocomial infections- hospital acquired drug-resistant infections. These drug resistant pathogens are invisible threats that continue to claim invisible victims in our hospitals. They are invisible because in India there is no government system to record the deaths due to drug-resistant infections. So we continue to remain oblivious to the actual burden of drug-resistant infections in our country” said Dr Kamini Walia.

That is why ICMR’s Dr Walia is setting up an antimicrobial surveillance network across the nation. She added: “A strong antimicrobial resistance surveillance system provides us real time information and evidence of what is the disease burden in the country, and how the antimicrobial resistance patterns and trends are changing with time, so that we can launch an informed and evidence based response. Data from both- hospitals and community needs to be correlated with antimicrobial consumption data.”

The ICMR Surveillance Network was started in 2013 and is functional across 30 tertiary care hospitals, including some private hospitals and some standalone laboratories, across the country. It focuses on six pathogenic groups that cause a large number of drug-resistant infections in the hospitals and in the communities. Along with surveillance, ICMR is also focusing on training participating hospitals in infection control and prevention practices and helping them to establish and implement antimicrobial resistance stewardship, to train the doctors to prescribe responsibly and appropriately.

ICMR data of 2020 shows large burden of drug-resistant bugs

Dr Kamini Walia said that 2020 Data released by ICMR shows that India has a very large burden of drug-resistant Gram negative infections- as high as 70% in E.coli and K. pneumoniae. A. Baumannii- a common pathogen seen in hospital-acquired infections showed 70% resistance to Carbapenem (a major last-line class of antibiotics to treat serious bacterial infections).

Stop doing bad, do more good

S.typhi was found to be highly resistant to floroquinolone but 100% sensitive to ampicillin, chloramphenicol and cotrimoxazole and cefixime- drugs to which it had become resistant in 1990s. But now it has once again become fully sensitive to them by simply reducing their usage. This provides evidence that when we stop using a particular antimicrobial, the organism once again becomes sensitive it, said Dr Walia.

However, there is a bad news too: Resistance to broad spectrum antibiotic Faropenem (used to treat respiratory tract and other infections) in India increased from 3% to 40% in just 6 years-2009-2015 because of its overuse.

Covid-19 and antimicrobial resistance

Bacterial and fungal pathogens isolated from Covid-19 patients hospitalised for a long time showed 35% patients had poly-microbial infections- and 8.4% had both bacterial and fungal infections, shared Dr Kamini Walia. We also saw 60-70% mortality in Covid-19 patients who acquired drug-resistant infections during their hospital stay. A lot of broad spectrum antimicrobials were used in treatment of hospitalised Covid-19 patients, which could lead to a bigger epidemic unfolding in India next year onwards.

Connecting the dots: Antimicrobial resistance, human health, food systems, animal health, and environment

Dr Haileysus Getahun, Director of the Department of Global Coordination and Partnership on Antimicrobial Resistance (AMR) at the WHO said that “having good infection control is key to controlling antimicrobial resistance. So if infection control is good along with water, sanitation and hygiene - in clinical settings, veterinary settings and in food producing settings - it will help to stop the spread of infection and this in turn will reduce the use of antimicrobials to treat those infections. Use of poor quality drugs and/or unnecessary use of antimicrobials in humans, animals and in food production is also fuelling antimicrobial resistance.”

Dr Haileyesus Getahun is also the Director of Joint Tripartite Secretariat on antimicrobial resistance (comprising of United Nations Food and Agriculture Organization - FAO, World Organization for Animal Health - OIE and WHO) that coordinates the joint work of the organisations across the #OneHealth spectrum. He said “Antimicrobial resistance is a complex problem that demands a comprehensive, multisectoral response. It is to be addressed through different mechanisms -including regulations and also by enhancing the robustness of the human and veterinary health systems to make sure that antimicrobials are prescribed based upon the needs and not due to oversight of the trained medical professionals.”