Author: Lai Chen Fang
Since the discovery of penicillin in 1928, the antibiotics had once been regarded as the magic bullet for treating various microbial infections. However, over decades, we are now at a crossroads where the prophetic warning from Alexander Fleming has become an urgent reality. In 1945, Fleming ended his Nobel lecture with a warning about the threat of antimicrobial resistance (AMR): “The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism.” As predicted, AMR is now one of the most critical public health threats facing humanity. It is no longer a distant threat, but a reality that demands our urgent actions.
Over the years, antibiotics have been used extensively but inappropriately most of the time. The situation turned worse especially during the COVID-19 pandemics, where antibiotics were frequently prescribed to the COVID-19 patients despite the fact that antibiotics do not work against the virus and bacterial coinfection only occur in a small portion of patients (Rayan, 2023). While the COVID-19 pandemic caught global attention, we should not overlook the silent pandemic of AMR.
The antibiotics misuse and overuse are the main drivers that accelerate the emergence and spread of AMR. Naturally, pathogens could develop resistance mechanisms through genetic changes. Some of these mechanisms include restricting access, destroying antibiotics, changing the antibiotic’s target, and bypassing the antibiotic effects. Antibiotic abuse has inevitably accelerated this development, where the antibiotic selective pressure kills the susceptible pathogens and increases the prevalence of resistance in our environment. The resistance developed could be transferred horizontally between different pathogens by mobile genetic elements. This could occur between environmental and clinical bacteria or between non-pathogens and pathogens.
Human activities that contaminate the environment could speed up the development and spread of AMR. Antibodies are only partially digested and absorbed in humans and animals, where approximately 30-90% of antibiotic swill be excreted through urines or feces (Frade et al., 2014) Hence, wastewater introduced into the environment often carries antibiotic residue. The major entrance sources of antibiotic residues into the environment include the hospital settings, municipal, agriculture and livestock production activities. As a result, the environment acts as a bioreactor that facilitates the emergence and dissemination of antimicrobial genes.
The spread of AMR could bring dire consequences as it renders the antibiotics ineffective, leading to more serious infections and frequent deaths. We are not only losing our first line of antibiotics. Instead, the resistance to last resort treatment, carbapenem, has been observed in Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, the leading cause of hospital acquired infections (HAIs) (Cadjoe & Donkor, 2017). Colistin is now the last resort for carbapenem-resistant pathogens. Hence, the increasing prevalence of colistin resistance in Enterobacteriaceae could be worrying (Sharma et al., 2022). The questions arise here are, do we have alternative therapeutic options after the loss of last resort antibiotics, and are we ready for the post-antibiotic era?
Chris Linaman, an executive chef in a medical center, has decided to advocate for the responsible use of antibiotics in food animals after his survival from a methicillin-resistant Staphylococcus aureus (MRSA) infection following surgery. “I was part of good outcome”, he said, “I don’t want my children to go through what I went through.” This short real-life story shared by a superbug survivor highlights the importance for collaborative global actions to tackle and reduce AMR, or else, our future generation will suffer.
Since AMR is a complex problem with serious implications, the One Health approach emerges as a holistic strategy, illustrating the need for collaborative and transdisciplinary actions needed to attain optimal health and sustainability for humans, animals, and environments. There is an urgent need for robust national governance and legal frameworks for the implementations of policies on AMR. The policy should emphasize the sustained funding on antimicrobial research, collaboration between countries, and implementation of antimicrobial stewardship programs. Global efforts are also pivotal for establishing an international standard for microbiological indications of AMR from environmental samples to ease AMR tackling. In 2015, WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) to provide standardized approach in AMR surveillance. This has contributed to a more efficient and reliable global surveillance system, but future improvements are still necessary to increase routine surveillance capacity, especially in the developing and underdeveloped countries (Tornimbene et al., 2022).
As AMR develops as an urgent threat to public health, its serious implications do not lie only in our health sectors. It has a long-term impact on the economy and could eventually increase the gap between developed and developing countries where low-income countries would be more likely to suffer from expensive treatment and labor loss due to AMR (Dadgostar, 2019). Agriculture and livestock industry would also be badly affected as AMR render the treatments on animals and plants ineffective. Additionally, when superbugs enter the food chain, it could pose a serious threat to food safety (Founou et al., 2021).
Hence, the time for action is now. The looming threat of AMR demands immediate coordinated global actions. 70 years of antibiotic abuse has led to the current situation. We reap what we sow. A post antibiotic era, where common infections and minor injuries could result in deaths, is now slowly becoming a reality. Investments and actions are therefore essential for addressing AMR. The choice is ours: Act responsibly now and safeguard the antibiotics as magic bullets against microbial infections or bear the risk of the post antibiotic era.
References
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