ANTIMICROBIAL RESISTANCE
(AMR)
Dr. Munmun Das (Sarkar)
Professor,
Department of Microbiology,
Calcutta School of Tropical Medicine, Kolkata
What are Microorganisms?
Are all Microbes harmful?
Can the same Microbe infect both
animals and people?
What are Antimicrobials?
• Antimicrobial agents are medicines used to treat
infectious diseases caused by microorganisms such
as bacteria, fungi, viruses and protozoan parasites
• (Antibacterials / Antibiotics)
• Antimicrobial drugs paved the way to better
living conditions for humans and animals
• Before modern medicine, infections due to minor
cuts could lead to bloodstream infections or
death
How are Antimicrobials used?
• Antimicrobials are used to treat, control and
prevent diseases in Humans, Plants and
Animals.
• A common practice is to add antimicrobials in
low concentrations to animal feed to stimulate
growth and production. This practice is
increasingly discouraged but still occurs in many
areas.
What is Antimicrobial Resistance?
• Antimicrobial resistance (AMR) is the ability of
microorganisms to persist or grow in presence
of the drugs designed to inhibit or kill them.
• When microorganisms become resistant to
antimicrobials, standard treatments become
ineffective, and in some cases, no drugs
provide effective therapy.
• This makes infections harder to treat and
increase the risk of disease spread, severe
illness and death.
What is Antimicrobial Resistance?
• Every time we use antimicrobial drugs in
people, animals and plants, microorganisms
have a chance to acquire the ability to tolerate
the treatments by becoming resistant, making
the drugs less effective over time
• AMR can spread among different hosts and
the environment.
• Today, antimicrobials help animals and humans
live longer and healthier lives, But how long will
this last?
• Many of the life-saving drugs are losing their efficacy
as previously susceptible microbes (bacteria, virus,
fungi, and parasites) become resistant.
• AMR has led to the emergence of “superbugs”, --
challenging health care workers, veterinarians, and
other animal health providers due to a reduction of
effective therapeutic options to prevent, control, and
treat infectious diseases.
What causes Microbes to acquire
Antimicrobial Resistance?
• Random mutations and gene transfer mechanisms.
• Bacteria can also acquire the resistance gene from
other bacteria.
• Microbes that are resistant can survive in the
presence of the antimicrobial, thus, when
antimicrobials are used, the drug sensitive
microbes are inhibited or killed but the resistant
microbes remain, -- these resistant microbes grow
and become the dominant members of the
microbial population.
Can we completely stop Microbes from
developing resistance to Antimicrobials?
• We cannot stop microbes from developing
resistance because this is a natural evolutionary
process, nor can we eradicate the problem.
• However, we can slow down the process by
ensuring the judicious use of antimicrobials.
• Employing hygienic practices, good food and
water sanitation - can reduce the transmission
of these antimicrobial resistant microorganisms.
Does stopping a course of antibiotics early
lead to antibiotic resistance?
• Feeling better, or an improvement in symptoms, does
not always mean that the infection has completely
gone.
• The kind of antibiotics a doctor prescribes and the
length of the course should be based on the best
evidence for that particular infection
• Prescribing doctor has had years of training and has
access to the latest evidence – so always good to follow
their advice.
How do we know which Microbes have
become resistant?
• Treatment failure because of AMR is occurring
more and more often. Hence, it is important to
know which antimicrobials will be effective for
treating an infection
• Laboratory tests (ABST) are available to determine
this
• Performing ABST before starting treatment is
important because if wrong drug is used, it will be
ineffective, resulting in treatment failure, it will also
contribute to the selection of more antimicrobial
resistant organisms.
Why we need to be concerned?
• Antimicrobial resistance (AMR) is one of the most
serious global health threats faced by humanity.
• It is called as the Silent Pandemic.
• We have seen COVID-19 pandemic, we know about
TB, Malaria, Dengue, AIDS – all these diseases kill
many patients but, infection with Multidrug
resistance Microorganisms having no treatment
options can kill more patients silently.
Why we need to be concerned?
• The emergence and spread of AMR microorganisms
continues to threaten our ability to treat common
infections.
• Especially alarming is the rapid global spread of
multi- and pan-resistant bacteria (“superbugs”) that
are not treatable with existing antimicrobial drugs.
• The first true antibiotic “Penicillin was discovered in
the year 1928 by Alexander Fleming. Following
that, many antimicrobials were discovered over the
years, but, at present, we do not have many new
antibiotics at hand.
Why we need to be concerned?
• Misuse and overuse of antimicrobials are the main
drivers in the development of drug-resistance.
• Lack of clean water and sanitation and inadequate
infection prevention and control promotes the
spread of microbes.
• If we do not change the way antibiotics are used
now and if we do not give enough importance to
infection prevention and control measures - new
antibiotics will also suffer the same fate and will
become ineffective.
Antimicrobial Resistance –
a Global and Multi-
Multi-sectorial Issue
• We are more concerned with human exposure to
AMR pathogens in hospitals and other healthcare
facilities and the ramifications related to public
health.
• There is presence of AMR microorganisms in our
farming systems - they also contaminate the food
and drink we consume.
• AMR microorganisms can move between animals,
humans, and the environment.
• This makes AMR a problem that crosses sectoral
boundaries.
Antimicrobial Resistance –
a Global and Multi-
Multi-sectorial Issue
• By means of Modern trade and travel antimicrobial
resistance can move easily across borders
• It is a growing threat to animal and human health,
as well as livelihoods and food security worldwide
• The good news is that solutions exist to curb the
emergence of drug-resistant microbes.
• And everyone–farmers, aquatic animal producers,
animal health providers, health care workers,
citizens from every country–can take action to fight
this threat to global health.
How resistance spreads from
Human Animal Food Environment
Dr M Das (Sarkar)
Bacteria can become resistant naturally to
antibiotics, However, our actions can increase
developing and spreading of resistant organism
This can happen by:-
1. Over prescription of antibiotics
2. when people don’t take antibiotics as directed.
3. sometimes, people use antibiotics prescribed
earlier for similar types of symptoms (instead of
consulting their Doctors).
4. Lack of hygienic practices
5. lack of infection prevention and control
6. Travelling around the world spreading resistant
bacteria.
• How Microorganisms can spread ?
• Between people
• direct contact (touching)
• coughing and sneezing
• exposure to body fluids (close personal contact).
• Contaminated surfaces
• Bacteria can live on surfaces - You can pick up bacteria
when you touch them.
• Contaminated food
• During handling, preparing or eating contaminated
food or food materials.
• Animals
• Bacteria can pass between animals and humans
through direct or indirect contact.
• Unwashed / undercooked foods and beverages.
Moreover,
We consume antibiotics for almost every illness
Pharmacies and dispensaries sale antibiotics without
prescription.
Informal Health Care providers & General population -
do not have proper knowledge.
Health professionals also prescribe unnecessary
antibiotics
Indiscriminate use in Livestock and Agriculture
(Disease prevention & Growth promotion)
Dr M Das (Sarkar)
How can we prevent the development of
Antimicrobial Resistance?
• For the use of treatment in humans and also in
animals there exist lists of first, second and last
choice antimicrobials for certain microbes.
• By following these antimicrobial formularies,
and not using a last choice antimicrobial before
trying a first choice, we can prevent the
microbes from acquiring resistance against the
last choice (last resort) antimicrobials.
How can we prevent the development of
Antimicrobial Resistance?
• We can use antimicrobials responsibly: Justify,
reduce and regulate their use.
• This means to use them –
only when necessary,
only use drugs – (that microbes are
susceptible to, after C/S testing),
for the required duration
with the dose as prescribed
How can we prevent the development of
Antimicrobial Resistance?
Prevention of - infection and spread of infection
Prevention of spread through pets and other domestic
animals.
Pharmacies and dispensaries to sale antibiotics with
proper prescription.
Informal Health Care providers to be educated with
proper knowledge and so they prescribe proper and
justified antibiotics.
General population to be educated regarding use of
antimicrobials.
Why we need to take action:-
• More infection by MDR organism = more hospital
stay = more morbidity & mortality more
financial loss of the patients,
• Less patient turn over (in hospital/ Health care
settings/ Practice) = less service to mankind &
more loss of govt revenues.
What should be our priorities ?
Awareness generation and understanding the
problem –
Information, Education, communications and
training to –
• Health professionals & other care givers,
• Students
• General population.
Dr M Das (Sarkar)
Awareness generation may include the
followings:
1. Prevention of infections by regularly washing hands
and keeping up to date with vaccinations
2. Prevention of food-borne infections by washing
fruits and vegetables and cooking food properly
3. Understanding that antibiotics only work against
bacteria. They do not work for colds and flus which
are caused by viruses
Awareness generation may include the
followings:
4. Not to pressure the health professional for
antibiotics if they say you don’t need them, ask
about other ways to relieve symptoms
5. To take antibiotics when they are prescribed, not to
use or share leftover antibiotics and dispose off
leftover antibiotic safely.
6. To follow health professional’s instructions when
antibiotics are prescribed.
What should be our priorities ?
Acquiring knowledge and evidence - through
surveillance and establishment & upgradation
of Microbiology laboratories
[+ State level standard operating procedures (SOP) for
collection, storage, transportation, processing and
quality assurance,
+Inclusion of all govt and private health facilities under
surveillance]
Dr M Das (Sarkar)
What should be our priorities ?
Prevention and control of Infection –
(in human health)
– hand washing, sterilization and cleaning,
Antibiotic guideline and policy as applicable,
Hospital infection control & HICC,
Biomedical waste management &
Collaboration with National vertical disease
control programmes.
Dr M Das (Sarkar)
Proper Hand
Hygiene can
reduce
Nosocomial
Infection Rates
by approx. 33%
What should be our priorities ?
(4) Optimizing use of antibiotics –
Antibiotic usage guideline and policy,
Prescription audit,
antibiotic consumption and antimicrobial
stewardship
Initiatives by Directorate of Drug control –
including awareness generation among
pharmacies [-including over the counter sale of
antimicrobials]
Dr M Das (Sarkar)
What else?
Collaborations – with – animal husbandry,
fisheries, agriculture, pollution control board,
drug regulator, food safety, science &
technology research institutes, private sector,
etc
(Priority - prevention of infection in animals,
Establishment of laboratories and data collection,
reduce use of antimicrobials in all sectors)
Dr M Das (Sarkar)
AMR: Few Things to Remember
• Antimicrobial resistance is one of the most urgent
threats to public health.
• Antimicrobial Resistance concerns the health of
people, animals, agriculture, livestock, food and
environment
• Antimicrobial resistance occurs in the
microorganisms when they defeat the drugs
designed to kill them.
• Our body does not become resistant to antibiotics.
AMR: Few Things to Remember
• Antimicrobial resistance can affect people at age.
• Infections with AMR organisms are difficult—
sometimes impossible to treat. Also, may require
extended hospital stays, additional follow-up doctor
visits, and the use of treatments that may be costly and
potentially toxic to the patient
• Healthy habits can protect us from infections and help
stop germs from spreading.
• Recommended vaccines to be taken, hands and wounds
to be kept clean, taking good care of chronic conditions
like diabetes is a must.
AMR: Few Things to Remember
• Antibiotics save human and animal lives.
• But, every time antibiotics are used, they can lead
to side effects and resistance.
• Antibiotics do not work on viruses, such as colds and
the flu. Talk to healthcare provider or veterinarian
about whether antibiotics are needed or not.
• Antimicrobial resistance has been found in all
regions of the world
AMR: Few Things to Remember
• By means of Modern trade and travel
antimicrobial resistance can move easily across
borders
• It can spread in places like hospitals, farms, the
community, and the environment.
• Prevention of infections and prevention of
spread of infection by AMR microorganism helps
towards containment.
Our time with antibiotics is running out
• Antimicrobial resistance(AMR) has become one of
the deadliest health issues of our time
• Imagine a world where infections and diseases in
humans, animals and plants are impossible to treat
• This worst-case scenario could become a reality as
microorganisms develop resistance to the drugs we
use to fight them.
• Solutions exist and everyone has a role to play in
the fight against this global threat.
