The World Health Organisation annually celebrates a world awareness week (“World Antimicrobial Awareness Week”) aimed at promoting correct and responsible use of antimicrobials and at increasing awareness of antimicrobial resistance.

WHO has declared antimicrobial resistance to be one of the top 10 global health problems, a worrying global health phenomenon that requires a multisectoral approach and which can also be countered through the collaboration of individuals in their daily lives.

Antimicrobial resistance

Antimicrobial resistance is the ability of microorganisms (bacteria, viruses, fungi, parasites) to resist the effects of antimicrobial drugs. The development of resistance to antimicrobials is a natural biological phenomenon, related to the ability of microorganisms to adapt to external stimuli, and has also been described prior to the human use of antimicrobial drugs [1,2]. However, the introduction of antimicrobial products for use in humans and animals and in agriculture has accelerated the selection of resistant microorganisms.

Antibiotics vs. antiviral drugs: let's obtain some clarity

Antimicrobial agents include antibiotics (or, more correctly, antibacterials), antivirals, antifungals, and antiparasitics. These drugs are agents developed to fight infections, but they act on different types of microorganisms.

Antibiotics work mainly against bacteria, while antivirals work against viruses. In the case of a likely viral infection (such as an upper respiratory tract infection), the intake of antibiotics is therefore not effective, and in addition to being associated with a risk of adverse events (as with any other drug), it contributes potentially to the selection of resistant microorganisms.

Antimicrobial resistance, an alarming phenomenon

Antimicrobial resistance is of concern [3] due to its potential to undermine the effectiveness of key tools for treating infections. The inappropriate use of antimicrobial agents significantly contributes to the emergence of resistant strains, making available treatments ineffective, and with notable consequences in terms of morbidity and mortality. [4]

Furthermore, medical procedures, even routine ones, become riskier due to the increased risk of difficult-to-treat infections, and resistant strains can spread in healthcare facilities, posing a threat not only to the individual patient but to the entire community . The economic burden is also considerable, with increased healthcare costs due to prolonged illness and hospitalization and the need for more expensive, non-first-line treatments.

Actions against antimicrobial resistance

 Addressing AMR requires a comprehensive, multisectoral approach involving governments, health systems, the pharmaceutical industry, agriculture, and international organizations. Several initiatives and strategies have been implemented globally to counter AMR.

In particular, global action plans [5] have been developed, mainly led by the World Health Organization in collaboration with other international bodies to provide shared guidelines and recommendations, as well as national [6] and regional action plans, more focused on managing the problem at a local level.

Surveillance and monitoring systems [7,8] of the spread of resistant microorganisms are fundamental, in order to increase knowledge on the epidemiological situation and speed up control interventions. Antimicrobial stewardship programs have been developed within healthcare facilities [9], aimed at optimizing the use of antimicrobials by promoting appropriate prescribing practices with the use of the correct drugs, at the appropriate dose and for the appropriate duration for the pathology being treated, with the aim of minimizing the inappropriate use of these molecules.

Finally, fundamental is the so-called "One Health" approach [10], defined as "an integrated and unifying approach that aims to balance and optimize the health of people, animals and ecosystems in a sustainable way", which therefore recognizes the impact of use of antimicrobials not only in humans but also in animals and the environment.

A collective responsibility that involves every individual

The fight against antimicrobial resistance is a collective responsibility that also involves individuals in their daily lives. Responsible use of antibiotics, which should only be taken under prescription, thus avoiding self-medication, and daily hygiene practices, such as hand washing, are essential to prevent the development and spread of infections.

Raising awareness of recommended vaccinations is crucial, firstly to prevent bacterial infections that may require the use of antibiotics, and also to reduce the risk of viral infections that could mistakenly lead to the use of antibiotics even if they are not necessary.

Article by Prof. Antonella Castagna, Full Professor of Infectious Diseases UniSR, Director of the Postgraduate School in Infectious Diseases and Head of the "Infectious Diseases" Unit of the IRCCS San Raffaele Hospital, and by Dr. Marco Ripa, Researcher in Infectious Diseases UniSR.

References

[1]     Larsen J, Raisen CL, Ba X, Sadgrove NJ, Padilla-González GF, Simmonds MSJ, et al. Emergence of methicillin resistance predates the clinical use of antibiotics. Nature 2022;602:135–41.

[2]     Darby EM, Trampari E, Siasat P, Gaya MS, Alav I, Webber MA, et al. Molecular mechanisms of antibiotic resistance revisited. Nat Rev Microbiol 2023;21:280–95.

[3]     Ten health issues WHO will tackle this year n.d. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 (accessed October 1, 2023).

[4]     Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022;399:629–55.

[5]     Global Action Plan on Antimicrobial Resistance. Microbe Wash DC 2015;10:354–5.

[6]     EpiCentro. Piano Nazionale di Contrasto all’Antibiotico-Resistenza (PNCAR) 2022-2025 n.d. https://www.epicentro.iss.it/antibiotico-resistenza/pncar-2022 (accessed October 1, 2023).

[7]     Surveillance and disease data for antimicrobial resistance. European Centre for Disease Prevention and Control 2010. https://www.ecdc.europa.eu/en/antimicrobial-resistance/surveillance-and-disease-data (accessed October 1, 2023).

[8]     Global antimicrobial resistance and use surveillance system (GLASS) n.d. https://www.who.int/initiatives/glass (accessed October 1, 2023).

[9]     Dyar OJ, Huttner B, Schouten J, Pulcini C. What is antimicrobial stewardship? Clin Microbiol Infect 2017;23:793–8.

[10]  Tripartite and UNEP support OHHLEP’s definition of “One Health” n.d. https://www.who.int/news/item/01-12-2021-tripartite-and-unep-support-ohhlep-s-definition-of-one-health (accessed October 1, 2023).