According not preventable but can be controlled, and

 According to
the World Health Organization, “antimicrobial resistance (AMR) is when
microorganisms such as bacteria, viruses, fungi, and parasites alter in ways,
which effects the medications used to treat the infection resulting in
ineffective treatment, or a phenomenon called as resistance1.” When
organisms become resistant they are referred to as “superbugs”. For example,
when an antibiotic/antimicrobial has lost its capacity to kill the
microorganism1 (i.e. bacteria), the bacteria becomes resistant and
continues to multiply and or mutate in the presence of antibiotics. Some
bacteria are naturally resistant to certain types of antibiotics, some can
become resistant by genetic mutation or bacterial conjugation also known as
“mating” in which they acquire resistance from other bacteria.

The development and spread of antimicrobial resistance (AMR) is a
universal threat to both humans and animals that is generally not preventable
but can be controlled, and it must be tackled in the most effective ways
possible. AMR is on the rise to the extent that it is becoming a global threat.
According to the world economic forum an estimated 700,000 people die each year
around the world because they have an infection that has become immune to the
drugs used to treat it. The UK Government’s review on
drug resistance predicts that by 2050 this number will rise
to 10 million deaths per year, with a cost to the global economy of $100
trillion2. Resistance is spreading and emerging globally, which is
challenging because what used to be a simple treatment to these infections is
now becoming deadly. An increasing list of infections such as pneumonia,
tuberculosis, septicemia and gonorrhea are becoming more difficult, and
sometimes impossible, to treat as antibiotics become less effective3.

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and other providers needs to come together and change the way antibiotics are
currently being used and prescribed. AMR is not only a threat to global health
but it is also a threat to the food security now that farmers are using
antibiotics for hygienic reasons or to keep animals from getting sick, and
development. “Antimicrobial resistance can affect anyone, at any age in any
country3”. Often antimicrobials are used in procedures such as
chemotherapy, organ transplant etc. to prevent infections. The rise in
resistance will make it extremely difficult for individuals who undergo these procedures.
This paper will discuss how microbes become resistant, the causes of AMR, how
resistance spreads, interventions such as the importance of sanitation, hygiene,
educating professionals and farmers and infection prevention measures as well
as surveillance or optimizing usage of antimicrobials in humans and animals,
the impact AMR has and a global action plan on addressing and or putting an end
to antimicrobial resistance. Antibiotics should only be used to treat
infections, simply using these medications are create resistance.


Articles on antimicrobial resistance published in English between 2001
and 2017 were identified via a MEDLINE/PUBMED search. Relevant clinical studies,
review articles and statistics from WHO were found using the text and keyword search
terms “Antimicrobial resistance”, importance of hand hygiene and AMR and surveillance
of antibiotic prescriptions in combination with epidemiology, prevalence,
incidence, outcome, intervention, prevention, hospital acquired infections, cost,
threat, educating and prescribing. The reference lists of articles, especially
the review articles, were checked for any extra studies which may have been
missed in the original search.


Article: Evidence of hand hygiene to reduce
transmission and infections by multidrug resistant organisms in health-care

article discusses the rise in antimicrobial resistance is mainly due to the inappropriate
use of antibiotics but in healthcare facilities is mainly due to contaminated
hands or lack of hand hygiene. This article is a systematic literature review of
multiple studies conducted from January 1980 to December 2013. This literature demonstrates
proper hand hygiene is not only important but the simplest and least expensive
options of reducing the prevalence or spread of AMR9. One study
conducted in Switzerland in 2000 hospital-wide demonstrated that proper hand
hygiene had reduce the spread of hospital acquired infections by up to 48%.4
Another randomized controlled trial to test the impact of hand washing conducted
in the United States (2009) demonstrated reduction in the prevalence of
resistant hospital acquired infections from one patient to another by 57%4.
Studies also included cost benefits of promoting hand hygiene. According to Chen
et al. every $1 spent on promoting hand hygiene may result in $23.7 benefit4.
Another study conducted by Pittet and colleagues reported that total cost
associated with hand hygiene promotion corresponded to less than 1% of costs
associated with spread of infections from patient to patient4. Some
patients who have a history of reoccurring resistant bacteria and often end up
being hospitalized and if providers are not practicing proper hand hygiene they
can easily spread these resistant bacteria from one patient to another. Proper
hand hygiene is proven to decrease the risk of these resistant bacterial
infections tremendously.

Article: Antimicrobial policy interventions in food
animal production in South East Asia

             Antibiotics are commonly used in the food
industry to promote growth of the animals and to keep them “healthy”. Farmers
are mainly concerned with profits and the bigger the animal the higher the
price they can sell it for. Asia in general reports to having higher rates of
antimicrobial resistance compared to Europe5. The South-East Asia
region seems to be behind the rest of the world when it comes to policies,
regulations, surveillance and educating or training of farmers and health
professionals to strengthen the regulations when it comes to antibiotic
resistance. One of the challenges South East Asia faces is that given their
economic and political status, many of the countries have been unable to inflict
policies and or regulations in place such as banning over the counter antibiotics
and growth promoters5. There is a low level of awareness in the
region because of costs and comprehension of the relationship between antibiotics
and resistance in humans, animals and the environment.5

Article: Surveillance of Broad-Spectrum Antibiotic Prescription in Singaporean
Hospitals: A 5-Year Longitudinal Study

           Another reason AMR is on the rise is due to inappropriate
prescription of antibiotics or in some countries people “self-diagnose”
themselves and can walk into a pharmacy and purchase antibiotics without a
prescription. A key intervention for improving the prescription of antibiotics is
surveillance. A study conducted by Liew et al. published in 2011, which was a
5-year longitudinal study conducted in Singaporean hospitals6. Four
out of the six public hospitals in Singapore participated in the study. This
study concluded a significant correlation between resistance and prescriptions.     


              AMR is becoming a global issue not only in low
income countries but in high income countries as well. How antibiotic resistance
spreads or how this resistance occurs is mainly due to two possibilities: by
genetic mutation or by acquiring resistance from another bacterium.7
When these mutations occur, the bacteria generate potent chemicals (enzymes).7
These potent chemicals make the antibiotics inactive or eliminate the
cell target.7 Bacteria acquire resistance from other bacteria by a
mating process known as “conjugation” in which bacteria transfer genetic
materials to one another.7 Resistance can be spread from humans to
humans, now that more people are travelling it can also spread via

the last few decades the food industry (farmers) have been giving animals
(livestock) antibiotics from keeping animals from falling ill or for hygiene
purposes. These animals build resistant bacteria in their gut which can remain
on the meat and if that meat is not handled or cooked properly it can spread to
humans and humans spread it to other humans or the community.8 Farmers
also use fertilizer or water which contains animal feces with the resistant
bacteria which is used on crops and if these crops are not handled properly can
be eaten and spread to humans and it can remain in human gut.8 When
these humans are admitted to hospitals if proper precautions such as hand
washing by providers are not taken they can spread the resistance to other
patients8. It becomes an ongoing process. Many countries in Asia
have policies in place which involves ban of all use of antibiotics for growth
purposes or other purposes but not many of these countries have the capacity to
safeguard their implementation5.

first intervention to conquer antimicrobial resistance is proper hand hygiene.  Often in hospitals the spread of these
antimicrobial-drug resistant occurs due to poor hand hygiene. Many times, providers
are too occupied and washing hands takes time as well as the fact that too much
hand washing has an adverse impact on the skin. To overcome this barrier hospitals
have introduced alcohol-based hand rubs. Proper hand hygiene and or wearing
gloves can also help reduce the risk of spreading these resistant
antimicrobials. Low income countries have a greater risk when it comes to AMR
because of sanitary reasons or because they do not have the luxury of accessing
clean water which may result in life-threatening diseases. WHO states that 90%
of health care professionals do not comply with the hand hygiene practices in low
income and middle income countries.9 Improper sanitation and hazardous
water causes a variety of infections which increases antibiotic resistance
therefore access to clean and safe water is essential to public health.

             The second intervention involves
educating professionals and farmers and strengthening regulations in the animal
health sector especially in South East Asia region.9 Antimicrobials/antibiotics
are used in food animal production for growth promotion and treatment, to the
contain the increase of disease, to prevent food contamination and to increase
productivity resulting in antimicrobial resistance.9 South East Asia
farmers have limited knowledge about fertilizers, antibiotics and pesticides
but use is on the rise. There is lack of regulations, policies and
implementation of standards for use of antibiotics in the food animal sector.9
There are also low standards of sanitation and hygiene which increases
antimicrobial resistance. These farmers should be educated about antibiotic
resistance as well as increasing surveillance and monitoring use of

growing list of infections such as pneumonia, tuberculosis, septicemia and gonorrhea
are becoming harder, and sometimes impossible, to treat as antibiotics become
less effective. The third intervention would be to increase surveillance of
prescribing antibiotics as well as educating patients about antibiotics. Often
a patient comes in with a common cold and refuses to leave the doctor’s office
with a prescription. Not understanding that antibiotics are used to treat
bacterial infections not viral infections such as a common cold. There are many
countries where antibiotics can be purchased for human or animal use without a
prescription. Similarly, in countries without standard treatment guidelines,
antibiotics are often over-prescribed by providers and veterinarians and
over-used by the public. It also increases if there is poor infection
prevention and control.  Without urgent
action, we are heading for a post-antibiotic era, in which a simple infection
and or minor injuries can once again take lives. As a society, we can all take
initiatives to reduce the spread of resistance by taking antibiotics only when
providers say it necessary and when only prescribed by a certified professional,
never share leftover antibiotics and finish our course of antibiotics even if
we are feeling better. We should always wash our hands and prepare food


            Most drug quality assurance systems
are weak. This can lead to poor quality medicines, exposing patients to
sub-optimal concentrations of antimicrobials, therefore creating the conditions
for drug resistance to develop. In some countries, poor access to
antimicrobials forces patients to take incomplete courses of treatment or to
seek alternatives that could include substandard medicines. We all can play an
important role in aiming to decrease the spread of antimicrobial resistance. Health
professionals can educate patients about the importance of antibiotics,
stressing the importance of finishing the full course of treatment, prescribe
antibiotics when necessary and by ensuring hands,
instruments, and environment are clean. We as patients should comply with treatment, practice
hand hygiene and preparing food hygienically. We should only use antibiotics
when prescribed by a certified provider. We should not share antibiotics with
others. And finally, policy
makers can ensure a robust national action plan to tackle antibiotic
resistance is in place, improve surveillance of resistant infections and
Implement and or strengthened programs in place for infection prevention and

resistance is one of our most serious health threats. Infections from resistant
bacteria are now too common, and some bacteria have even become resistant to
multiple types or classes of antimicrobials. The loss of effective antibiotics
will undermine our ability to fight infectious diseases and manage the
infectious complications common in vulnerable patients undergoing chemotherapy
for cancer, dialysis for renal failure, and surgery, especially organ transplantation,
for which the ability to treat secondary infections is crucial. While there are some new antibiotics in development, none of them
are expected to be effective against the most dangerous forms of
antibiotic-resistant bacteria. With frequent travelling, antibiotic resistance is a global
problem, requiring efforts from all nations and many sectors.