ANTIMICROBIAL
RESISTANCE (AMR)
Module 1: AMR awareness for
healthcare providers
Antimicrobial Resistance
Introduction
• Antimicrobial Resistance (AMR) serious global public
health threats of the 21st century.
• World Health Organization labelled AMR among the top
10 global public health threats for humanity.
• AMR threatens effective treatment of new and existing
infections caused by microbes.
• Maybe Next Pandemic is global AMR, may land us in Pre
Alexander Fleming era 1940, when throat infection can
kill
Resistance
Introduction
• Antimicrobials: antibiotics, antivirals, antifungals
& antiparasitic are medicines to prevent & treat
infections in humans, animals and plants.
• Microorganisms that develop resistance to
medicines are sometimes referred as
“superbugs”.
• AMR occurs when microbes change over time,
don’t respond to medicines, infections persist in
the body, increasing the risk of deaths &
prevalence.
Resistance
Introduction
• Antimicrobials: antibiotics, antivirals, antifungals
& antiparasitic are medicines to prevent & treat
infections in humans, animals and plants.
• Microorganisms that develop resistance to
medicines are sometimes referred as “superbugs”.
• AMR occurs when microbes change over time, don’t
respond to medicines, infections persist in the body,
increasing the risk of deaths & prevalence.
Resistance
Introduction
• Misuse & overuse of antimicrobials main drivers
of drug-resistant pathogens.
• Without effective antimicrobials, treating
infections, cancer, conducting surgeries would be
hard.
Resistance
Introduction
• ANTIMICROBIAL RESISTANCE
(ANTI – MICROBES(medicine) RESISTANCE (by
microbes)
• Antibiotic Resistance
• Antifungal Resistance
• Antiviral Resistance
• Antiparasitic Resistance
Resistance
Introduction
• ANTIMICROBIAL RESISTANCE
(ANTI – MICROBES(medicine) RESISTANCE
• Antibiotic Resistance Highest Incidence
• Antifungal Resistance
• Antiviral Resistance
• Antiparasitic Resistance
ANTIBIOTIC
RESISTANCE
• Antibiotics transformed medicine, making lethal
infections treatable, surgeries & transplants
possible
• Antibiotic resistance is the biggest threats to
human & animal health, food security and
Environment.
• Antibiotic resistance can affect anyone, anywhere.
• Occurs naturally & slowly, but misuse of antibiotics
is accelerating the process.
• Infections such as pneumonia, tuberculosis, UTI,
gonorrhoea, and others are harder to treat.
resistance & One
Health
One Health
DRUG RESISTANCE
AMR A Global Concern
• Drug resistant infections are rapidly emerging,
compromising our ability to treat even common infections.
• Rapid Spread of Superbug (multi & pan resistant bacteria)
not treatable with existing antibiotics.
• The success of Modern medicine in treating infection,
conducting surgeries, transplants, chemotherapies at risk.
• Huge economic loss, lower productivity, prolong
hospitalization stay & expensive treatment.
AMR A Global Concern
• The clinical pipeline of new antimicrobials is dry. New
antibacterials urgently needed.
• Carbapenem-resistant gram-negative bacterial
infections very hard to treat.
• Rampant use can cause side effects and antibiotic
resistance.
• In U.S. 28% of prescribed antibiotic are unnecessary.
• Cost of AMR to national economies & health systems.
Current Situation of AMR Conti’
• For common bacterial infections like UTI, Sepsis,
STI, diarrhoea resistance observed worldwide.
• Klebsiella pneumoniae common intestinal
bacteria but can cause life-threatening infections.
• Carbapenem Resistance in K. pneumoniae spread
globally. Causing HAIs & 50% therapeutic failure.
• Fluoroquinolones resistance to UTI is common.
Current Situation of AMR
• Colistin treatment of last resort against resistant
K.Pneumonia are showing increasing resistance.
• In 2019, a new AMR indicator added in SDG monitoring
framework. That monitors (MRSA) & E. coli.
• GLASS collect the surveillance data on resistant string
• Drug Resistant TB, 0.5M new cases, majority
resistant to two most powerful drugs. Resistance
against last resort
Current Situation of AMR Conti’
• Antiviral resistance an increasing concern.
• Resistance developed to most antivirals including
antiretroviral (ARV) drugs & drug-resistant HIV (HIVDR).
>50% infants in Africa resistant to HIV drugs.
• Emergence of drug-resistant parasites poses one of the
greatest threats to malaria control. Artemisinin-based
combination therapies (ACTs)started to show resistance.
• Drug-resistant fungal infections is increasing and
exasperating the already difficult treatment situation.
Current Situation of AMR Conti’
• Drug-resistant Candida auris, common invasive
fungal infections with resistance to common used
fluconazole, amphotericin B & voriconazole.
• Black fungus is reported during COVID-19 prolong
hospitalization, with lengthily treatment.
• Among all drugs consumed in Pakistan,
antimicrobials are 3rd highest in the category.
• Lack of information related to AMR among health
professionals.
AMR STEWARDSHIP PROGRAM
A coordinated program to :-
• Promotes the appropriate use of antimicrobials
(including antibiotics),
• Improves patient outcomes,
• Reduces microbial resistance,
• Decreases the spread of infections caused by
resistant microorganisms.
• Reduce healthcare expenditure
AMR STEWARDSHIP PROGRAM
• IDSA has created a program to designate
Antimicrobial Stewardship Centers of Excellence
(CoE) across the U.S. health care system.
• The IDSA Antimicrobial Stewardship Centers of
Excellence Program builds upon the criteria for
meaningful differentiation of CDC core elements.
The Importance of Antimicrobial
Stewardship
• Each year, more than 700,000 individuals die due
to antimicrobial resistance (AMR) infections.
• Infectious Diseases Society of America (IDSA) has
promoted antimicrobial stewardship (AS) as an
avenue to combat AMR for many years.
• The CDC and the Joint Commission have set
standards for hospitals to have antimicrobial
stewardship programs (ASPs) in place.
Antimicrobials
prescribing guidelines
• There are guidelines to used as a reference to
develop local guidelines as antibiogram program
at health facility level.
• Reference guidelines
o NHS
o IDSA (organ specific)
o Local guidelines developed by National Health
facilities.
o https://medicines.blmkccg.nhs.uk/wp-content/
uploads/2020/09/antimicrobial-guidelines-
updated-march-2021-NC.pdf
GUIDELINES FOR AMR
The John Hopkins guidelines for antibiotic use
comprises of following sections
• Syndrome Specific: Bacterial Urinary Tract
Infection, Cellulitis, Clostridium difficile Infection,
Community-Acquired Pneumonia, Hospital-Acquired
Pneumonia
• Testing: Verigene, Fungal Diagnostics
• Drug Specific: Ceftaroline, Cefepime, Ceftriaxone,
Piperacillin/tazobactam
GROUP ACTIVITY
• Module 1 Group Activity…..
