Antimicrobial Resistance: What it is, why it is a global concern and how to guard against it

World Antimicrobial Awareness Week or WAAW is observed every year between 18 and 24 November. The theme for 2021 is ‘’Spread Awareness, Stop Resistance’’. The awareness movement, in accordance to this year’s theme calls for health stakeholders, healthcare providers, policymakers and most importantly the general public to be Antimicrobial Resistance (AMR) Awareness champions.What are antimicrobials?Before delving into Antimicrobial Resistance, let us first look at what antimicrobials are. Antimicrobials refer to medicines that are used to prevent and treat infections in humans, animals and plants. Infections are caused by bacteria, virus, fungus and parasites. Antimicrobials, therefore are blanket terms that include anti-bacterial, anti-viral, anti-fungal and anti-parasites.‘Antibacterial’ includes drugs that are derived from bacteria or mold or are synthesized. Antibiotics refer only to such antimicrobials that are produced from bacteria or molds but now the term antibiotic is also referred to when meaning ‘antibacterial drug’.What is antimicrobial resistance?Now that the term ‘antimicrobial’ is clear, let us look at what Antimicrobial resistance means. Antimicrobial resistance also referred to as AMR happens when bacteria, fungi, viruses and parasites change over time and do not respond to medicines. This makes infections harder to treat and eventually leads to the spread of infection, resulting in severe illness and sometimes even death.Why is antimicrobial resistance a global concern?AMR is one of the top ten global public health threats facing humanity. The emergence and spread of antimicrobial-resistant organisms have a direct consequence on the ability to treat common infections. We are all aware of the global spread of superbugs that are multi and pan-resistant bacteria.  These cause infections that cannot be treated by existing antibiotics.While we need new antibiotics, it is important to change the way antibiotics are being used. If our behavior towards antibiotics do not change, then new antibiotics will also eventually become ineffective.Antibiotic resistance leads to increased medical costs, longer hospital stays and increased rate of death. The cost of AMR therefore to health systems and national economies is profound.What accelerates the emergence and spread of antimicrobial resistance?Antimicrobial resistance happens naturally over a period of time and often through genetic changes.  Antimicrobial-resistant organisms are found in environments that is in the water, soil and air. They are also found in animals, plants, food, and in humans. These organisms can spread from person to person and even between people and animals including from food of animal origin.What leads and drives antimicrobial resistance?

• Misuse of antimicrobials
• Overuse of antimicrobials
• Lack of access to clean water
• Sanitation and hygiene factors both in humans and animals
• Poor infection control and disease prevention measures in healthcare facilities and in animal farms.
• Lack of access to quality and affordable medicines, vaccines and diagnostics
• poor access to quality, affordable medicines, vaccines and diagnostics
• Lack of awareness on AMR
• Inadequate regulation and lack of enforcement of regulations

How do we deal with AMR?AMR requires a united and multi-sectoral approach due to its complexities. The ‘One Health’ approach aims to bring together multiple sectors and stakeholders that are involved in human, terrestrial and aquatic animal and plant health, food and feed production. The approach aims to work together in the implementation of programs, policies, research and legislation to attain better public health outcomes.Is it not more convenient to develop newer and stronger antimicrobials?The development of new antimicrobials is a lengthy and arduous process with multiple challenges and needless to say, expensive. It also takes a long time for it to be delivered in the market from the time it is developed. The number of new antimicrobials that are being launched has decreased over time. It is important that antimicrobials are appropriately used to overcome the hazards of AMR, regardless of the supply of new antimicrobials.What do we need to do protect ourselves and our family from AMR? It is not possible for anyone to completely avoid an infection but we all can take a few steps to minimise the risk.

• Stay healthy and keep others healthy

Clean your hands with soap and water, cover the mouth and nose when you are coughing or sneezing. It is important to stay at home when you are sick so that others are not put at risk. Use of masks is advisable, especially if it is an upper respiratory infection. Avoid close contact with people who are sick, have an active cold or have an upper respiratory infection. Avoid touching eyes, nose and mouth with unwashed hands.

• Be Antibiotic SMART with appropriate use of antibiotics

Firstly, antibiotics should be taken only when prescribed by a certified healthcare professional. Never use antibiotics on your own accord. It is important to take antibiotics exactly as prescribed by the doctor and should cover the entire duration suggested by the doctor. Discard any leftover antibiotics and never use it for any other later illness. Please do not share antibiotics with others even in the family or take antibiotics that have been prescribed for someone else.

• Maintain healthy habits around animals

It is important to thoroughly clean your hands after touching, feeding, or caring for animals. It is also important to keep animals healthy to avoid the risk of infection.

• Prepare food safely

Follow the five WHO Keys to safe food:

• Clean your hands, cooking utensils and surfaces
• Separate raw food from cooked food
• Cook thoroughly
• Chill leftovers immediately
• Use safe and clean water and raw materials

It is also important to choose foods that have been produced without the use of antibiotics for growth promotion or disease prevention in healthy animals.

• Stay healthy when traveling

Be vigilant and aware when traveling abroad. Know what vaccinations are needed for the place you’re travelling to and ensure the consumption of safe food and drinks.Key Messages for Antimicrobial Awareness Week

• It is clear that antimicrobials are a precious resource whose usefulness is lost without appropriate use,
• Antimicrobial resistance is a phenomenon that is happening NOW and is a global problem that affects both human and animal health
• Antibiotic resistance happens when bacteria stop an antibiotic from working effectively – meaning some infections may become impossible to treat
• Because of the limitations to developing new antimicrobials, few new antimicrobials are being developed to tackle the AMR challenge
• Misuse of antimicrobials contributes to antimicrobial resistance.
• Antimicrobials, when used should be used appropriately and with utmost care.

Dr Ekta Patil is the senior Microbiologist at SRL, Global Reference Laboratory in Mumbai. She joined SRL in 2014 as Microbiologist and now heads the Microbiology and Serology section of SRL Mumbai lab. She is an SME (Subject Matter Expert) for Microbiology & Serology and also a member of COTE (Council of Quality & Technical Excellence) at SRL. She has done her MBBS and MD from TNMC and Nair hospital. She is a certified NABL internal auditor. Her areas of interest involve Antimicrobial resistance and Mycobacteriology. With various publications to her credit she has also delivered lectures at scientific meets and conferences.