Every now and then we hear news about new antibiotic-resistant bacteria. In fact, over the last decade, 19 new strains have developed mechanisms to resist antibiotics. A good example is the ‘last resort’ colistin, which was the last effective antibiotic held in reserve – at least until 2015, when researchers reported the emergence of colistin resistance in E. coli.
Today, it is hard to imagine modern medicine without antibiotics, the ‘magic bullets’ that enable us to perform the most incredible life-saving interventions, including organ transplantations and major heart surgeries.
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However, since the discovery of penicillin, bacteria have been able to ‘strategically’ find ways to resist the effects of antibiotics, so that they are not killed, or their growth is not stopped.
It’s not just human medicine that has this influence. Antimicrobial resistance, or AMR, naturally occurs in the environment as many species of bacteria produce antimicrobial agents.
To survive such environmental exposure, bacteria have to find ways to avoid the effect of such antimicrobials. One of the most common ways is by transferring the genes that provide resistance between species.
The fact is that, even without human intervention, the natural environment already contributes to the selection of antibiotic resistant microorganisms.
How big is the threat of AMR?
Unfortunately, AMR is not a problem that will happen in the future: it is happening now. Currently, 700,000 people die worldwide every year from infections that no longer respond to antibiotics.
It is estimated that the number of deaths will increase to 10 million per year by 2050, consequently costing the healthcare systems 100 trillion US dollars unless appropriate measures are implemented to control the spread of AMR.
In addition to the human death toll, AMR reduces the effectiveness of standard treatment, which results in prolonged patient illness and longer stay in hospitals, thus increasing the healthcare cost.
Recently, the World Health Organisation has warned that we are entering the “Post Antibiotic Era”, when there could be very little done to treat simple infectious diseases.
AMR is a complex phenomenon largely impacted by human activities, behaviour and socioeconomic and environmental factors. High production and usage of antibiotics (hundreds of thousands of tonnes per year), the release of pharmaceutical manufacturing waste into the environment, uncontrolled use of ‘antibiotic growth promoters’ in animals, and availability to buy antibiotics ‘over-the counter’ have led to serious antibiotic resistance issues.
The misuse and overuse of antibiotics creates a favourable environment for promoting resistance among the susceptible bacteria. For example, antibiotics used on farm animals contribute to the development of resistant bacteria that can be transmitted to humans through food consumption. This in turn can lead to food-borne infections that become increasingly difficult to treat.
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Recently, my research showed that bacteria resistant to multiple antibiotics are widespread in non-healthcare environments. The fact that the AMR levels in public settings were comparable with those found inside the hospital suggests that such public places may well be reservoirs for antibiotic resistant bacteria capable of moving between the two and humans.
How can we stop AMR?
AMR is a global issue. It is as serious a threat as climate change and similarly requires concrete global efforts. In fact, a 2018 study published in Nature Climate Change found that global warming may be accelerating the problem of AMR.
Bacteria thrive at higher temperatures that provide them with a favourable environment to rapidly increase in numbers, creating better opportunities for mutations and transmission.
The good news is that with collective efforts we can tackle AMR. Everyone in the world can contribute to solving the problem by simply limiting their use of antibiotics to only when they are needed, and by promoting AMR Awareness campaigns, for example, on social media. Without human-induced antibiotic exposure, the bacteria may well return to its ‘susceptible’ state.
The world is running out of effective antibiotics that we depended on for so many years. Our children and grandchildren will inherit the world as we leave it to them. And to me there is nothing more important than making the right choices to make our planet a better place for them.
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