Antimicrobial resistance in 10 elementary statements

Antimicrobial resistance is a complex, multifaceted societal and economic challenge comparable with other global challenges like climate change.

In short AMR can be described by means of 10 rule-of-thumb statements:

1. AMR is a global challenge affecting all countries around the globe and potentially impacting everybody: young and old, healthy and diseased. As a result of traveling and food transports AMR easily further spreads around the globe.
2. AMR is a hidden and likely underestimated threat as infectious diseases may not always be diagnosed, let it be that the causing microorganism has been identified and its antibiotic resistance profile determined. And, if properly diagnosed at all, the patient data may not always be documented and communicated to the relevant health authorities: there is no standardised system for recording the prevalence of AMR deaths.
3. Lowering the use of antimicrobials is fine but does not provide the ultimate solution as infectious diseases will occur more frequently and may give rise to novel outbreaks. In countries where antibiotics are difficult to obtain and/or unaffordable the chances on epidemics substantially increase.
4. AMR prevents the effective treatment of infectious diseases but also complicates medical treatments where antibiotics are used on a routine basis like surgery, chemotherapy and stem cell therapy.
5. AMR comprises resistance at bacteria and also at viruses, fungi, yeasts and parasites. Antibiotic resistance in bacteria provides the biggest health and economic problems. Recent outbreaks of resistant fungi (azole-resistant Aspergillus and multidrug resistant Candida) show that also these microorganisms increasingly threaten public health.
6. AMR so far has developed against all commercially available antibiotics. Resistant bacteria were found within months or years after the introduction and sometimes even before commercial introduction. Emerging antimicrobial strategies (may) claim that they will not result in resistant microorganisms.
7. The current pipelines of novel antibiotics is pretty empty whereas there is a constant need for novel antimicrobial products and alternative strategies. The major cuases are the lack of a solid business case for the involved pharma companies and the fact that the low hanging fruit of promising compounds has clearly been picked.
8. AMR at a global scale is escalating whereby the LMIC’s bear the harshest burdens in terms of fatalities, loss of livestock and economic losses. There are indications that climate change, especially observed in these LMIC’s, will further increase the impact of AMR.
9. AMR is considered a OneHealth challenge involving both Human Health, Animal Health and Environment and has its impact on related industries such as the Agri and Food (dairy, meat) sectors, the water sector (drinking and swimming water) and also the Tourism sector.
10. There is not one single solution to AMR. In fact AMR can only be restrained and contained by the global implementation of 5 ‘key strategies’ to curb AMR: see below. 

The 5 key strategies to curb AMR

Both at an international as well as at a national level action plans have been set up by organisations like WHO, FAO, ECDC, CDC and others to fight AMR. These plans have five underlying ‘key strategies’ in common:

1. Improving the prevention of infectious diseases by raising more awareness, improving hygiene and sanitation, and by vaccination.
2. Extending the implementation of antibiotics stewardship including the mandatory prescription of antimicrobials for human and veterinary use, refraining from using antibiotics as animal growth enhancer and prohibiting the free sale of antibiotics as occurs in some of the LMIC’s.
3. Developing and applying improved molecular microbiological diagnostics for both microbial species identification as well as antimicrobial susceptibility testing and (hopefully) resulting in better, more selective and more justified prescription of the proper antimicrobial products.
4. Developing new (classes of) antibiotics and other antimicrobial products to which no resistance exists as yet. This strategy includes the reuse of older antibiotics, revitalization of previously written off antibiotics as well as the registration of existing commercially available antibiotics for novel indications.
5. Developing alternative antimicrobial strategies which pave the road to entirely new preventive and therapeutic approaches to bacteria and other microorganisms such as Phage therapy, CRISP-CAS, the use of Nano, Polymer, Resin and Coatings technologies and products, Natural products as well as other innovative strategies.