Antimicrobial resistance (AMR) is a hidden pandemic: “Millions of people die every year from the effects of AMR”
Antibiotics save lives, but it is increasingly common for bacteria to become resistant to them. Maarten van Dongen is a molecular and medical microbiologist and founder of AMR Insights, an organization that increases awareness about antimicrobial resistance. He discusses the urgency of this problem and explains how we can combat resistance.
Imagine you’re having a urinary tract infection on your doctor’s appointment. The chances are that you will be prescribed a course of antibiotics and after a few days you’ll be completely old again. The use of antibiotics is a matter of course worldwide. Van Dongen explains that this is not a matter of course and is even a major threat to public health.
Antibiotic resistance is the principle that a bacterium develops resistance to one or more antibiotics. “That means that they are no longer susceptible to the action of those antibiotics,” says Van Dongen. “All micro-organisms can become resistant to the means that we have developed to combat them. This concerns not only bacteria, but also, for example, viruses, fungi and yeasts. We are therefore talking about antimicrobial resistance (AMR).”
AMR Insights
AMR Insights is an organization that fights antimicrobial resistance by informing, training and connecting professionals worldwide. It has a global network of more than 650 ambassadors in 60 countries. Through a knowledge platform, newsletters, training courses and organizing symposia and AMR innovation missions, they aim to raise awareness about AMR.
No alternative
In practice, having a condition caused by a resistance bacterium means that a prescribed antibiotic simply does not work.”In the case of a urinary tract infection, the consequences can still be seen. But in more serious conditions, such as a blood infection, it is very important that an antibiotic works.” It is possible that a bacterium develops resistance to several or even all of the available antibiotics. In that case, as a doctor, you no longer have alternatives and there is a chance that the patient will die.
In addition, antibiotics are administered for prevention during medical interventions, such as surgeries or a caesarean section. “Take the caesarean section, for example, if you are dealing there with a resistant bacterium then there is no way to protect the pregnant woman. A relatively safe medical procedure then becomes impossible to perform.”
Excessive use
Resistance is a natural genetically determined feature that bacteria can develop. The genetic material with the resistance is passed on to the offspring at division. But resistance can also be acquired when bacteria take up pieces of genetic material with resistance. Resistance can therefore be naturally present, obtained from other bacteria or acquired from, for example, the environment.
Resistance is caused, among other things, by excessive use of antibiotics, both by humans and animals. “In many countries, antibiotics are simply available from the pharmacist or they are easily prescribed. At the same time, large amounts of antibiotics are discharged into the environment through the discharge of wastewater from, for example, hospitals and through the use of antibodies in agriculture and livestock farming.” What contributes to this problem is that the same types of antibiotics that are necessary to combat infectious diseases in humans are widely used in the agricultural sector. “Antibiotics have a growth-enhancing effect in animals and are inexpensive. This makes them an obvious tool in various developing countries. It is a balance between economic and medical interests.”
Abstract problem
Van Dongen argues that AMR is now a bigger problem than the COVID pandemic, but that there is relatively little attention to it. “AMR is an abstract problem, it is much more difficult to understand. The COVID pandemic was very tangible and came close. You could do a test and you were infected with the virus or not.” With AMR, this is much more complicated. “You read in a death certificate that a patient dies from tuberculosis, but not that it is a tubercolosis that can no longer be treated by a resistant bacterium.” At the same time, the numbers do not lie about it and resistant bacteria spread rapidly. “In total, five million people die annually, directly or indirectly, from the effects of AMR. It is expected that by 2050 this number will rise to ten million deaths per year.”
Combating resistance
According to Van Dongen, there are five important strategies to curb resistance: prevention of infections, monitoring of antibiotic use in humans and animals, developing new antibiotics and improving diagnostics and reducing AMR in the environment. “Through vaccination and hygiene measures we can do a lot to prevent infections. In addition, the control of the use of antibiotics in humans and animals is important and we should give greater priority to the development of new antibiotics. It is also important to reduce the amount of antibiotics in wastewater. Not only in production facilities, but also in hospitals, nursing homes and in people’s homes. Finally, we need to improve the diagnosis of infections. In doing so, we must be able to identify very quickly which infection and bacteria are concerned and to which they are resistant. Only then can you prescribe more targeted antibiotics.”
According to Van Dongen, everyone in society should take responsibility to contribute to the fight against resistance. “Not only doctors, pharmacists and veterinarians can do something, but also patients and healthy citizens. For example, you can take hygiene into account when preparing food and washing your hands regularly.”
