AMR

Question 1

Discuss what is meant by the one health approach. (Meza et al, 2022)

Answer 1

AMR is the one that most clearly illustrates the One Health approach. AMR is a critical global problem affecting humans, the environment, and animals. The One Health approach is defined as a joint effort of various disciplines that come together to provide solutions for human, animal, and environmental health [1]. AMR is linked to each of these three components due to the irresponsible and excessive use of antimicrobials in various sectors (agriculture, cattle raising, and human medicine).

Question 2

What are the main reasons for the AMR crisis?

Answer 2

Under the pressure of antimicrobial selection, bacteria acquire resistance genes and mobile genetic elements that can spread to other bacteria of the same or different genus. When bacteria acquire resistance to antimicrobials, they also acquire a greater ability to proliferate in animals, humans, and the natural world [4]. Mismanagement of antimicrobials, inadequate infection control, agricultural debris, contaminants in the environment, and migration of people and animals infected with resistant bacteria facilitate the spread of resistance [4,5].

Of particular concern is the rapid global spread of multidrug-resistant bacteria causing infections that cannot be treated with current antimicrobials. In 2019, the World Health Organization (WHO) identified 32 antimicrobials in hospital development, of which only six were classified as innovative. The lack of antimicrobials is affecting global health systems. Currently, infections caused by antimicrobial-resistant microorganisms are difficult to treat because antimicrobials are increasingly ineffective against these infections resulting in higher mortality rates.

The main factor of AMR includes improper and excessive use of antimicrobials; lack of access to clean water, sanitation, and hygiene for humans and animals; poor infection prevention and control measures in hospitals; poor access to medicines and vaccines; lack of awareness and knowledge; and irregularities with legislation [12].

Question 3

Outline types of antibiotics and what they target.

Answer 3

• Cell wall active
  
  • Beta lactams, Glycopeptides
• Protein synthesis inhibitors
  
  • Aminoglycosides, chloramphenicol, clindamycin, fusidic acid, macrolides, tetracycline, synercid, linezolid, rifampicin
• DNA synthesis inhibitors
  
  • Quinolones
• Other mechanisms
  
  • Metronidozole, trimethoprim

Question 4

List the key strategies for addressing AMR from the one heath approach.

Answer 4

1. Conduct a global public awareness campaign to educate our society about the harm caused by the overuse and misuse of antimicrobials.
2. Improve and strengthen hygiene measures and prevent the spread of infections. By improving healthcare systems and living standards, we can significantly reduce the demand for antimicrobial and thus reduce the risk of the emergence of the new resistant strain.
3. Reduce the unnecessary use of antimicrobials in agriculture and their dissemination to the environment. Globally, the largest amounts of antimicrobials are consumed in agriculture and aquaculture. The use of antimicrobials as prophylaxis and growth promoters should be considered dangerous and unnecessary. Furthermore, it has been documented that animal excretes a significant percentage (75%–90%) of antimicrobials without being metabolized and dispersed into the environment.
4. Improve global surveillance of drug resistance. Develop a clear understanding of current and historical data on AMR to clarify the new mechanisms of resistance acquisition. To do so requires a better understanding of three areas: antibiotic consumption in humans and animals, current rates of antibiotic resistance, and a better understanding of the molecular basis of AMR.
5. Promote new and rapid clinical diagnoses. Misdiagnoses made in public or private hospitals lead to unnecessary antibiotic prescriptions.
6. Promote the development and use of vaccines and alternatives.
7. Recognize and increase the number of people working with infectious diseases.
8. A global innovation fund for early-stage research on new treatments.
9. Create better incentives to promote investment in new drugs and in the improvement of existing drugs. The development of new antimicrobials is unattractive to pharmaceutical companies because there are still relatively effective antimicrobials on the market.
10. Build a global coalition for real action against AMR. Global action is essential to make significant progress in the fight against AMR. Putting AMR on the international political agenda and addressing it using One Health approach is important to effect change.

Question 5

Discuss Colistin in relation to AMR.

Answer 5

Colistin (polymyxin B) is a highly bactericidal antibiotic that has been used by humans and animals for decades, but its systemic administration causes nephrotoxicity. The use of this antibiotic is limited to treating patients with skin infections or cystic fibrosis. However, the frequency of systemic administration of colistin has been increased for treating infections caused by carbapenem-resistant bacteria (Escherichia coliandPseudomonas aeruginosa).

Colistin resistance was initially chromosomally encoded, but in 2015, the plasmid-mediatedmcr-1gene was reported to cause colistin resistance inE.colistrains, isolated from samples of foods, animals, and blood cultures in China. Additionally, themcr-1gene is present in other bacterial genera (P.aeruginosa,Enterobacterspp., andKlebsiella pneumoniae).