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Antimicrobial resistance (AMR) is one of the most serious global public health threats in this century.  The first World Health Organization (WHO) Global report on surveillance of AMR, published in April 2014, collected for the first time data from national and international surveillance networks, showing the extent of this phenomenon in many parts of the world and also the presence of large gaps in the existing surveillance. In this review, we focus on antibacterial resistance (ABR), which represents at the moment the major problem, both for the high rates of resistance observed in bacteria that cause common infections and for the complexity of the consequences of ABR. We describe the health and economic impact of ABR, the principal risk factors for its emergence and, in particular, we illustrate the highlights of four antibiotic-resistant pathogens of global concern – Staphylococcus aureus, Klebsiella pneumoniae, non-typhoidal Salmonella and Mycobacterium tuberculosis – for whom we report resistance data worldwide. Measures to control the emergence and the spread of ABR are presented.

Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.

Rapid population ageing, tight healthcare budgets, a shortage of health workers and the recovery from the COVID-19 pandemic are all putting increased pressure on healthcare systems.

Australia's First National Antimicorbial Resistance Strategy 2015-2019

Background paper for the Technical Symposium on Antimicrobial Resistance:

How to Foster Innovation, Access and Appropriate Use of Antibiotics? 

Global attention to antimicrobial resistance (AMR)

has been dominated by a focus on the health and

agriculture sectors. However, the environment is also

key to the development, transmission and spread of

AMR to humans, animals and plants.

Since the introduction of penicillin in 1942, antimicrobials have transformed the treatment of infections and saved millions of lives. But organisms “resistant” to penicillin were noticed from almost the very beginning. Now, decades of misuse and outdated guidelines have driven a rise in the organisms that are resistant to these lifesaving drugs.

Australia is the eighth highest user of antibiotics out of 28 European countries. Antibiotic resistance is happening now in Australia and around the world.

Antimicrobial resistance poses a major global threat to society that can only be tackled through close cooperation and collaboration among nations.

Antimicrobial resistance (AMR) is one of the greatest threats faced by humankind. The development of resistance in clinical and hospital settings has been well documented ever since the initial discovery of penicillin and the subsequent introduction of sulfonamides as clinical antibiotics. In contrast, the environmental (i.e., community-acquired) dimensions of resistance dissemination have been only more recently delineated. The global spread of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) between air, water, soil, and food is now well documented, while the factors that affect ARB and ARG dissemination (e.g., water and air quality, antibiotic fluxes, urbanization, sanitation practices) in these and other environmental matrices are just now beginning to be more fully appreciated.

Antimicrobial resistance (AMR) is one of the most serious global public health threats in this century. The first World Health Organization (WHO) Global report on surveillance of AMR, published in April 2014, collected for the first time data from national and international surveillance networks, showing the extent of this phenomenon in many parts of the world and also the presence of large gaps in the existing surveillance.

Antimicrobial resistance (AMR) is a global public health threat. Emergence of AMR occurs naturally, but can also be selected for by antimicrobial exposure in clinical and veterinary medicine. Despite growing worldwide attention to AMR, there are substantial limitations in our understanding of the burden, distribution and determinants of AMR at the population level. We highlight the importance of population-based approaches to assess the association between antimicrobial use and AMR in humans and animals. Such approaches are needed to improve our understanding of the development and spread of AMR in order to inform strategies for the prevention, detection and management of AMR, and to support the sustainable use of antimicrobials in healthcare.

Antimicrobial resistance (AMR) is a serious threat to global public health. It increases morbidity and mortality, and is associated with high economic costs due to its health care burden. Infections with multidrug-resistant (MDR) bacteria also have substantial implications on clinical and economic outcomes. Moreover, increased indiscriminate use of antibiotics during the COVID-19 pandemic will heighten bacterial resistance and ultimately lead to more deaths. This review highlights AMR’s scale and consequences, the importance, and implications of an antimicrobial stewardship program (ASP) to fight resistance and protect global health. Antimicrobial stewardship (AMS), an organizational or system-wide health-care strategy, is designed to promote, improve, monitor, and evaluate the rational use of antimicrobials to preserve their future effectiveness, along with the promotion and protection of public health. ASP has been very successful in promoting antimicrobials’ appropriate use by implementing evidence-based interventions. The “One Health” approach, a holistic and multisectoral approach, is also needed to address AMR’s rising threat. AMS practices, principles, and interventions are critical steps towards containing and mitigating AMR. Evidence-based policies must guide the “One Health” approach, vaccination protocols, health professionals’ education, and the public’s awareness about AMR.

For the last 70 years, doctors have prescribed drugs known as antimicrobial agents to treat infectious diseases. These are diseases that occur due to microbes, such as bacteria, viruses, and parasites. Some of these diseases can be life-threatening.

As COVID-19 rages on, the pandemic of antimicrobial resistance (AMR) continues in the shadows. The toll taken by AMR on patients and their families is largely invisible but is reflected in prolonged bacterial infections that extend hospital stays and cause needless deaths.1 Moreover, AMR disproportionately affects poor individuals who have little access to second-line, more expensive antibiotics that could work when first-line drugs fail.

Antimicrobial resistance (AMR) has now emerged as a chronic public health problem globally, with the forecast of 10 million deaths per year globally by 2050. AMR occurs when viruses, bacteria, fungi and parasites do not respond to antimicrobial treatments in humans and animals, thus allowing the survival of the microorganism within the host. The prominent cause contributing to the current crisis remains to be the overuse and misuse of antimicrobials, particularly the inappropriate usage of antibiotics, increasing the global burden of antimicrobial resistance. The global consumption and usage of antibiotics are therefore closely monitored at all times. This review provides a current overview of the implications of strategies used by international governmental organisations, including the UN’s 17 Sustainable Development Goals (SDGs), to address the problem of antibiotic resistance, as well as the “One Health Approach,” a system incorporating a multidisciplinary effort to achieve the best possible health outcome by acknowledging the clear connections between humans, animals and their shared environment. The importance of public awareness and health literacy of lay audiences still needs to be further emphasised as part of global and local action plans. Antimicrobial resistance continues to be a major global public health dilemma of the 21st century. Already this topic is receiving substantial political input from the G7 countries and continues to be on the agenda of numerous political conferences. The consequences of failure to adequately address AMR are profound, with estimations of a return to the pre-antibiotic era, where everyday infections relating to childbirth, surgery and open fractured limbs could be potentially life-threatening. AMR itself represents a microcosm of factors, including social anthropology, civil unrest/war, diasporas, ethnic displacement, political systems, healthcare, economics, societal behaviour both at a population and individual level, health literacy, geoclimatic events, global travel and pharmaceutical innovation and investment, thus finding a solution that adequately addresses AMR and which helps stem further AMR emergence is complicated. Success will involve individuals, communities and nations all working together to ensure that the world continues to possess a sufficient armamentarium of effective antimicrobials that will sustain human and animal health, both now and in the future.

Despite an increasing prevalence of antimicrobial-resistant pathogens, the health and economic impact of colonization and infection with these organisms has not been fully elucidated. We explore how antimicrobial resistance can affect patient outcomes by enhancing virulence, causing a delay in the administration of appropriate therapy, and limiting available therapy. Next, we examine the different perspectives held by hospitals, third-party payers, patients, and society on the impact of resistance. Finally, we review methodological issues in designing and assessing studies that address the clinical outcomes for patients infected or colonized with resistant pathogens, including adjustment for important confounding variables, control group selection, and the quantification of economic outcomes.

For comparison of the impacts of infections due to antimicrobial-resistant bacteria with those of infections due to antimicrobial-susceptible strains of the same bacteria, data were evaluated from 175 published and unpublished reports of investigations of nosocomial and community-acquired infections with selected bacteria. The evaluation of outcomes of hospital-acquired infections with resistant organisms was often confounded by risk factors also associated with poor outcomes. Nevertheless, for both nosocomial and community-acquired infections, the mortality, the likelihood of hospitalization, and the length of hospital stay were usually at least twice as great for patients infected with drug-resistant strains as for those infected with drug-susceptible strains of the same bacteria. Poor outcomes could be attributed both to the expected effects of ineffective antimicrobial therapy and to the unexpected occurrence of drug-resistant infections complicated by prior antimicrobial therapy for other medical problems. Although the adverse economic and health effects of drug-resistant bacterial infections can only be roughly quantified, it is concluded that antimicrobial resistance is an important health problem and an economic burden to society.

Wound infection with antimicrobial-resistant bacteria may result in prolonged debility of the patient and increased healthcare costs. Avoidance of the development of resistance therefore needs increasing attention in the management of patients with wound infections. Antimicrobial use is the major determinant in the development of resistance. Knowledge of the criteria for wound infections, the causative pathogens, and their prevailing susceptibility patterns is a prerequisite for the rational prescribing of antimicrobials.

Antimicrobial resistance has become a global concern. Though an evolutionary phenomenon, it is promulgated by faulty human behaviours. It is a growing concern ever since first reported in 1940s. Today, a plethora of newer generation antimicrobials have become ineffective against previously susceptible organisms. This is a huge challenge for health care managers all across the globe, compounded by the “discovery void” in the field of development of new antibiotics. If proper steps are not taken presently, the lurking fear of reaching a therapeutic dead end will become a reality. This paper aims at describing the pandemic of AMR from a public health perspective and suggesting strategies to deal with it in an effective and collaborative manner.

When microorganisms (such as bacteria or viruses) are highly exposed to antimicrobial drugs, they can develop the capacity to defeat the drugs designed to eradicate them. Long-term accumulation of adaptations to survive drug exposure can lead to the development of antimicrobial resistance (AMR). The success of antibiotics has led to their widespread overuse and misuse in humans, animals and plants.

Antimicrobial resistance (AMR) has been prioritized by the World Health Organization (WHO) as one of the top 10 global public health threats facing humanity [1]. The High-Level Meeting of the UN General Assembly on Antimicrobial Resistance in 2016 officially declared the importance of AMR and solicited countries to commit to their individual AMR National Action Plans [2]. Despite these efforts, drug-resistant infections were estimated to contribute to a devastating 4.95 million deaths globally in 2019, with the bulk of the clinical burden borne by low- and middle-income countries (LMICs), particularly in sub-Saharan Africa [3]. This far exceeds the annual global deaths attributable to tuberculosis (1.5 million), malaria (643,000) and HIV/AIDS (864,000). Without intervention it is estimated that global deaths attributable to AMR could reach 10 million annually by 2050 [4]. Here, we discuss the Special Issue commissioned by PLoS Medicine dedicated to AMR. These research studies affirm the complexity and multi-faceted dynamics of AMR and the enormous challenge faced in understanding the problem and in designing tractable, equitable and cost-effective interventions to control its spread.

Antibiotic medications are used to treat infections and diseases caused by bacteria. They have made a major contribution to improving human health and life expectancy. Many diseases that once killed people can now be treated effectively with antibiotics. However, some strains of bacteria have become resistant to antibiotics. This is called antimicrobial resistance, also known as antibiotic resistance.

In the space of a century, antibiotics have gone from ground-breaking discovery to losing their effectiveness as a result of antimicrobial resistance (AMR), which could lead to 10 million deaths per year by 2050.

Infectious diseases are caused by bacteria, viruses, fungi and parasites that enter the body and cause damage to our tissues. Antimicrobial resistance occurs when these infectious agents become resistant to the drugs that would normally kill them or inhibit their growth.

The World Health Organization (WHO) has identified antimicrobial resistance as one of the top ten global public health threats that has the potential to reverse the great advances of medicine in the last 100 years. The global problem of anti-microbial resistance is largely due to genetic changes that arise in bacteria as these organisms are exposed to antibiotics. This natural form of biological evolution has been accelerated by factors such as misuse of prescription antibiotics, poor adherence to dose and regimens, counterfeit or substandard antibiotic preparations in some countries, poor infection control and global trade and travel.

Antimicrobial resistance is a global problem of increasing proportions that we cannot afford to look away from. This World Antimicrobial Awareness Week, we shine a light on the crisis and ways we can all help to address it.

Antimicrobials is the term used to refer to all antibiotics, antivirals, antifungals, and antiparasitic agents. They are each important medicines that treat and prevent particular infections caused by microorganisms, including bacteria, viruses, fungi and parasites.

Antimicrobial resistance (AMR) is the failure of an antimicrobial to effectively treat or prevent an infection that it was previously able to. This means that a microorganism has developed resistance to an antimicrobial. AMR affects all antimicrobials, not just antibiotics.

The antimicrobial resistance (AMR) crisis is the increasing global incidence of infectious diseases affecting the human population, which are untreatable with any known antimicrobial agent. This crisis will have a devastating cost on human society as both debilitating and lethal diseases increase in frequency and scope. Three major factors determine this crisis: (1) the increasing frequency of AMR phenotypes among microbes is an evolutionary response to the widespread use of antimicrobials; (2) the large and globally connected human population allows pathogens in any environment access to all of humanity; and (3) the extensive and often unnecessary use of antimicrobials by humanity provides the strong selective pressure that is driving the evolutionary response in the microbial world. Of these factors, the size of the human population is least amenable to rapid change. In contrast, the remaining two factors may be affected, so offering a means of managing the crisis: the rate at which AMR, as well as virulence factors evolve in microbial world may be slowed by reducing the applied selective pressure. This may be accomplished by radically reducing the global use of current and prospective antimicrobials. Current management measures to legislate the use of antimicrobials and to educate the healthcare world in the issues, while useful, have not comprehensively addressed the problem of achieving an overall reduction in the human use of antimicrobials. We propose that in addition to current measures and increased research into new antimicrobials and diagnostics, a comprehensive education program will be required to change the public paradigm of antimicrobial usage from that of a first line treatment to that of a last resort when all other therapeutic options have failed.

 Antimicrobial resistance, referring to microorganisms’ capability to subsist and proliferate even when there are antimicrobials is a foremost threat to public health globally. The appearance of antimicrobial resistance can be ascribed to anthropological, animal, and environmental factors. Human-related causes include antimicrobial overuse and misuse in medicine, antibiotic-containing cosmetics and biocides utilization, and inadequate sanitation and hygiene in public settings. Prophylactic and therapeutic antimicrobial misuse and overuse, using antimicrobials as feed additives, microbes resistant to antibiotics and resistance genes in animal excreta, and antimicrobial residue found in animal-origin food and excreta are animals related contributive factors for the antibiotic resistance emergence and spread. Environmental factors including naturally existing resistance genes, improper disposal of unused antimicrobials, contamination from waste in public settings, animal farms, and pharmaceutical industries, and the use of agricultural and sanitation chemicals facilitatet its emergence and spread. Wildlife has a plausible role in the antimicrobial resistance spread. Adopting a one-health approach involving using antimicrobials properly in animals and humans, improving sanitation in public spaces and farms, and implementing coordinated governmental regulations is crucial for combating antimicrobial resistance. Collaborative and cooperative involvement of stakeholders in public, veterinary and ecological health sectors is foremost to circumvent the problem effectively.

Antimicrobials are medicines that kill or attack germs such as viruses, bacteria, parasites and fungi that cause infections. They include antibiotics, which are commonly used against bacteria, as well as other medicines including antivirals and antifungals.

Antimicrobial resistance occurs when the germs that cause infections develop defences against these medicines. This means the medicines are less effective at stopping infections.

Resistance to antimicrobial therapies reduces the effectiveness of these drugs, leading to increased morbidity, mortality, and

health care expenditure. Because globalization increases the vulnerability of any country to diseases occurring in other countries, resistance presents a major threat to global public health, and no country acting on its own can adequately protect the health of its population against it. International collective action is therefore essential. Nevertheless, responsibility for health remains predominantly national. Consequently, there is a potentially significant disparity between the problems and solutions related to antimicrobial resistance and the institutions and mechanisms that are available to deal with them.

This paper considers the capacity of national and international institutions and mechanisms to generate a collective response to antimicrobial resistance. Strategies for containing resistance are outlined, with particular reference to globally coordinated activities of countries. The adequacy of national and international responses to resistance is assessed, and the actions that international bodies could take to solve difficulties associated with present responses are highlighted. Approaches are suggested for securing international collective action for the containment of antimicrobial resistance.

Antimicrobial agents play a key role in controlling and curing infectious disease. Soon after the discovery of the first antibiotic, the challenge of antibiotic resistance commenced. Antimicrobial agents use different mechanisms against bacteria to prevent their pathogenesis and they can be classified as bactericidal or bacteriostatic. Antibiotics are one of the antimicrobial agents which has several classes, each with different targets. Consequently, bacteria are endlessly using methods to overcome the effectivity of the antibiotics by using distinct types of mechanisms. Comprehending the mechanisms of resistance is vital for better understanding and to continue use of current antibiotics. Which also helps to formulate synthetic antimicrobials to overcome the current mechanism of resistance. Also, encourage in prudent use and misuse of antimicrobial agents. Thus, decline in treatment costs and in the rate of morbidity and mortality.

This review will be concentrating on the mechanism of actions of several antibiotics and how bacteria develop resistance to them, as well as the method of acquiring the resistance in several bacteria and how can a strain be resistant to several types of antibiotics. This review also analyzes the prevalence, major clinical implications, clinical causes of antibiotic resistance. Further, it evaluates the global burden of antimicrobial resistance, identifies various challenges and strategies in addressing the issue. Finally, put forward certain recommendations to prevent the spread and reduce the rate of resistance growth.

The lack of new antibiotic classes calls for a cautious use of existing agents. Yet, every 10 min, almost two tons of antibiotics are used around the world, all too often without any prescription or control. The use, overuse and misuse of antibiotics select for resistance in numerous species of bacteria which then renders antimicrobial treatment ineffective. Almost all countries face increased antimicrobial resistance (AMR), not only in humans but also in livestock and along the food chain. The spread of AMR is fueled by growing human and animal populations, uncontrolled contamination of fresh water supplies, and increases in international travel, migration and trade. In this context of global concern, 68 international experts attending the fifth edition of the World HAI Resistance Forum in June 2015 shared their successes and failures in the global fight against AMR. They underlined the need for a “One Health” approach requiring research, surveillance, and interventions across human, veterinary, agricultural and environmental sectors. This strategy involves concerted actions on several fronts. Improved education and increased public awareness are a well-understood priority. Surveillance systems monitoring infections need to be expanded to include antimicrobial use, as well as the emergence and spread of AMR within clinical and environmental samples. Adherence to practices to prevent and control the spread of infections is mandatory to reduce the requirement of antimicrobials in general care and agriculture. Antibiotics need to be banned as growth promoters for farm animals in countries where it has not yet been done. Antimicrobial stewardship programmes in animal husbandry have proved to be efficient for minimising AMR, without compromising productivity. Regarding the use of antibiotics in humans, new tools to provide highly specific diagnoses of pathogens can decrease diagnostic uncertainty and improve clinical management. Finally, infection prevention and control measures – some of them as simple as hand hygiene – are essential and should be extended beyond healthcare settings. Aside from regulatory actions, all people can assist in AMR reduction by limiting antibiotic use for minor illnesses. Together, we can all work to reduce the burden of AMR.

he accelerating tide of antimicrobial resistance (AMR) is a major worldwide policy concern. Like climate change, the incentives for individual decision-makers do not take into account the costs to society at large. AMR represents an impending “tragedy of the commons,” and there is an immediate need for collective action to prevent future harm. Roope et al. review the issues associated with AMR from an economics perspective and draw parallels with climate change. A major stumbling block for both challenges is to build consensus about the best way forward when faced with many uncertainties and inequities.

Antimicrobial resistance (AMR) is a critical issue in health care in terms of mortality, quality of services, and financial damage. In the battle against AMR, it is crucial to recognize the impacts of all four domains, namely, mankind, livestock, agriculture, and the ecosystem. Many sociocultural and financial practices that are widespread in the world have made resistance management extremely complicated. Several pathways, including hospital effluent, agricultural waste, and wastewater treatment facilities, have been identified as potential routes for the spread of resistant bacteria and their resistance genes in soil and surrounding ecosystems. The overuse of uncontrolled antibiotics and improper treatment and recycled wastewater are among the contributors to AMR. Health-care organizations have begun to address AMR, although they are currently in the early stages. In this review, we provide a brief overview of AMR development processes, the worldwide burden and drivers of AMR, current knowledge gaps, monitoring methodologies, and global mitigation measures in the development and spread of AMR in the environment.

Antimicrobial resistance (AMR) has been declared one of the 10 global public health threats facing humanity by the World Health Organization. A review commissioned by the government of the United Kingdom found that by 2050 more people would die from infections with multidrug-resistant bacteria or pan-resistant bacteria than from cancer and the annual cost would at that time reach 1 trillion USD

The causes of antimicrobial resistance (AMR) in developing countries are complex and may be rooted in practices of health care professionals and patients’ behavior towards the use of antimicrobials as well as supply chains of antimicrobials in the population. Some of these factors may include inappropriate prescription practices, inadequate patient education, limited diagnostic facilities, unauthorized sale of antimicrobials, lack of appropriate functioning drug regulatory mechanisms, and non-human use of antimicrobials such as in animal production. Considering that these factors in developing countries may vary from those in developed countries, intervention efforts in developing countries need to address the context and focus on the root causes specific to this part of the world. Here, we describe these health-seeking behaviors that lead to the threat of AMR and healthcare practices that drive the development of AMR in developing countries and we discuss alternatives for disease prevention as well as other treatment options worth exploring.

Antimicrobial resistance is the ability of microorganisms to grow despite being exposed to antimicrobial agents. As a result, the microorganisms continue to remain in the body spreading the infections to others. There are several biological and social causes that lead to antimicrobial resistance.

The microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs.” As a consequence, the disease is not eradicated from the body increasing the risk of spreading it to others.

Antimicrobials are drugs – such as antibiotics – that kill or control disease-causing microbes. Antimicrobial resistance (AMR) occurs when microbes mutate or adapt in ways that enable them to withstand antimicrobials, rendering treatments ineffective. AMR is dramatically accelerated by the over-use and misuse of antimicrobials, including antibiotics, in people and animals.

Antimicrobial resistance (AMR) is the ability of microorganisms to persist or grow in the presence of drugs designed to inhibit or kill them. These drugs, called antimicrobials, are used to treat infectious diseases caused by microorganisms such as bacteria, fungi, viruses and protozoan parasites.

Antimicrobial resistance is one of the most serious global One Health threats of the 21st century, linking the interests, concerns and efforts of human health, animal health, and environmental health. Documented in almost all regions of the world,1 antimicrobial resistance is considered by many as the silent global pandemic that will undermine healthcare systems and food safety and supply, and result in millions of deaths.

AMR poses a major threat to human health around the world. AMR occurs when microorganisms, such as bacteria, adapt in ways that make currently available treatments for infections less effective.

This resource outlines what antimicrobial resistance (AMR) is, and how we need to limit our use of antimicrobials – such as antibiotics, antivirals, antifungals and antiparasitics – to reduce the risk of drug-resistant infections and impact of AMR.

We are working to halt the rising death rate and economic burden of antimicrobial resistance (AMR) in Australia by 2030. This will be achieved by enabling and accelerating R&D and providing pathways to market for new and emerging solutions to prevent, manage and respond to AMR in humans, animal and the environment.

Combatting antimicrobial resistance has been recognised as a priority for global public health. In 2015, WHO issued a global action plan on antimicrobial resistance and urged each country to formulate its own plan.1 According to WHO, information about antimicrobial resistance, such as its incidence, prevalence, and geographical distribution, is inadequate and, therefore, urgently needed.1 O’Neill's 2014 report2 presented numerous economic and epidemiological estimates related to antimicrobial resistance, including number of deaths attributable to antimicrobial-resistant infections; these numbers included deaths due to tuberculosis, malaria, and HIV. The report mentioned possible limitations of the estimates resulting from poor reporting and surveillance.2 However, the report did not provide detailed methods on how these numbers were calculated, and it is likely that numbers were underestimated because the incidence of infections caused by antimicrobial-resistant organisms from the European Antimicrobial Resistance Surveillance Network (EARS-Net) was used to estimate the number of resistant infections in countries not in EARS-Net.

Antimicrobial resistance (AMR) is a challenge to human wellbeing the world over and is one of the more serious public health concerns. AMR has the potential to emerge as a serious healthcare threat if left unchecked, and could put into motion another pandemic. This establishes the need for the establishment of global health solutions around AMR, taking into account microdata from different parts of the world. The positive influences in this regard could be establishing conducive social norms, charting individual and group behavior practices that favor global human health, and lastly, increasing collective awareness around the need for such action. Apart from being an emerging threat in the clinical space, AMR also increases treatment complexity, posing a real challenge to the existing guidelines around the management of antibiotic resistance. The attribute of resistance development has been linked to many genetic elements, some of which have complex transmission pathways between microbes. Beyond this, new mechanisms underlying the development of AMR are being discovered, making this field an important aspect of medical microbiology. Apart from the genetic aspects of AMR, other practices, including misdiagnosis, exposure to broad-spectrum antibiotics, and lack of rapid diagnosis, add to the creation of resistance. However, upgrades and innovations in DNA sequencing technologies with bioinformatics have revolutionized the diagnostic industry, aiding the real-time detection of causes of AMR and its elements, which are important to delineating control and prevention approaches to fight the threat.

Antimicrobial resistance is a well-recognized global threat; thus, the development of strong infection control policies coupled with antimicrobial stewardship strategies and new therapies is required to reverse this process. In its 2013 report on antimicrobial resistance, the Centers for Disease Control and Prevention focused on this problem while presenting estimated annual rates of infections with antimicrobial-resistant organisms and their related mortality rates. Whereas some resistant pathogens were considered less threatening, others such as carbapenem-resistant Enterobacteriaceae were associated with higher mortality rates owing to limited treatment options.

Antimicrobial resistance happens when microbes (like bacteria and fungi) are able to outsmart medications providers use to treat them. This can happen naturally or when certain medications are used a lot — germs can develop changes (mutations) that allow them to survive common drugs. It’s hard to treat infections caused by antimicrobial-resistant germs.

Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses, and fungi.

Alexandra Geue, former Director of the Infection Management Section, Department of Health and Ageing, describes the progress towards a national antibiotic resistance management program since the JETACAR report. Tim Dyke from the National Registration Authority for Agricultural and Veterinary Chemicals, describes the regulation of veterinary antibiotics in Australia.

Bacteria have antibiotic resistance when specific antibiotics have lost their ability to kill or stop the growth of the bacteria. Some bacteria are naturally resistant to certain antibiotics (intrinsic or inherent resistance). A more worrying problem is when some bacteria, that are normally susceptible to antibiotics, become resistant as a result of genetic changes (acquired resistance). Resistant bacteria survive in the presence of the antibiotic and continue to multiply causing longer illness or even death. Infections caused by resistant bacteria may require more care as well as alternative and more expensive antibiotics, which may have more severe side effects.  

Each year antimicrobial resistance – the ability of microbes to survive agents designed to kill them – claims more lives than malaria and HIV/Aids combined. Africa bears the brunt of this development, which thrives on inequality and poverty. Nadine Dreyer asked Tom Nyirenda, a research scientist with over 27 years’ experience in infectious diseases, what health organisations on the continent are doing to fight this threat to medical progress.

Bacteria have antibiotic resistance when specific antibiotics have lost their ability to kill or stop the growth of the bacteria. Some bacteria are naturally resistant to certain antibiotics (intrinsic or inherent resistance). A more worrying problem is when some bacteria, that are normally susceptible to antibiotics, become resistant as a result of genetic changes (acquired resistance). Resistant bacteria survive in the presence of the antibiotic and continue to multiply causing longer illness or even death. Infections caused by resistant bacteria may require more care as well as alternative and more expensive antibiotics, which may have more severe side effects.  

Importance:  The development of antibiotics is considered among the most important advances of modern science. Antibiotics have saved millions of lives. However, antimicrobial resistance (AMR) threatens this progress and presents significant risks to human health.

The need to stem the growing problem of antimicrobial resistance has prompted multiple, sometimes conflicting, calls for changes in the use of antimicrobial agents. One source of disagreement concerns the major mechanisms by which antibiotics select resistant strains. For infections like tuberculosis, in which resistance can emerge in treated hosts through mutation, prevention of antimicrobial resistance in individual hosts is a primary method of preventing the spread of resistant organisms in the community. By contrast, for many other important resistant pathogens, such as penicillin-resistant Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus faecium resistance is mediated by the acquisition of genes or gene fragments by horizontal transfer; resistance in the treated host is a relatively rare event. For these organisms, indirect, population-level mechanisms of selection account for the increase in the prevalence of resistance. These mechanisms can operate even when treatment has a modest, or even negative, effect on an individual host’s colonization with resistant organisms.

New concepts have emerged in the past few years that help us to better understand the emergence and spread of antimicrobial resistance (AMR). These include, among others, the discovery of the mutator state and the concept of mutant selection window for resistances emerging primarily through mutations in existing genes. Our understanding of horizontal gene transfer has also evolved significantly in the past few years, and important new mechanisms of AMR transfer have been discovered, including, among others, integrative conjugative elements and ISCR (insertion sequences with common regions) elements. Simultaneously, large-scale studies have helped us to start comprehending the immense and yet untapped reservoir of both AMR genes and mobile genetic elements present in the environment. Finally, new PCR- and DNA sequencing-based techniques are being developed that will allow us to better understand the epidemiology of classical vectors of AMR genes, such as plasmids, and to monitor them in a more global and systematic way.

Antimicrobial resistance (AMR) is a dominant and growing global health threat that led to

1.27 million deaths in 2019. Given the widespread use of antimicrobials in agriculture and industrial applications in addition to healthcare and a range of factors affecting AMR, including climate variability, demographic trends, and plastic and metal pollution, an economy-wide approach is essential to assess its macroeconomic implications. This study summarizes the existing literature on the identified factors driving AMR and reviews the factors that have been considered in existing macroeconomic studies. We highlight the limitations in the available studies and suggest how those could be overcome via an economy-wide modeling approach that integrates the factors behind the evolution of AMR. We present three frameworks to conceptualize the economy-wide use of antimicrobials, the epidemiology of AMR, and how AMR affects the economy in a stylized economy embedded within a more extensive system. We propose how the AMR impacts could be mapped onto economic variables, discuss the significance of these shocks, and outline how AMR evolution scenarios could be designed, particularly with reference to climate change, demographic trends, and associated socioeconomic changes. We also discuss how modeling studies could be improved to increase their utility to policymakers and increase comparability across studies. We conclude with the major policy implications arising from the study which emphasize an economy-wide one-health approach to address AMR; regulation of the antimicrobial supply chain and incentivizing innovations; global cooperation to address AMR, and alleviating uncertainties for policymaking via scaling up the surveillance of AMR, encouraging research collaboration and enabling access to data on AMR and antimicrobial consumption.

Antimicrobial resistance (AMR) refers to when micro-organisms (bacteria, fungi, viruses, and parasites) develop resistance to antimicrobial substances, like antibiotics. The emergence of AMR represents a real and growing threat in Victoria and across the world. It is relevant for the health of humans, animals and the environment.

Antimicrobial resistance (AMR) has been identified as one of the most pressing global challenges we face this century. In fact, the World Health Organisation (WHO) has declared AMR as one of the top 10 global public health threats, and AMR is listed on the UK Government’s National Risk Register. In 2019 there were 4.95 million deaths associated with bacterial AMR across 204 countries, and 1.27 million of those were directly attributed, leading the WHO to declare it a top global public health threat.

Antimicrobial resistance (AMR) arises when the organisms that cause infection evolve ways to survive treatments. The term antimicrobial includes antibiotic, antiprotozoal, antiviral and antifungal medicines.

Antimicrobial resistance (AMR) occurs when microorganisms are able to survive exposure to antimicrobial medicines such as antibiotics that would normally kill them or stop their growth. This results in the drugs no longer working to treat infections. Of particular concern are microorganisms which become resistant to most antimicrobials - they are known as superbugs. Infections which were once easily treatable can become fatal.

AMR happens when microorganisms evolve and stop responding, or respond less, to treatment. This process is on the rise worldwide and was responsible for nearly 1.3 million deaths in 2019, making it a bigger killer than AIDS and malaria. And the situation is expected to get worse.

Antimicrobial resistance, or AMR, is one of the most complex and urgent issues facing the world today. Drug-resistant infections already contribute significantly to mortality and morbidity worldwide. If we fail to act soon, by 2050 AMR could lead to more deaths each year than currently caused by cancer. But this is not only a human health issue. Unchecked, AMR will have devastating consequences on the global economy, food security and agricultural livelihoods, and will undoubtedly jeopardise the achievement of the Sustainable Development Goals.

In this paper, we provide a state-of-the-art overview of the ethical challenges that arise in the context of antimicrobial resistance (AMR), which includes an introduction to the contributions to the symposium in this issue. We begin by discussing why AMR is a distinct ethical issue, and should not be viewed purely as a technical or medical problem. In the second section, we expand on some of these arguments and argue that AMR presents us with a broad range of ethical problems that must be addressed as part of a successful policy response to emerging drug resistance. In the third section, we discuss how some of these ethical challenges should be addressed, and we argue that this requires contributions from citizens, ethicists, policy makers, practitioners and industry. We conclude with an overview of steps that should be taken in moving forward and addressing the ethical problems of AMR.

As a result of antimicrobial resistance (AMR), economies will experience an increase in mortality, reduced productivity for labor and the livestock sector, and increased health care costs. This paper assesses the potential global poverty impacts of AMR using a unique macro-micro framework. To estimate poverty effects of AMR, price, wage, and employment results from a dynamic, multi-country, multi-sector computable general equilibrium CGE model are used in a microsimulation model that integrates household surveys from 104 countries. The analysis in this paper advances other studies of AMR in two ways: (1) it links macro results to a microsimulation model to provide insight on poverty impacts for the world economy and countries of different income levels; and (2) it uses a global multi-sector model, rather than an aggregate global model, to generate macroeconomic results with structural details for capturing the economy-wide impact within countries and the spread across countries via trade flows. Relative to a world without AMR, the progression of antimicrobial resistance is expected to make it more difficult to eliminate extreme poverty, potentially adding 24.1 million people to become extremely poor, of whom 18.7 million live in low-income countries. The expected losses during 2015–50 may sum to $85 trillion in gross domestic product and $23 trillion in global exports (in present value). By 2050, the global gross domestic product could deviate negatively by 3.8 percent from the baseline (in the worst-case scenario considered). Because it is a global public bad, the optimal policy response will require global cooperation. The poverty outcomes induced by AMR in all country groups will deteriorate with short-sighted isolationist policies. Moreover, assistance from high-income countries to improve the economic resiliency of lower-income countries will also benefit the higher-income countries and world economy in general.

Antimicrobial therapy transformed medical practice from a merely diagnosis-focused approach 80 years ago to a treatment-focused approach, saving millions of lives in the years to follow.  Today, numerous medical advances made possible by effective antibiotics are being threatened by the relentlessly rising rates of bacteria resistant to all currently available antibiotics.  This phenomenon is a consequence of antibiotic misuse, which exerts undue selective pressure on micro-organisms, combined with defective infection control practices that accelerate their spread. Its impact on societies worldwide is immense, resulting in loss of human life and money. An alarming pattern of resistance involving multidrug-resistant and sometimes pandrug-resistant Gram-negative bacteria is currently emerging. In response to the global public health threat posed by antimicrobial resistance (AMR), a number of national and international actions and initiatives have been developed in recent years to address this issue.  Although the optimally effective and cost-effective strategy to reduce AMR is not known, a multifaceted approach is most likely to be successful.  It should include actions aiming at optimising antibiotic use, strengthening surveillance and infection control, and improving healthcare worker and public education with regard to antibiotics.  Research efforts to bring new effective antibiotics to patients need to be fostered in order to negate the consequences of the current lack of antimicrobial therapy options.  A holistic view of AMR as well as intersectoral collaboration between human and veterinary medicine is required to best address the problem.

As a result of antimicrobial resistance (AMR), economies will experience an increase in mortality, reduced productivity for labor and the livestock sector, and increased health care costs.  This paper assesses the potential global poverty impacts of AMR using a unique macro-micro framework.  To estimate poverty effects of AMR, price, wage, and employment results from a dynamic, multi-country, multi-sector computable general equilibrium CGE model are used in a microsimulation model that integrates household surveys from 104 countries.  The analysis in this paper advances other studies of AMR in two ways: (1) it links macro results to a microsimulation model to provide insight on poverty impacts for the world economy and countries of different income levels; and (2) it uses a global multi-sector model, rather than an aggregate global model, to generate macroeconomic results with structural details for capturing the economy-wide impact within countries and the spread across countries via trade flows. Relative to a world without AMR, the progression of antimicrobial resistance is expected to make it more difficult to eliminate extreme poverty, potentially adding 24.1 million people to become extremely poor, of whom 18.7 million live in low-income countries. The expected losses during 2015–50 may sum to $85 trillion in gross domestic product and $23 trillion in global exports (in present value). By 2050, the global gross domestic product could deviate negatively by 3.8 percent from the baseline (in the worst-case scenario considered). Because it is a global public bad, the optimal policy response will require global cooperation.  The poverty outcomes induced by AMR in all country groups will deteriorate with short-sighted isolationist policies. Moreover, assistance from high-income countries to improve the economic resiliency of lower-income countries will also benefit the higher-income countries and world economy in general.

ntimicrobial resistance (AMR) is a serious global health challenge [1]. It is predicted that by 2050 there will be more than ten million deaths per year attributed to AMR [2]. Further, it is predicted that the greatest number of these deaths will be in developing countries [2]. Therefore, there is an urgent need to take action to minimize the emergence of antimicrobial resistant bacteria in developing countries [3, 4]. The management of development and spread of AMR requires a multifaceted approach, including the participation of all healthcare workers [5]. According to the first objective of the World Health Organization (WHO) global action plan on AMR, avoiding overuse and misuse of antibiotics requires healthcare professionals awareness and understanding of AMR with effective communication, education and training [6]. In this context, healthcare professionals have a key role to play to optimize the use of antibiotics in the community.

Pharmacists are important members of the healthcare team and they play a major role in medicine use and the provision of advice regarding appropriate medicines use [7]. Education and training of pharmacists has the potential to influence the behaviour of healthcare team members and consumers [8] as part of a multidimensional strategy for changing practice and ensure the quality use of antibiotics [9]. They are well placed to improve the understanding of antibiotics and inform their judicious use by direct contact with consumers in the community [10] and in hospital [11]. Consumer education is an important component of the fight against AMR and pharmacists can improve consumer’s awareness of safe and appropriate medication practices concerning antibiotics [12]. Comprehensive and relevant education and training on the use of antibiotics and AMR is essential for pharmacists in order that they may take a leading role in changing behaviours regarding antibiotic consumption in all healthcare settings.

Knowledge of the clinical and economic impact of antimicrobial resistance is useful to influence programs and behavior in healthcare facilities, to guide policy makers and funding agencies, to define the prognosis of individual patients and to stimulate interest in developing new antimicrobial agents and therapies.  There are a variety of important issues that must be considered when designing or interpreting studies into the clinical and economic outcomes associated with antimicrobial resistance.  One of the most misunderstood issues is how to measure cost appropriately.  Although imperfect, existing data show that there is an association between antimicrobial resistance in Staphylococcus aureus, enterococci and Gram-negative bacilli and increases in mortality, morbidity, length of hospitalization and cost of healthcare.  Patients with infections due to antimicrobial-resistant organisms have higher costs (US$6000–30,000) than do patients with infections due to antimicrobial-susceptible organisms; the difference in cost is even greater when patients infected with antimicrobial-resistant organisms are compared with patients without infection.  Given limited budgets, knowledge of the clinical and economic impact of antibiotic-resistant bacterial infections, coupled with the benefits of specific interventions targeted to reduce these infections, will allow for optimal control and improved patient safety.  In this review, the authors discuss a variety of important issues that must be considered when designing or interpreting studies of the clinical and economic outcomes associated with antimicrobial resistance. Representative literature is reviewed regarding the associations between antimicrobial resistance in specific pathogens and adverse outcomes, including increased mortality, length of hospital stay and cost.

Rising rates of antimicrobial resistance (AMR) globally continue to pose agrave threat to human health. Low- and middle-income countries (LMICs) are disproportionately affected, partly due to the high burden of communicable diseases.

We reviewed current trends in AMR in LMICs and examined the forces driving AMR in those regions. The state of interventions being undertaken to curb AMR across the developing world are discussed, and the impact of the current COVID-19 pandemic on those efforts is explored.

The dynamics that drive AMR in LMICs are inseparable from the political, economic, socio-cultural, and environmental forces that shape these nations. The COVID-19 pandemic has further exacerbated underlying factors that increase AMR. Some progress is being made in implementing surveillance measures in LMICs, but implementation of concrete measures to meaningfully impact AMR rates must address the underlying structural issues that generate and promote AMR. This, in turn, will require large infrastructural investments and significant political will.

For the first time since the introduction of antimicrobials, we are faced with the loss of their efficacy in treating human disease.  Data from the Centers for Disease Control and Prevention's (CDC) National Nosocomial Infections Surveillance (NNIS) System indicates that resistance to vancomycin is increasing among Enterococcus spp.  Most of these vancomycin-resistant enterococci (VRE) are resistant to all currently available antimicrobials.6, 14 As a consequence, treatment options for patients with nosocomial infections associated with VRE are limited, often to unproven combinations of antimicrobials or experimental compounds. Other reports highlight the increasing resistance among nosocomial isolates of Staphylococcus aureus, Enterococcus spp., Enterobacter spp., and Pseudomonas aeruginosa.4, 5, 13, 15, 28, 34

 As antimicrobial resistance increases, the search for the means to understand and control the problem also increases. One place to search is the use of antimicrobials themselves.  The relationship between antimicrobial use and antimicrobial resistance seems obvious at first glance.  However, the relationship often is more complex, because some studies do not show such an association.  The objective of this article is to examine this relationship and determine alternative explanations for antimicrobial resistance in hospitals when antimicrobial use fails to explain antimicrobial resistance.

Antibiotics are among the most important discoveries of the 20th century, having saved millions of lives from infectious diseases. Microbes have developed acquired antimicrobial resistance (AMR) to many drugs due to high selection pressure from increasing use and misuse of antibiotics over the years.  The transmission and acquisition of AMR occur primarily via a human–human interface both within and outside of healthcare facilities.  A huge number of interdependent factors related to healthcare and agriculture govern the development of AMR through various drug-resistance mechanisms.  The emergence and spread of AMR from the unrestricted use of antimicrobials in livestock feed has been a major contributing factor.  The prevalence of antimicrobial-resistant bacteria has attained an incongruous level worldwide and threatens global public health as a silent pandemic, necessitating urgent intervention.  Therapeutic options of infections caused by antimicrobial-resistant bacteria are limited, resulting in significant morbidity and mortality with high financial impact.  The paucity in discovery and supply of new novel antimicrobials to treat life-threatening infections by resistant pathogens stands in sharp contrast to demand.  Immediate interventions to contain AMR include surveillance and monitoring, minimizing over-the-counter antibiotics and antibiotics in food animals, access to quality and affordable medicines, vaccines and diagnostics, and enforcement of legislation. An orchestrated collaborative action within and between multiple national and international organizations is required urgently, otherwise, a postantibiotic era can be a more real possibility than an apocalyptic fantasy for the 21st century.  This narrative review highlights on this basis, mechanisms and factors in microbial resistance, and key strategies to combat antimicrobial resistance.

Antimicrobial resistance poses a significant threat to humanity, health leaders have warned, as a study reveals it has become a leading cause of death worldwide and is killing about 3,500 people every day.

More than 1.2 million – and potentially millions more – died in 2019 as a direct result of antibiotic-resistant bacterial infections, according to the most comprehensive estimate to date of the global impact of antimicrobial resistance (AMR).

The stark analysis covering more than 200 countries and territories was published in the Lancet. It says AMR is killing more people than HIV/Aids or malaria. Many hundreds of thousands of deaths are occurring due to common, previously treatable infections, the study says, because bacteria that cause them have become resistant to treatment.

Antimicrobial resistance (AMR) has developed as one of the major urgent threats to public health causing serious issues to successful prevention and treatment of persistent diseases. In spite of different actions taken in recent decades to tackle this issue, the trends of global AMR demonstrate no signs of slowing down.  Misusing and overusing different antibacterial agents in the health care setting as well as in the agricultural industry are considered the major reasons behind the emergence of antimicrobial resistance.  In addition, the spontaneous evolution, mutation of bacteria, and passing the resistant genes through horizontal gene transfer are significant contributors to antimicrobial resistance.  Many studies have demonstrated the disastrous financial consequences of AMR including extremely high healthcare costs due to an increase in hospital admissions and drug usage.  The literature review, which included articles published after the year 2012, was performed using Scopus, PubMed and Google Scholar with the utilization of keyword searches.  Results indicated that the multifactorial threat of antimicrobial resistance has resulted in different complex issues affecting countries across the globe.  These impacts found in the sources are categorized into three different levels: patient, healthcare, and economic.  Although gaps in knowledge about AMR and areas for improvement are obvious, there is not any clearly understood progress to put an end to the persistent trends of antimicrobial resistance.

Increased antimicrobial resistance in bacteria that are important pathogens of humans, and spread of resistance from the closed environment of hospitals into open communities are increasingly perceived as a threat to public health. Any antimicrobial use, whether in humans, animals, plants or food processing technology, could lead to bacterial resistance. Use of antimicrobials in livestock production is suspected to significantly contribute to this phenomenon in species of bacteria which are common to humans and animals. Further research is required into the specific use conditions that govern the selection and dissemination of resistant bacteria. International travel and trade in animals and food increase the risks of antimicrobial resistance world-wide. Countries are considering import restrictions for products deemed a risk to public health. The Office International des Epizooties, a World Trade Organization reference organisation for the Agreement on the Application of Sanitary and Phytosanitary Measures, develops international standards on antimicrobial resistance which, as is the case for national measures, must be based on risk analysis. The scientific background and problems of resistance in human medicine are reviewed. Current knowledge, missing information and actions to be taken are identified.

Antimicrobials is the collective term for medicines that are used to prevent and treat infections in humans, animals and plants.  These medicines include antibiotics, antivirals, antifungals and antiparasitics.

 Antimicrobial resistance (AMR) develops when microorganisms such as bacteria, fungi, viruses and parasites, are exposed to antimicrobials and, in order to protect themselves against antimicrobials, undergo changes that prevent these medicines from working effectively against them. 

Speaking to The Hindu, Dr. Rakesh Mishra, Director, TIGS highlights the threat of Antimicrobial Resistance and how wastewater surveillance coupled with meta-genomic analysis and gene sequencing can help in keeping track of it in our environment.

Sewage sample surveillance being carried out in some of the major cities in India has been indicating a high prevalence of Antimicrobial Resistance in environment; effective and constant surveillance can help find out which antibiotics will not work and where to reduce unnecessary use.

he rampant misuse and overuse of antimicrobials in human, animal, and plant health has exponentially accelerated growing resistance. On top of these factors, ongoing pollution of the environment is contributing to the widespread presence of antimicrobials and antimicrobial resistance genes in the population.

Every year millions of antibiotic prescriptions are written inappropriately (National Institute for Health and Care Excellence (NICE), 2015). Because of incorrect or lacking information, some doctors may end up prescribing antibiotics for infections already resistant to this treatment or even for viral infections which are in no way treated by antibiotics. In other cases, second- or third- line antibiotics that are reserved for last-resort scenarios may be prescribed in situations where the first line antibiotic would have been able to treat the infection.

Antimicrobials, particularly antibiotics, are a critical part of food security which has made agriculture and aquaculture breeding grounds for resistance via improper usage. Antibiotics are used to treat infections in animals and plants; however, a more worrying usage is the practice of using antimicrobials to compensate for poor hygiene conditions and/or to promote growth (AMR Review, 2016).

As more and more antibiotics are becoming ineffective against resistant infections, last-resort antibiotics may be used more frequently. When used in livestock, the risk of AMR increases as low-level consumption of antibiotics in the food chain has the consequent effect of reducing antibiotic efficacy in humans (Allen HK, 2014). Globally, it is not uncommon for more antimicrobials to be used on animals than for human health. In the U.S., for example, over 70% of antibiotics deemed medically important for humans are used in animal husbandry (The Review on Antimicrobial Resistance, 2015).

They rank among humanity’s most spectacular achievements.  Antimicrobial drugs, such as antibiotics that are used to treat bacterial infections, paved the way to better living conditions for humans and animals.  Before modern medicine, infections due to minor cuts could lead to bloodstream infections or death.

Today, antimicrobials help animals and humans live longer and healthier lives.  But how long will this last?  Many of these life-saving drugs are losing their efficacy as previously susceptible microbes (bacteria, virus, fungi, and microscopic parasites) become resistant.  The phenomenon is known as “antimicrobial resistance” or AMR. Antimicrobial resistance has led to the emergence of so-called “superbugs”, that are challenging health care workers, veterinarians, and other animal health providers due to a reduction of effective therapeutic options to prevent, control, and treat infectious diseases.  Animals and humans are becoming helpless, once again, in the face of infection. 

Antibiotics are medications used to treat infections caused by bacteria.  Bacteria can become insensitive (resistant) to antibiotics. If this occurs, the antibiotics cannot kill or inhibit the bacteria.  The antibiotics then no longer work.  This is called antimicrobial resistance or antibiotic resistance.

In addition to bacteria, other micro-organisms do not always respond well to treatment with medicines either.  Antimicrobial resistance (AMR) is therefore a growing concern.

AMR occurs when pathogens evolve and find ways to resist the effects of antimicrobial medicines. The resistant pathogens survive, grow and spread their resistance. The more an antimicrobial is used, the more pressure pathogens have to develop resistance – this process of adaptation leads to AMR.1,2

AMR can affect anyone, of any age, in any country. The World Health Organization (WHO) characterizes AMR, particularly in Gram-negative bacteria, as one of the biggest threats to global public health today.1

Globally, AMR causes 700,000 deaths annually. If no solution is found, the devastating impact is likely to worsen.2

Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.

AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.  As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.

Antimicrobials - including antibiotics, antivirals, antifungals and antiparasitics - are medicines used to prevent and treat infections in humans, animals and plants. Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.

Antimicrobial resistance (AMR) became in the last two decades a global threat to public health systems in the world.  Since the antibiotic era, with the discovery of the first antibiotics that provided consistent health benefits to human medicine, the misuse and abuse of antimicrobials in veterinary and human medicine have accelerated the growing worldwide phenomenon of AMR.   This article presents an extensive overview of the epidemiology of AMR, with a focus on the link between food producing-animals and humans and on the legal framework and policies currently implemented at the EU level and globally.  The ways of responding to the AMR challenges foresee an array of measures that include: designing more effective preventive measures at farm level to reduce the use of antimicrobials; development of novel antimicrobials; strengthening of AMR surveillance system in animal and human populations; better knowledge of the ecology of resistant bacteria and resistant genes; increased awareness of stakeholders on the prudent use of antibiotics in animal productions and clinical arena; and the public health and environmental consequences of AMR.  Based on the global nature of AMR and considering that bacterial resistance does not recognize barriers and can spread to people and the environment, the article ends with specific recommendations structured around a holistic approach and targeted to different stakeholders.

Antimicrobial resistance (AMR) is one of the greatest threats faced by humankind. The development of resistance in clinical and hospital settings has been well documented ever since the initial discovery of penicillin and the subsequent introduction of sulfonamides as clinical antibiotics. In contrast, the environmental (i.e., community-acquired) dimensions of resistance dissemination have been only more recently delineated. The global spread of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) between air, water, soil, and food is now well documented, while the factors that affect ARB and ARG dissemination (e.g., water and air quality, antibiotic fluxes, urbanization, sanitation practices) in these and other environmental matrices are just now beginning to be more fully appreciated.

In this Account, we discuss how the global perpetuation of resistance is dictated by highly interconnected socioeconomic risk factors and illustrate that development status should be more fully considered when developing global strategies to address AMR.  We first differentiate low to middle income countries (LMICs) and high-income countries (HICs), then we summarize the modes of action of commercially available antibiotics, and then discuss the four primary mechanisms by which bacteria develop resistance to those antibiotics.  Resistance is disseminated via both vertical gene transfer (VGT; parent to offspring) as well as by horizontal gene transfer (HGT; cell to cell transference of genetic material). A key challenge hindering attempts to control resistance dissemination is the presence of native, environmental bacteria that can harbor ARGs. Such environmental “resistomes” have potential to transfer resistance to pathogens via HGT.  Of particular concern is the development of resistance to antibiotics of last-resort such as the cephalosporins, carbapenems, and polymyxins.

Antimicrobial resistance (AMR) occurs when a micro-organism survives despite being exposed to medicines designed to inhibit or kill it. 

Overuse and misuse of antimicrobials are the main drivers of AMR.  Antimicrobials - including antibiotics, antivirals, antifungals and antiparasitics - are medicines used to prevent and treat infections in humans, animals or plants.

The continued evolution of antimicrobial resistance in the hospital and more recently in the community threatens to seriously compromise our ability to treat serious infections.  The major success of the seven-valent Streptococcus pneumoniae vaccine at reducing both infection and resistance has been followed by the emergence of previously minor serotypes that express multiresistance.  The almost universal activity of cephalosporins and fluoroquinolones against community Escherichia coli strains has been compromised by the spread of CTX-M β-lactamase-producing, fluoroquinolone-resistant strains, and the emergence of community-onset methicillin-resistant Staphylococcus aureus, particularly in the United States, has forced us to re-think our empirical treatment guidelines for skin and soft-tissue infections. Finally, our most potent and reliable class of antibiotics, the carbapenems, is compromised by the growth, primarily in intensive care units, of multiresistant Klebsiella pneumoniae, Acinetobacter baumanni, and Pseudomonas aeruginosa.  The lack of a robust pipeline of new agents, particularly against resistant Gram-negative bacteria, emphasizes the importance of optimizing our use of current antimicrobials and promoting strict adherence to established infection control practices.

There is an incoming tide of concern about the problems of antimicrobial resistance. For several years alarm has been expressed in the United States,1 and the past 12 months have seen two World Health Organisation meetings prompted by increasing anxieties about the role of antimicrobials in animal husbandry2 a report by Britain's House of Lords on antimicrobial resistance; and a report from the US Institute of Medicine on emerging infections.3  This week the Danish Chief Medical Officer, Einar Krag, has called together colleagues from the European Union and their advisors for a conference on “the microbial threat” to “assess the strategies to prevent and control the emergence and spread of antimicrobial resistant micro-organisms.” Is all this activity warranted? We believe it is: in the words of the House of Lords' report, “Resistance to antibiotics … constitutes a major threat to public health and ought to be recognised as such more widely than it is at present.”  This issue of the BMJ is helping to broadcast this message.

The causes of these problems and gloomy portents are not difficult to find. In the past 50 years people in both the developed and developing worlds have accepted antibiotics as their right — to obtain a prescription at the first sign of a trivial infection or treat themselves with a handful of cheap antibiotics. We cannot conceive a return to the pre-antibiotic days, yet the unbridled use of these agents in man and animals is inexorably propelling us …

The threat of antimicrobial resistance causing drug-resistant infections and the escalating health, social and economic consequences are now becoming visible at a global level. Here, we discuss the economic and political considerations for creating a truly global and effective response to antimicrobial resistance.

Antimicrobial resistance (AMR) is a major public health issue worldwide. It is a complex issue driven by a variety of interconnected factors. AMR occurs when microorganisms (e.g. fungi, bacteria, viruses and parasites) evolve to resist the effects of treatment.

Antibiotics are used to treat infections caused by bacteria. It is possible for bacteria to change and adapt. The bacteria can find new ways to survive the effects of an antibiotic, making it and related antibiotics less effective. Resistant bacteria make bacterial infections harder to treat, increasing the risk of severe illness and death.

Antimicrobial resistance (AMR) causes an estimated 700,000 deaths annually worldwide, and every country is potentially affected. If not properly addressed, the number could grow to 10 million per year by 2050.

Causes of antimicrobial resistance

AMR occurs when bacteria and other microbes adapt and become less susceptible to medical treatment.

While much attention is focused on the improper use of antimicrobials, there is increasing evidence that medicine quality is another significant factor. Medicines with a lower dose of the active ingredient can lead to resistance. Strategies aimed at addressing antimicrobial resistance include ensuring broad access to affordable medicines, proper stewardship of existing antimicrobial treatments, investments in the development of new treatments. Medicine quality underpins all three.