The challenge
Get an overview of the challenge of antimicrobial resistance that threatens continuity of successful treatment and prevention of infectious disease.
Bacterial resistance to antimicrobials is recognized by the WHO as a major health threat of the 21st century. Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections. Infections such as tuberculosis and septicemia - the scourge of earlier centuries - are once again killing patients at frightening rates. Bacterial resistance is driven by the continued use of antimicrobials and it is unlikely that the threat of resistance can be effectively mitigated by the discovery of new antimicrobials. We have used, or are using, our so-called drugs of last resort. There is nothing left in the armory and investments in new drugs are missing, we are moving into the post-antimicrobial era. Click on the elements below to learn more about the challenges.
Seven pathological threats
Mechanisms of antimicrobial resistance
History of resistance
Treatment quality
The costs
More information
Treatmentquality
The following examples of pathological threats are now part of the daily fight against of infectious diseases:
Acquired antimicrobial resistance is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by the microorganism. Resistant microorganisms are able to withstand attack by antimicrobial drugs so that standard treatments become ineffective and infections persist, increasing the risk of spreading the resistant microorganism to others. The evolution of resistant microbial strains is a natural phenomenon that occurs when microorganisms replicate themselves erroneously or when resistance genes are exchanged between them. The use and misuse of antimicrobial drugs accelerates the emergence of drug-resistant strains. Poor infection control, inadequate sanitary conditions, and inappropriate food handling also encourages the further spread of antimicrobial resistance.
The already small and dwindling pipeline of antimicrobial drug candidates makes it unlikely that the rescue will come from newly discovered drugs. Between 1935 and 1968, 14 different classes of antimicrobials were developed. In the 47 years since 1968, only five have been brought out. No new classes have been developed since 1987. One problem is the missing profit potential: profit depends on volume. Many pharmaceutical companies have pulled out of antimicrobial drug development, and instead focus on drugs for chronic conditions, such as diabetes or blood pressure, where the patient is medicated for their whole life. Not surprisingly, this is more profitable than selling drugs for medical ordinations lasting just days or weeks.
Convincing evidence points at the relation between increased antimicrobial consumption and higher levels of antimicrobial resistance [1]. Therefore, it is quite controversial that surveillance data from European Centre for Disease Prevention and Control (ECDC) shows a huge variation in the usage and prescription of antimicrobials among the European countries. Even more striking is it that the usage of Quinolones, Cephalosporins and other broad-spectrum antimicrobials such as Piperacillin/tazobactam is increasing. Despite the change from narrow-spectrum antimicrobials Center for Disease Control (CDC) states that the empirical coverage of microbiologically documented infections is around 50-70%, and that around 50% of all antimicrobial use is inappropriate meaning one of the following:
Inappropriate antimicrobial use not only fails to help patients, it may also cause harm. Like every other drug, antimicrobials have side effects and can also interact or interfere with the effects of other medicines. The inappropriate use of antimicrobials unnecessarily promotes antimicrobial resistance at increasing speed if nothing is done.
Consumption of antimicrobials for systemic use (ATC group JO1) at ATC group level 3 in the community, EU/EER countries, 2012, expressed as defined daily dose per 1.000 inhabitants and per day.
1.Sande-Bruinsma van de N, Grundmann H, Verloo D, Tiemersma E, Monen J, Goossens H, Ferech M. European Antimicrobial Resistance Surveillance System Group; European Surveillance of Antimicrobial Consumption Project Group. Antimicrobial drug use and resistance in Europe. Emerg Infect Dis 2008;14:1722-30.
Center for Disease Control (CDC) estimates that in the United States, more than two million people are affected every year by antimicrobial-resistant infections, with at least 23,000 dying as a result. The estimates are based on conservative assumptions and are likely minimum estimates. The estimates have translated into several approximations of the costs of increasing resistance in the United States. The total economic cost of antimicrobial resistance is difficult to calculate, but estimates have ranged as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion per year. Examples of the estimates of the costs be center for disease control of individual resistant pathogens are shown below:
Below you can find links to more information about the challenge of antimicrobial resistance from the perspectives of the Centre for Disease Control (CDC), the European Centre for Disease Control (ECDC) and the World Health Organization (WHO). Centre for Disease Control The World Health Organization