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Daily Editorial: Lean and Practice – Anti-Microbial Resistance – The Superbug Problem



Anti-Microbial Resistance – The Superbug Problem


Click here to Download Daily Editorial PDF (2nd March 2017)


Introduction


Antibiotics which once cured diseases are now becoming the potential killers by prolonged illness and disability. The world is transitioning into a post-antibiotic era where even the common infections and minor injuries are beginning to kill due to increasing “Anti-Microbial Resistance” (AMR)


What is Anti-Microbial Resistance?


  • Antimicrobial resistance (AMR) is resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive.
  • Resistant organisms (they include bacteria, viruses and some parasites) are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and anti-malarials, so that standard treatments become ineffective and infections persist and mayspread to others. These resistant pathogens are commonly called superbugs.
  • AMR is a consequence of the use, particularly the misuse, of antimicrobial medicines and develops when a microorganism mutates or acquires a resistance gene.

Why is it an Alarming Situation?


  •  AMR kills, hampers the control of infectious diseases, threatens a return to the pre-antibiotic era, increases the costs of health care, threatens health security, and damagestrade and economies and jeopardizes health-care gains to society.
  • In 2015, AMR was identified as the cause for about 23,000 deaths annually in the US andabout 25,000 such deaths in Europe.
  • Accurate data on AMR in India is unavailable but the highest number of deaths caused by resistant pathogens passed on to newly born babies from mothers or the environment—approximately 58,000.
  • Antimicrobial resistance a ‘greater threat than cancer by 2050’ the director of health at the UN Development Programme.

Causes for the AMR


  • In certain cases occurs through the natural evolution of resistance in bacterial pathogens.
  • The rising consumption of antibiotics is a major contributor.
  • New Delhi metallo-beta- lactamase (NDM) enzyme, which makes bacteria resistant tobeta-lactam antibiotics, is now present globally. This indicates free movement of ABR across boundaries, with serious consequences.

Factors responsible for increasing AMR


The weak public health system, cheap antibiotics available in the market, and their unregulated use, that has created ideal conditions for superbugs.

  • Prescription of antibiotics for a variety of diarrhoeal and respiratory infections despite their limited curative potential has exacerbated the situation.
  • Poor regulation of pharmacies and licensing out several pharmacies to a single pharmacist introduces a large number of unqualified personnel into the supply chain.
  • New virtual marketplaces have made the entire drug distribution process an opportunity for unchecked financial gains by irresponsible actors.
  • The lack of awareness among patients regarding the appropriate use of antibiotics has led to self-medication and non-adherence to the prescribed course of antibiotics, further intensifying the problem.

Measures taken so far


Chennai Declaration, 2012

  • A Roadmap to Tackle the Challenge of Antimicrobial Resistance – A Joint meeting of Medical Societies in India” was organized as a pre-conference symposium of the 2nd annual conference of the Clinical Infectious Disease Society (CIDSCON 2012) at Chennai
  • This was the first ever meeting of medical societies in India on issue of tackling resistance, with a plan to formulate a road map to tackle the global challenge of antimicrobial resistance from the Indian perspective.
  • The outcome emerged as Chennai Declaration.

Some major recommendations made in the Declaration include

  • formulation of an effective national policy to control the rising trend of antimicrobial resistance,
  • a ban on the over-the-counter sale of antibiotics, and
  • changes in the medical education curriculum to include training on antibiotic usage and infection control
  • Setting up of a National Task Force to guide and supervise the regional and State infection control committees.
  • An Infection Control Team (ICT) be made mandatory in all hospitals.
  • Regulatory authorities and accreditation agencies such as the National Accreditation Board for Hospitals and ISO must insist on a functioning ICT during the licensing and accreditation process
  • The Medical Council of India should introduce one-week antibiotic stewardship and infection control training in the third, fourth and final year of MBBS and two-week training at the PG level.
  • National Accreditation Board for Hospitals & Healthcare Providers (NABH) insist on strict implementation of hospital antibiotic and infection control policy, during hospital accreditation and re-accreditation processes.

Actions Taken Under Chennai Declaration


  • To meet the obligations of the declaration, the National Programme on Containment of Antimicrobial Resistance was launched under the 12th Five-year Plan.
  • A core objective was the generation of quality data from 30 laboratories on antimicrobial resistance of pathogens posing a grave public health risk.
  • Though meant to be completed within 2017, only 10 labs have so far been brought within the data-gathering exercise.

Global Action Plan on AMR


Alert to this crisis, the May 2015 World Health Assembly of WHO adopted a global action plan on antimicrobial resistance, which outlines five objectives:

  • to improve awareness and understanding of antimicrobial resistance through effective communication, education and training;
  • to strengthen the knowledge and evidence base through surveillance and research;
  • to reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures;
  • to optimize the use of antimicrobial medicines in human and animal health;
  • to develop the economic case for sustainable investment that takes account of the needs of all countries and
  • to increase investment in new medicines, diagnostic tools, vaccines and other interventions

Way Forward


  • Tackling the superbug problem requires massive data collection and analysis. Well-designed studies and indicator surveys providing general insight into the situation are critical to begin with.
  • Studies can provide a clearer picture of the prescribed doses of antibiotics and their pattern of use (including the why, when, where, and for what relating to antibiotic consumption)
  • Indicator surveys can attempt to identify the health outcomes emerging from the use of such antibiotics for different ailments.
  • Frequently repeated surveys, with their range expanded to track geographic and demographic representative data are a policy imperative if India wants to build comprehensive indicators of ABR.
  • The health departments of the Central and state governments work in coordination with nodal bodies in the technology space to develop an information-sharing grid.
  • The grid should also have smart data-mining solutions built into it.
  • Molecular biologists should be consulted for their insights on the genetic and molecular mechanisms responsible for such resistance.

Conclusion


The integration of data from various public and privately operated hospitals, pharmacies, and drug procurement services across the country, data analytics to track the correlation between antibiotic consumption and induced drug resistance, and robust information sharing with the public and health authorities is the right approach moving forward.

  • Access to this online database can help physicians track ABR patterns; predict health outcomes; and prescribe drugs suitable for patient needs.
  • It will not only help in improving clinical outcomes but also facilitate the deployment of computational and statistical models to accurately predict epidemics.
  • This can aid local health bodies in issuing warnings and controlling the outbreak of infection.

India, sitting at the cusp of a digital revolution, is well placed to integrate such solutions with public health management and address the ABR problem.


Questions

  1. Medicine is losing more and more mainstay as pathogens develop resistance, has the world done enough to deal with the crisis?
  2. How could technology help in dealing with the new world epidemic of Anti-microbial crisis?
  3. What are the measures taken by Indian Government to tackle AMR? Critically examine.

 

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