Resistance to Antimicrobial
Drugs
Introduction
Definition: Antimicrobial resistance (AMR) occurs when
microorganisms (bacteria, viruses, fungi, and parasites) evolve
mechanisms to survive drugs designed to kill them.
• Importance: A major public health challenge leading to treatment
failures, prolonged illness, and increased mortality.
• Key Terms:
• Antimicrobial drugs: Substances that kill or inhibit microbial
growth.
• Resistance: The ability of microorganisms to withstand
antimicrobial agents.
Causes of Antimicrobial
Resistance
• Natural Causes:
• Mutation and genetic variation in microorganisms.
• Horizontal gene transfer between microorganisms.
• Human-Induced Causes:
• Misuse and overuse of antibiotics.
• Incomplete or incorrect dosages.
• Excessive use of antimicrobials in agriculture and livestock.
• Lack of hygiene and infection control in healthcare settings.
Mechanisms of Resistance
• 1. Enzymatic Destruction or Modification
• Microorganisms produce enzymes that degrade or alter antimicrobial drugs.
• Example: Beta-lactamase enzymes destroy beta-lactam antibiotics like penicillin.
• 2. Efflux Pumps
• Bacteria develop pumps to expel antibiotics from the cell.
• Example: Resistance to tetracyclines.
• 3. Alteration of Target Sites
• Modifying drug-binding sites, rendering the drug ineffective.
• Example: MRSA altering penicillin-binding proteins.
• 4. Reduced Permeability
• Altering cell membrane or wall to prevent drug entry.
Types of Antimicrobial Resistance
1. Intrinsic Resistance
•Natural resistance inherent to the microorganism.
•Example: Gram-negative bacteria resistant to vancomycin due to
their outer membrane.
2. Acquired Resistance
•Resistance developed through mutation or acquiring resistance
genes.
•Example: E. coli acquiring resistance to carbapenems.
3. Cross-Resistance
•Resistance to one antimicrobial conferring resistance to similar
drugs.
•Example: Resistance to fluoroquinolones affecting ciprofloxacin and
levofloxacin.
Consequences of Antimicrobial Resistance
•Increased treatment failure and prolonged illnesses.
•Higher mortality rates.
•Escalating healthcare costs.
•Threat to global health and economic stability.
•Loss of effective treatment options for common infections.
Key Examples of Resistant Organisms
•Methicillin-resistant Staphylococcus aureus (MRSA):
•Resistant to beta-lactams.
•Vancomycin-resistant Enterococci (VRE):
•Resistance to glycopeptides.
•Carbapenem-resistant Enterobacteriaceae (CRE):
•High mortality rates.
•Multidrug-resistant Tuberculosis (MDR-TB):
•Resistant to first-line TB drugs.
Detection of Antimicrobial Resistance
Laboratory Methods
•Phenotypic Testing:
• Disk diffusion (Kirby-Bauer method).
• Minimum inhibitory concentration (MIC) testing.
• Automated systems (e.g., VITEK, MALDI-TOF).
•Genotypic Testing:
• Polymerase Chain Reaction (PCR) for resistance genes.
• Whole genome sequencing.
Strategies to Combat Antimicrobial Resistance
1. Rational Use of Antibiotics
•Prescribe only when necessary.
•Complete prescribed courses.
2. Infection Prevention and Control (IPC)
•Hand hygiene and sanitation.
•Isolating infected patients.
3. Surveillance Programs
•Monitoring resistance patterns.
•Reporting data to public health authorities.
4. Research and Development
•New antibiotics and alternative therapies.
•Vaccination programs to prevent infections .
Role of the Laboratory in AMR
•Accurate and timely identification of pathogens.
•Performing susceptibility testing.
•Participating in resistance surveillance networks.
•Educating healthcare workers on proper sample collection.
Global Efforts to Address AMR
•WHO Global Action Plan:
•Awareness and understanding.
•Surveillance and research.
•Infection prevention.
•One Health Approach:
•Collaborative efforts across human, animal, and environmental health sectors.
•Policies and Regulations:
•Restricted use of critical antibiotics in agriculture.
