A pathogen overpowering the medicine and making the latter ineffective is a challenge that the medical world is dealing with. Antimicrobial resistance is real and has only worsened post-Covid-19, thanks to the rampant misuse of antibiotics.
The World Health Organisation (WHO) has also declared Antimicrobial Resistance (AMR) as one of the top 10 global public health threats humanity is facing, while listing the misuse and overuse of antimicrobials as the main reason for the development of drug-resistant pathogens. A 2016 review on AMR commissioned by the UK government showed that AMR is killing more people than cancer and road traffic accidents combined.
Prof Joseph Selvin, professor and head, Department of Microbiology, Pondicherry University, Puducherry and one of the authors of the 2021 study titled ‘Delineating the impact of COVID-19 on antimicrobial resistance: An Indian perspective’ says that antibiotic consumption increased drastically during the Covid-19 pandemic.
“Almost everyone who had the infection was on multiple antibiotics. At the time, people were looking for ways to tide over the pandemic rather than thinking about antimicrobial resistance. AMR poses a much more dangerous threat when compared to Covid and other such pandemics. Pandemics may come and go but AMR will stay with us,” Prof Selvin tells Happiest Health.
What is antimicrobial resistance?
Dr Kirti Sabnis, infectious diseases specialist, Fortis Hospital Mulund & Kalyan, Mumbai says that antimicrobial resistance is the ineffectiveness of antibiotics for certain infections because the pathogen, the bacteria or the fungus which is causing the infection is not responding to that particular antibiotic or group of antibiotics.
“The bacteria or fungus are alive and they acquire resistance to a particular antibiotic when they’re colonizing or growing in an environment,” says Dr Sabnis.
Some of the consequences of drug resistant infections include prolonged illness, increased healthcare costs, and a higher mortality risk.
Explaining the phenomenon, Dr Sabnis says that while earlier, a person who has developed a urinary tract infection (UTI) could be treated with oral antibiotics, if someone now develops a drug resistant-UTI, oral antibiotics may not work.
“They may need injectable antibiotics to treat the same kind of infection,” she says.
Antimicrobial Resistance post Covid-19
Dr Sabnis says that Covid, overall, triggered antibiotic usage globally. “Antibiotic usage in India is high. Those with uncontrolled diabetes who had SARS-CoV2 infection were given steroids. Some had secondary infections (like mucormycosis, a fungal infection). When people were sick, we had no alternatives but to prescribe a higher antibiotic when they were not responding to the previous mode of treatment,” she explains.
Dr Sabnis says that lack of proper hospital infection control practices also led to the emergence of new hospital-acquired infections.
“We started noticing that a resistant organism was coming in from the patient’s samples. So, there were increasing resistance patterns in people who were immunocompromised and people who were required to be on multiple devices for various reasons – for instance, people who had a stroke, a lung infection etc. had to stay in the hospital for very long and developed resistant-organism infections,” she says.
Dr Alexander Thomas, founder and patron, Association of Healthcare Providers- India, says, “During the Covid-19 pandemic, due to fear and limited access at the time to doctors- telemedicine did come in a little late during the pandemic – many people were scared and out of fear started consuming antibiotics without adhering to any proper guidelines.” Now is the time to assess the situation, he adds.
Long-term implications of antimicrobial resistance
Dr Sabnis says that one of the long-term implications of antimicrobial resistance is that our antibiotic pipeline may get exhausted. “There are new drugs for cancer, Blood Pressure and diabetes coming up. For antibiotics however, we have a very limited pipeline. We don’t have many antibiotics for use,” she says.
“Bacteria are smarter than us. Eventually, if antibiotic usage is not controlled, and is not used correctly for the minimum possible duration, we will face a shortage of antibiotics,” adds Dr Sabnis.
Antimicrobial resistance: What is the solution?
Dr Sabnis emphasizes that one of the ways to tackle antimicrobial resistance and preserve our antibiotic pipeline is using antibiotics carefully, to save their efficacy for an infection where it is really required. “Do not use a broad-spectrum antibiotic for smaller infections,” adds Dr Sabnis.
Dr Selvin says that the Indian Council for Medical Research (ICMR) has also given a call for surveillance programmes in India. “Only post the surveillance will we be able to find out by how much the burden of AMR post-Covid in India has increased and what is the prevalence of AMR in clinical settings as well as in the environment,” he adds.
What is antimicrobial susceptibility testing?
Dr Sabnis says that antimicrobial susceptibility testing is a process which can help treating doctors determine whether a particular antibiotic will be effective in a person’s body in controlling the infection.
“In AMR susceptibility test, a specimen like sputum or blood is taken. The bacteria is grown in a lab to analyze whether using a particular antibiotic will kill the bacteria,” she says. This report helps to plan antibiotic therapy better.
However, Dr Sabnis adds, one cannot always wait for the results of the AMR susceptibility test to start treating a person since the entire process takes at least 48 to 72 hours.
The antimicrobial susceptibility testing is done for all severe infections in blood, urine and also for chest infections, for post-surgery wound complications.
Prof Selvin says that antimicrobial susceptibility testing aids to choose effective treatments tailored to specific microbial profiles.
Dr Thomas says that all hospitals must implement an antibiotic policy, for effective management of pathogens that are present locally.
- Antimicrobial resistance, a phenomenon in which the efficacy of antimicrobial medicines reduces over time, partly due to their misuse or overuse, has become a global health concern today.
- Experts advise careful antibiotic use and strictly warn against self-medicating.