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What is the social and economic impact of AMR?

For patients, families, and doctors that deal with untreatable infections the threat and impact of AMR is very visible. However, even for those who are not in direct contact with AMR, its repercussions reach far and wide. There is the rising death toll, but the economic impact of AMR is also enormous with estimates putting it at 100 trillion USD per year by 2050 (AMR Review, 2016). At the moment, the World Health Organization (WHO) states that infections due to multidrug-resistant bacteria cost the European Union (EU) alone more than 1.5 billion Euro per year in healthcare expenses and productivity losses.  In terms of individuals, the AMR Review 2016 estimates that by 2050, on average, 1 person will die every three seconds and every individual in the world today will be 10,000 USD worse off.

The OECD predicts that across Europe, North America, and Australia 2.4 million people could die if antimicrobial resistance is not addressed (OECD, 2018). Aside from the human cost, the economic cost of ignoring AMR is also astronomical. As drug resistance becomes more widespread, healthcare costs will climb and sustainable food sources will feel a greater strain. Due to these predictions, the World Bank Group estimates that as many as 24 million people worldwide may be forced into extreme poverty conditions by 2030 (World Bank Group, 2019).  The main burden of this economic downturn will fall on already strained low-income countries and, globally, could be comparable to the 2008 financial crisis (WHO, 2019).

What are antimicrobial agents and what are they used for?

An antimicrobial agent kills microorganisms (i.e. bacteria, viruses, fungi) or stops their growth. It is used to combat infections and is categorised based on the type of organisms is combats: antibiotics are used against bacteria, antivirals against viruses and antifungals against fungi.

What is the difference between antibiotics and other antimicrobial agents?

Antibiotics specifically target bacteria and are used to treat bacterial infections. On the other hand, antimicrobials encompass a broader range of products that act on microbes in general. Microbes encompass different types of organisms: bacteria, fungi, viruses, protozoa.

Source: WHO

Can the same bacteria be resistant to several antibiotics?

The European Centre for Disease Control (ECDC) and the Center for Disease Control & Prevention (CDC) have created terminology for drug resistant bacteria: multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (Pathog, et al., 2016). Multidrug-resistant was defined as “acquired nonsusceptibility to at least one agent in three or more antimicrobial categories”. Extensively-drug resistant was defined as “nonsusceptibility to at least one agent in all but two or fewer antimicrobial categories” (i.e. bacterial isolates remain susceptible to only one or two antimicrobial categories). Pandrug-resistant was defined as “nonsusceptibility to all agents in all antimicrobial categories” (Pathog, et al., 2016).

Recently, cases of multidrug-resistant organisms have exploded in number globally; AMR is a grave threat to how we treat infections and will increase the morbidity and mortality of these diseases. For the patient, AMR will also lead to longer stays in the hospital as well as higher costs for healthcare. In the same vein, AMR is expected to cause enormous economic loss to governments in both increased health costs and loss of productivity (Pathog, et al., 2016).

Hospitals themselves have paradoxically become a breeding ground for resistant microbes; Klebsiella pneumoniae, E. coli, and Proteus sp., for example, can develop resistance quickly and spread like wildfire throughout a hospital (Pathog, et al., 2016).

When was the first case of resistance to antibiotics registered?

The first effective antimicrobials, the sulphonamides, were introduced in 1937 and by the late 1930s resistance was already reported. Actually, we have known about AMR since the very first uses of antimicrobials (Microbiology and Molecular Biology Reviews, 2010).

Which common illnesses are often wrongly treated with antibiotics?

A series of mostly viral infections are incorrectly treated with antibiotics:

  • common cold – it comes with sneezing, running or stuffy nose, cough, and sore throat. In most cases it is caused by rhinoviruses and antibiotics won’t work (CDC);
  • sore throat – smoking, allergies, the viruses that cause colds or flu, or a bacteria group called A Streptococcus (i.e., Streptococcus pyogenes) are among the causes of this type of illness. Only the infection caused by Streptococcus needs antibiotic therapy, the rest do not(CDC);
  • flu (Influenza) – is caused by influenza viruses and can infect the nose, throat and the lungs sometimes. Common symptoms include: fever and/or chills, cough, sore throat, running or stuffy nose, headaches, tiredness, muscle and/or body pains. Antibiotic therapy is not needed (CDC);
  • acute bronchitis or chest cold – this disease is manifested by cough due to the mucus produced in the lungs by the swelling of the lungs’ airways. Besides coughing (with or without mucus), you can also feel soreness in the chest, tiredness (fatigue), mild headache, mild body aches or sore throat. In most cases it is a viral infection whose recovery takes up to three weeks (CDC).
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