“A little less conversation, a little more action please” – we need to tackle antimicrobial resistance

Opinion piece by Professor Laura Bowater MBE and Dr Tina Joshi
An interactive workshop to discover new forms of antibiotic resistance using cutting-edge DNA sequencing methods.

Drug-resistant infections – or antimicrobial resistance – is one of the biggest threats to humanity today. There are a host of steps planned to help curb the crisis, but what’s actually being done?
To coincide with World Antimicrobial Awareness Week 2023, Professor Laura Bowater MBE, Head of the University of Plymouth’s Peninsula Medical School, and Dr Tina Joshi, Molecular Microbiologist in Peninsula Dental School, discuss.

What is antimicrobial resistance and why does it matter?

Antimicrobial resistance (AMR) is a global threat that requires urgent action from across sectors. It arises when microbes – bacteria, viruses, fungi and parasites – evolve and stop responding to the magic bullet medicines (antibiotics) that we have relied on for more than 70 years. 

The World Health Organization (WHO) has in fact declared that AMR is one of the top 10 global threats facing humanity – in 2019 alone, 4.95 million deaths were associated with bacterial Antimicrobial Resistance across 204 countries.

Misuse and overuse of these drugs are one of the main drivers in the development of AMR pathogens; these microbes adversely affect human health. A lack of clean water, sanitation and hygiene (WASH) combined with inadequate commitment to effective infection prevention and control, has led to the spread of human pathogens that are resistant to antimicrobial treatment.
The cost of AMR to the economy is significant. In addition to death and disability caused by infectious diseases, prolonged hard-to-treat infections result in longer hospital stays, and the need for more expensive medicines.  The financial challenges are compounded by the fact that patients can struggle to manage a successful return to the workplace when their infection requires prolonged treatment. 
Global business vector [shutterstock_85392325]

How is AMR being tackled?

Despite the gravity of the situation, there has been little progress in tackling this global concern. Nevertheless, all is not lost – yet. It is possible to tackle AMR. 

It will take action, commitment, require significant investment, and it depends on a sustained and multifaceted approach that includes reducing the unnecessary use of antimicrobial drugs in human and animal health, and agriculture. 
This can be achieved through the implementation of effective infection prevention and control measures, such as hand hygiene, better access to clean water, development of diagnostics to aid antimicrobial stewardship, improved investment and uptake of vaccines, and careful controlled use of the effective antibiotics that we are currently relying on.  

What needs to happen?

Alongside effective infection prevention and control measures, there must be a concerted effort to invest in the research and development of new antimicrobial medicines, vaccines, and diagnostic tools. 
In 2015 the WHO developed a Global Action Plan on Antimicrobial Resistance, with five key objectives to provide a roadmap to address the problem of AMR along with a framework to measure implementation success. These objectives are: 
  1. To improve awareness and understanding of antimicrobial resistance through effective communication, education and training.
  2. To strengthen the knowledge and evidence base through surveillance and research.
  3. To reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures.
  4. To optimize the use of antimicrobial medicines in human and animal health through stewardship.
  5. To develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions.

Could we be doing more?

Despite the many initiatives designed to raise awareness about this global concern - such as World Antimicrobial Awareness Week - a recent study published in PLOS Medicine has reported that between 2010-2020, approximately 136 million hospital-associated resistant infections are still occurring annually worldwide. This is a worrying statistic.

The recommendations from the O’Neill Report, a seminal report focused on AMR and published in the UK, have also not been met; novel point- of-care diagnostics are still urgently needed to rationalise antibiotic use across all sectors; animal, human and environment. 
The “One Health” aspect to AMR is complicated but must be addressed. Critically, the release of raw sewage into UK waters has been a reductive step in UK efforts to tackle AMR. True action is needed to make a difference to AMR.
Another recent report by the European Court of Auditors on the European Union’s (EU) strategy to tackle AMR states that except for reducing the use of antibiotics in the animal sector, the EU has also failed to deliver significant results when it comes to tackling AMR. 
The clinical pipeline of new antimicrobials is not replete with new innovative drugs coming through, in fact the development of new antimicrobial drugs remains stubbornly slow. In 2019 WHO identified 32 antibiotics in clinical development that address the WHO list of priority pathogens, of which only six were classified as innovative.
COVID-19

Has COVID-19 disrupted progress in tackling AMR? 

Without a doubt the arrival of a global pandemic, COVID-19, in 2020 significantly impacted healthcare services and diverted resources from tackling AMR. 

However, if lessons are to be learnt, perhaps one of the most important messages to take away from the pandemic is that global infections have the potential to emerge at any time and they can be deadly threats, impacting all aspects of human lives. 

Consider the threat of Candida auris; a fungus that causes human infections, has caused mortality globally and is resistant to three classes of Antifungals. When it comes to treating infections, especially infections that are becoming increasingly resistant to the antimicrobial drugs we rely on, prevention is key but so is investing in diagnostic and drug discovery pipelines if we are to succeed in combating AMR.

And finally…

With the United Nations General Assembly convening to discuss AMR in September 2024 (UNGA2024), world leaders will again come together to have conversations about effectively addressing AMR. 
However, since the last UNGA AMR in 2016, what has really changed? Global leaders must do more. It’s time for a little less conversation, and more global action, please.

New research highlights reality of AMR

Research co-written by Dr Tina Joshi has showed spores of Clostridioides difficile, commonly known as C. diff, are completely unaffected despite being treated with high concentrations of bleach used in many hospitals.
With incidence of biocide overuse only serving to fuel rises in antimicrobial resistance (AMR) worldwide, the study has called for urgent research to find alternative strategies to disinfect C. diff spores.
Clostridium difficile spores survive on hospital gowns after disinfection with chlorine at 1000 ppm (recommended guidelines).
Tina Joshi

Faculty of Health

Exceptional clinical and academic learning, social engagement and research in medicine, dentistry, nursing, psychology and health professions.
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