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Antimicrobial resistance

Two petri dishes with antibiotic resistance tests
Antibiotic resistance tests: Bacteria are streaked on dishes with white disks, each impregnated with a different antibiotic. Clear rings, such as those on the left, show that bacteria have not grown—indicating that these bacteria are not resistant. The bacteria on the right are fully resistant to three of seven and partially resistant to two of seven antibiotics tested.[1]

Antimicrobial resistance (AMR or AR) occurs when microbes evolve mechanisms that protect them from antimicrobials, which are drugs used to treat infections.[2] This resistance affects all classes of microbes, including bacteria (antibiotic resistance), viruses (antiviral resistance), protozoa (antiprotozoal resistance), and fungi (antifungal resistance). Together, these adaptations fall under the AMR umbrella, posing significant challenges to healthcare worldwide.[3] Misuse and improper management of antimicrobials are primary drivers of this resistance, though it can also occur naturally through genetic mutations and the spread of resistant genes.[4]

Microbes resistant to multiple drugs are termed multidrug-resistant (MDR) and are sometimes called superbugs.[5] Antibiotic resistance, a significant AMR subset, enables bacteria to survive antibiotic treatment, complicating infection management and treatment options.[3] Resistance arises through spontaneous mutation, horizontal gene transfer, and increased selective pressure from antibiotic overuse, both in medicine and agriculture, which accelerates resistance development.[6]

The burden of AMR is immense, with nearly 5 million annual deaths associated with resistant infections.[7] Infections from AMR microbes are more challenging to treat and often require costly alternative therapies that may have more severe side effects.[8] Preventive measures, such as using narrow-spectrum antibiotics and improving hygiene practices, aim to reduce the spread of resistance.[9]

The WHO claims that AMR is one of the top global public health and development threats, estimating that bacterial AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths[10]. Moreover, the WHO and other international bodies warn that AMR could lead to up to 10 million deaths annually by 2050 unless actions are taken.[11] Global initiatives, such as calls for international AMR treaties, emphasize coordinated efforts to limit misuse, fund research, and provide access to necessary antimicrobials in developing nations. However, the COVID-19 pandemic redirected resources and scientific attention away from AMR, intensifying the challenge.[12]

  1. ^ Kirby-Bauer Disk Diffusion Susceptibility Test Protocol Archived 26 June 2011 at the Wayback Machine, Jan Hudzicki, ASM
  2. ^ "About Antimicrobial Resistance". US Centers for Disease Control and Prevention. 22 April 2024. Retrieved 11 October 2024.
  3. ^ a b "Antimicrobial resistance Fact sheet N°194". who.int. April 2014. Archived from the original on 10 March 2015. Retrieved 7 March 2015.
  4. ^ Tanwar J, Das S, Fatima Z, Hameed S (2014). "Multidrug resistance: an emerging crisis". Interdisciplinary Perspectives on Infectious Diseases. 2014: 541340. doi:10.1155/2014/541340. PMC 4124702. PMID 25140175.
  5. ^ Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. (March 2012). "Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance". Clinical Microbiology and Infection. 18 (3): 268–281. doi:10.1111/j.1469-0691.2011.03570.x. PMID 21793988.
  6. ^ Dabour R, Meirson T, Samson AO (December 2016). "Global antibiotic resistance is mostly periodic". Journal of Global Antimicrobial Resistance. 7: 132–134. doi:10.1016/j.jgar.2016.09.003. PMID 27788414.
  7. ^ "Better use of vaccines could reduce antibiotic use by 2.5 billion doses annually, says WHO". World Health Organization. 10 October 2024. Retrieved 11 October 2024.
  8. ^ Saha M, Sarkar A (December 2021). "Review on Multiple Facets of Drug Resistance: A Rising Challenge in the 21st Century". Journal of Xenobiotics. 11 (4): 197–214. doi:10.3390/jox11040013. PMC 8708150. PMID 34940513.
  9. ^ Swedish work on containment of antibiotic resistance – Tools, methods and experiences (PDF). Stockholm: Public Health Agency of Sweden. 2014. pp. 16–17, 121–128. ISBN 978-91-7603-011-0. Archived (PDF) from the original on 23 July 2015. Retrieved 23 July 2015.
  10. ^ "Antimicrobial resistance". www.who.int. Retrieved 20 November 2024.
  11. ^ Chanel S, Doherty B (10 September 2020). "'Superbugs' a far greater risk than Covid in Pacific, scientist warns". The Guardian. ISSN 0261-3077. Archived from the original on 5 December 2022. Retrieved 14 September 2020.
  12. ^ Rodríguez-Baño J, Rossolini GM, Schultsz C, Tacconelli E, Murthy S, Ohmagari N, et al. (March 2021). "Key considerations on the potential impacts of the COVID-19 pandemic on antimicrobial resistance research and surveillance". Trans R Soc Trop Med Hyg. 115 (10): 1122–1129. doi:10.1093/trstmh/trab048. PMC 8083707. PMID 33772597.

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