Mass bathing in Ganga aggravates anti-microbial resistance woes: 

Mass bathing in Ganga aggravates anti-microbial resistance woes: 

Context:

Mass bathing in the Ganga during pilgrimages may be contributing to Anti-microbial resistance (AMR), say a government-commissioned report on the threat from AMR.

Introduction:

• The government report – Scoping Report on Antimicrobial Resistance in India — made public on Wednesday  and cites compilation of all scientific studies done in India on the threat from AMR, causes and sources that aggravate it.
• The report was commissioned by the Department of Biotechnology and the UK Research Council and prepared by the Centre for Disease Dynamics and Economic Policy.
• Anti-microbial resistance (AMR) is the reason for certain key antibiotics becoming ineffective against diseases, including tuberculosis.
• Researchers from the Newcastle University in the United Kingdom and the Indian Institute of Technology-Delhi sampled water and sediments at seven sites along the Ganga in different seasons.
• In 2014, researchers that levels of resistance genes that lead to “Superbugs” were found to be about 60 times greater during the pilgrimage months of May and June than at other times of the year.

The government report on Antimicrobial Resistance:

• The report was commissioned by the Department of Biotechnology and the UK Research Council and prepared by the Centre for Disease Dynamics and Economic Policy.
• India has some of the highest antibiotic resistance rates among bacteria that commonly cause infections in the community and healthcare facilities.
• Resistance to the broad-spectrum antibiotics fluoroquinolones and third generation cephalosporin was more than 70% in Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae, and more than 50% in Pseudomonas aeruginosa.
• Other than ‘cultural factors’ such as bathing in the Ganga, the drivers of AMR included excessive use of antibiotics in the livestock industry and unchecked discharge of effluents by the pharmaceutical industry. However, in spite of the challenge, too little work had been done so far to understand it.
• “This mapping exercise indicates that AMR research studies in India were of limited scope in all areas, ” the researchers noted.

Global comparison:

• In 2014, India was the highest consumer of antibiotics, followed by China and the United States. However, the per-capita consumption of antibiotics in India was much lower than in several other high-income countries.

What is antimicrobial resistance?

• Antimicrobial resistance happens when microorganisms (such as bacteria, fungi, viruses, and parasites) change when they are exposed to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics). Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.
• AMR is the ability of a microorganism like bacteria, viruses, and some parasites to stop an antimicrobial such as antibiotics, antivirals, and antimalarials from working against it.
• As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.
• According to WHO, Antimicrobial resistance is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it.
• It is not a country specific issue but a global concern that is jeopardizing global health security.
• Antimicrobial resistance is one of the major public health problems.
• In India the infectious disease burden is among the highest in the world

Challenges:

• Inadequacy of public finance which will result in the conditions favorable for development of drug resistance.
• Antimicrobial resistance will result in difficulty in controlling the diseases in the community and ineffective delivery of the health care services.  Neonates and the elderly both are more prone to infections and are vulnerable
• families of bacteria that pose the greatest threat to human health and most of these 12 superbugs have presence in India.

How do bacteria become resistant to antibiotics?

• Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm.

How do bacteria become superbugs?

• Superbugs. Mutations in bacteria can result in them becoming resistant to antibiotics, turning the bacteria into a ‘superbug’. Superbugs can develop while a person is taking a course of antibiotics.

Why is antimicrobial resistance a global concern?

• New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases, resulting in prolonged illness, disability, and death.
• Without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarean sections or hip replacements) become very high risk.
• Antimicrobial resistance increases the cost of healthcare with lengthier stays in hospitals and more intensive care required.
• Antimicrobial resistance is putting the gains of the Millennium Development Goals at risk and endangers achievement of the Sustainable Development Goals.
• Spread of resistance-genes that promote life-threatening bacteria

What accelerates the emergence and spread of antimicrobial resistance?

• Antimicrobial resistance occurs naturally over time, usually through genetic changes.
• The misuse and overuse of antimicrobials is accelerating this process.
• In many places, antibiotics are overused and other misused in people and animals, and often given without professional oversight.
• Antimicrobial resistant-microbes are found in people, animals, food, and the environment in water, soil and air. They can spread between people and animals, and from person to person.
• Poor infection control and inadequate sanitary conditions and inappropriate food-handling encourage the spread of antimicrobial resistance.
• Discharge of antimicrobial waste into environment by pharmaceutical industry.
• Lack of new antibiotic being developed.
• Poor infection control in hospitals and clinics.

Solutions:

• Preventing the spread of resistance-genes that promote life-threatening bacteria could be achieved by improving waste management at key pilgrimage sites.
• Rationalizing antibiotic use to limit antibiotic resistance in India.
• Improving regulation of drug production and sales.
• Better managing physician compensation.
• Regulating medical sector particularly in the prescription of medicine.
• Improving management of health care delivery system.
• Promoting investment for antimicrobial resistance activities, research and innovation.
• Strengthening India’s commitment and collaborations on antimicrobial resistance at international, national and sub-national level.