Antibiotic Resistance: A Major Threat To Public Health Essay.

Causes and Consequences of Antibiotic Resistance

Antibiotic resistance or AMR has been found to be developed as one of the most significant and urgent threats to the public health, that causes, serious issues towards the successful prevention as well as the successful treatment of disease. Antibiotic resistance has been found to happen when bacteria and fungus develop the ability of growing and surviving in the presence of a drug. In other words, it can be said that antibiotic resistance, is primarily responsible for most of the superbug associated hospital-based infections of the world (Alabi et al. 2022). The misuse or overuse of different antibacterial agents in healthcare setting has been found to be associated with the agricultural industry. For example, according to the US reports, more than 2.8 million, infections occur due to AMR in the US. The CDC has been found to estimate that every year, 2 million people, gets affected by AMR. AMR in the agricultural industry has been found to reduce the crop growth and led to the destruction of crops (Al-Yasseri and Hussain 2019). Antimicrobial resistance has also been linked to a direct influence on GDP. The same has been discovered to have a significant impact on the labour force, owing to lost productivity. Antibiotic resistance has been linked to mortality, resulting in a reduction in the workforce and, as a result, a reduction in population growth. As a result, AMR has been identified as a major concern to the healthcare industry (Baloch et al. 2021). A theoretical model was proposed in a research study to evaluate the economic consequences of AMR on the labour force in the future. They contrasted the historical AMR trend with the present AMR trend in this example. Added to the same, spontaneous evolution has led to the development of antibiotic resistance, which is needed to be checked and acted upon, in order to prevent further destruction of human assets (Belachew, Hall and Selvey 2021). The associated research study was found to be a literature review, which used papers from 2012, in order to analyse the implications of antibiotic resistance and set goals to fight against it. Thus, the aims of the research study were associated with the above data only. The present study is aimed at critically reviewing the research paper, and finding out the strength and weaknesses of the study.

Antimicrobial resistance or AMR has been found to occur when the microbes such as bacteria, virus, and fungus becomes able to grow in the presence of the antibiotic (Collignon and McEwen 2019). AMR has also been considered to be a significant threat to the system of public health and it has been found to be associated with the developing countries across the world. Infectious diseases can no longer be specifically treated with antibiotics, which will depict an unknown future in the healthcare service (Chokshi et al. 2019). The infection associated with AMR has been found to cause serious increase in the cost associated with healthcare. On the other hand, CDC has been found to report of the same incident only. Thus, the study topic can be stated to be justified. In other words, it can be said that the significance of the study lies in this fact only. Furthermore, it can be stated that the researchers have added justified information in the background section (Da Silva Carvalho 2021). AMR has been found to be a daunting threat and therefore it has become a factor of particular importance, especially with bacteria. This is because of the fact that people affected by antibiotic resistance bacterial diseases, leads to the increase in healthcare costs. This increase in healthcare costs have been found to be associated with the cause of an economic burden on the patients.

Impact of Antibiotic Resistance on Public Health

As stated in the ending part of the previous section, it can be stated that the increasing rate of AMR is posing a serious public health issue, even in terms of a serious economic burden (Efthymiou, Gkentzi and Dimitriou 2020). AMR has been found mainly to develop due to the physicians prescribing unnecessary medications. This induces a length course of antibiotics and also increases the financial pressure on the people, affected by the disease. There is another factor, that contributes to the overprescribing of the antibiotics by the healthcare providers. There are many studies where patient requests for the prescribing of antibiotics to their doctors in order to stay in a safe zone. As the rate of antibiotic resistance will continue to grow, different types of antibiotics will be needed for the treatment of bacteria. Antibiotic resistance, or AMR, has been identified as one of the most serious and urgent risks to public health, posing substantial challenges to disease prevention and treatment (Collignon and McEwen 2019). The agriculture business has been linked to the misuse or abuse of several antibacterial drugs in hospital settings. AMR has been discovered to inhibit crop growth and result in crop devastation in the agriculture business. In addition, natural selection has resulted in the development of antibiotic resistance, which must be monitored and addressed in order to prevent further loss of human assets (Majumder et al. 2019). The related research study was discovered to be a literature review that used articles from 2012 to analyse the consequences of antibiotic resistance and create targets to combat it. As a result, the research study's objectives were solely based on the information provided above. Thus, it can be stated that the authors have specifically discussed the public health issue and the same needs to be addressed in order to prevent the over spreading of antibiotic resistance (Malik and Bhattacharyya 2020). Antibiotic resistant bacteria, are mainly found in the guts of human beings as well as animals. In other words, it can be said that s the animals are slaughtered for extracting meat or other animal products, the transfer of these bacteria from one host to another occur. The use of specific antibiotics in food animals have been found to create antibiotic resistance (Da Silva Carvalho 2021). In other words, it can be said that the spread of antibiotic resistance from humans to animals and then from animals to humans is a cycling process. Some information regarding the same was discussed in this research also.

AMR has been found to have been developed as one of the most disastrous threats to mankind. In spite of the various actions which were taken in recent decades for tackling the issue, the trends of global AMR have been found to demonstrate no symbols of slowing down (Majumder et al. 2020). The misuse and overuse of antibiotics have been found to be the main causes of the phenomena. There are many studies, which have demonstrated this issue, however, none of the studies did talk of the implications and the future goals against antibiotic resistance. The research study has been performed using a secondary research design – Scopus, PubMed and Google Scholar associated with the use of keyword based searches (Dadgostar 2019). A secondary research design was selected because of its high evidence base level. In other words, it can be said that the selection of such a research design is justified for a research study like this. In other words, it can be said that this type of research study is specifically associated with many primary papers and thus it is easy to conduct secondary studies (Malik and Bhattacharyya 2020). The results have indicated that the threat associated with AMR is multifactorial and the same has resulted in the development of a different complex issue. There are many impacts, which are found in the sources that are categorized and placed in three different levels – patient, economic and healthcare. However, there are major gaps in knowledge, which were not specifically addressed for AMR. These are the areas of improvements, which can be expected in the future research studies.

Link Between Agricultural Industry and Antibiotic Resistance

AMR has been found to cause severe delay in the control of infectious diseases. This is because of the fact that the microbes are resistant to most of the antibiotics (Al-Yasseri and Hussain 2019). The previously stated phenomena prevent normal anti-microbials from killing of preventing the growth of the target microbe. For this reason, AMR is a major issue in infectious illness control.

The absence of novel antimicrobial discoveries, is becoming a promoting factor towards anti-microbial resistance. According to research finding, it can be said that there are not discoveries of novel antibiotics since 1978. Microorganisms have already become resistant to the previously discovered and synthesized drugs. Thus, the requirement of novel drugs is an urgent necessity of today’s world. However, the funding system, needs to be strong enough in order to allow the researchers in running the clinical trials for the discovery of novel antibiotics (Baloch et al. 2021).

The low-income countries (LMIC), have mainly been found to be associated with the use of first-generation antibiotics. Therefore, the prevalence of AMR has been found to cause hardships to the primary healthcare sectors in several LMICs. The discovery of novel drugs is the most significant way to deal with the hiked prevalence of AMR in LMICs.

As per the information has been obtained from recent statistical data, it can be said that drug resistant microbes are prevalent in every region of the world. Several factors have been found to influence this hiked prevalence of AMR across various regions of the world (Efthymiou, Gkentzi and Dimitriou 2020). The statistical reports have given information on the fact that the 3^rd generation drug resistant E.coli has caused 6.7 million infections on a worldwide basis (Rather et al. 2017). The higher rates or resistance has been found to cause hiked amount of deaths in the world. Ciprofloxacin resistance was found to be one of the most significant changes observed in E.coli. Nine percent of E.coli was found to be resistant to ciprofloxacin in the past. 93% of E.coli is resistant to Ciprofloxacin in today’s world.

Fig 1: The trends in consumption of antibiotics in the outpatient sectors of European healthcare services.

(Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)17907-0/fulltext)

The structure of the review has shown transparency and evidence-based analysis which has been specifically justified. No specific section for research purpose, aim and objectives including the hypothesis were given. In other words, it can be said that the research study has lost some of its quality, in this section. Nevertheless the research strategy was discussed in a very precise way and the information has also been properly discussed in the research study. Data was also found to be presented with a justifiable and analytical order (Da Silva Carvalho 2021). The critical review ill analyse the three main areas associated with the implications and goals against AMR.

The mortality and morbidity have been found to be the significant consequences of AMR which affects the patient. This type of finding has been found to be stated in another research study also (Majumder et al. 2020). The negative outcomes of the disease have been found to be associated with the increase in severity of resistant infections and the susceptibility of the host. Antimicrobial resistance has thwarted decades of worldwide efforts to combat illnesses such as TB, HIV, and malaria. The number of HIV cases resistant to treatment is increasing, especially in Sub-Saharan Africa, where 60% of HIV patients have developed resistance to treatment.  Patients who are resistant to HIV medications have a greater chance of dying from the virus, which is unsurprising (Prestinaci, Pezzotti and Pantosti 2015). According to the 2017 HIV medication resistance study, such persistent developments in HIV treatment resistance jeopardise the worldwide aim of ending AIDS by 2030. These findings were observed in another research study also. The increase in drug resistance were observed in malarial parasites also. Patients have also been found to pay a major role in adding up to the list of variable perspectives in AMR.

Need to Combat Antibiotic Resistance

The main causes of AMR have been stated in Figure 2. The overuse of antibiotics in communities, hospitals, agriculture and animals have resulted in the development of AMR in the environment (Mapanguy et al. 2021).

Fig 2: The factors responsible for the development of AMR.

Source: (https://www.frontiersin.org/articles/10.3389/fmicb.2019.02240/full)

1. The human factors are associated with the irrational use of antibiotics in clinical therapies as well as agriculture.
2. Increased consumption of antibiotics, above the dosage range of the drug.
3. Environmental factors associated with the increase of improper dumping of antibiotics in gutters and drains.
4. The increase in antibiotic susceptibility, for the bacteria, resulting in overuse of antibiotics and finally the development of AMR.

In terms of healthcare perspectives, it can be stated that AMR has specific disastrous impacts on healthcare costs. As per the CDC reports, it can be said that antibiotic resistance adds up to a very large amount of hospital economy (Mapanguy et al. 2021). The treatment of patients with antibiotic resistant infections have been found to increase in number and high costs were found to be associated with the expensive treatments as well as escalation in the utilisation of resources. These factors are associated with intensive treatments and escalations in the utilization of resources. The treatment of patients, who are associated with resistant infections, were found to be resistant to the use of antibiotics also. Moreover, it was observed that the treatment of patients, increases the healthcare costs. This type of increase in healthcare costs have been found to be significantly discussed in other research studies (Malik and Bhattacharyya 2020). This finding can be stated to have been justified, because of the fact that increase in direct monitory effect is directly proportional to the burden on the healthcare system. Added to the direct monetary effects, AMR has also been found to generate antimicrobial resistance, and AMR will be a challenge to be tackled by the human population. The researchers have talked of other instances where the discussions of antibacterial drug resistances were focussed. The overall prevalence of AMR has been found to prohibit the physicians from the administration of antibiotics to the patients affected by cancer. Since, there is limited data, no specific cost value can be stated, that limits the understanding of what can be stranded to lose.

In terms of healthcare, it may be said that AMR has a particularly negative influence on healthcare expenses. Antibiotic resistance, according to CDC statistics, accounts for a significant portion of hospital spending. Patients with antibiotic-resistant illnesses are being treated in greater numbers, and high costs have been linked to both expensive therapies and increased resource use (Naylor et al. 2018). These variables are linked to more extensive treatments and increased resource use. Antibiotic resistance was discovered in the treatment of individuals with resistant infections.

The review has provided new instances which indicates that the cost of AMR across the world is specifically high. There are differences of the same in each country. The above stated finding has been reported in another research study (Shamsah et al. 2021). The authors can thus be stated to have performed an extensive literature review in order to throw light on the economic perspectives of antibiotic resistances. Due to ARM, the gap present in between the small developing countries and large developed countries have become more pronounced. Most of the people, who were specifically pushed to the extremities of poverty, as a result of AMR, it can be stated to specifically affect the human population.

There is also a direct impact on GDP associated with antimicrobial resistance. The same has been found to impose a major influence on the labour force, via productivity loss. The deaths have been found to be associated with antibiotic resistance, which decreases the workforce and in turn affects the population size. AMR has thus been found to be a serious threat to the healthcare economy also (Naylor et al. 2018). A research study has talked of a theoretical model to estimate the economic impacts of AMR on the labour force in future. In this case, they have compared the previous trend of AMR with the current trend of AMR.

According to the reports, global trade has been predicted to be heavily affected by AMR if the trends in AMR persists (Priyadharsini, 2019). AMR has also been found to affect the animals also. In other words, it can be said that the same will ultimately lead to the decreased production as well as trade of livestock, which results in the increased prices of food materials. Shortage of protein has been found to be a major concern, considering the overall demand for animal proteins (Sweileh 2021). These types of predictions were made in another research study also. As per the reports of world bank, AMR will definitely have a negative impact on the livestock population. This is because of the fact that AMR will be affecting the animals also and the older drugs or medicines will fail to work. This type of prediction was given in another research study also. Moreover, it can be said that there will be a specifically 11% loss in production of livestock by 2050. The same can be stated to lead to the decline in the generation of income, which can exacerbate the situation of economy (Collignon and McEwen 2019). Because the rise in direct monitory impact is exactly proportionate to the strain on the healthcare system, this conclusion may be said to be justified. AMR has been proven to develop antimicrobial resistance, in addition to the direct monetary impacts, and AMR will be a problem for the human population to overcome (Chokshi et al. 2019). Other occasions when antibacterial antibiotic resistances were discussed were mentioned by the researchers. The general incidence of AMR has been discovered, preventing physicians from prescribing antibiotics to cancer patients. Because there is a scarcity of data, no exact economic value can be assigned, which restricts our comprehension of what might be lost. Estimates have been found to indicate that if the persistent trends in AMR fails to slow down, there might be a substantial loss in the animal production, which will lead to a decline in the generation of income.

Fig 3: Effect of AMR on the world GDP

Source: (https://www.researchgate.net/figure/aMr-impact-on-World-trade_fig2_317235163)

A major reduction in the world GDP has been observed since 2018, due to the increase in prevalence of AMR. The projected decrease in GDP is expected by the year 2050. By 2050, the expected decrease in GDP will be 100 to 93, on a scale of 100.

A research study has stated that surveillance of AMR in the LMIC is always a challenge. In other words, it can be said that apart from GLASS as well as other government-oriented initiatives, there are very a smaller number of programmes for LMICs (Shamsah et al. 2021). There are various barriers associated with the AMR surveillance in LMICs. The issues associated with lab infrastructures in LMICs have led to the development of lower quality drugs and less effective drugs also (Rather et al. 2017). Absence of proper funding and human resource support, leads to the lack of surveillance in AMR. There is also an observed lack of consumables in the LMICs which causes the accuracy of results to reduce and also reduce the quality of diagnostics as well as reagents.   

Ethics in agriculture –

The novel antimicrobials for animals and faming have been made accessible and affordable to all the customers. However, it has been found to create moral issues, including spread of pathogenic viruses due to the environmental diffusion of antibiotics (Saleem et al. 2019).

Ethics in future generation obligations –

AMR has been found to raise an obligation for the future generations in the preservation of effective antibiotics. The antibiotic usage is needed to be reduced drastically. Withholding of treatment for the current generation is expected to cause ethical dilemma in future generations also. Several planning policies are needed to take care of ethical dilemma in AMR and ethical issues (Sweileh et al. 2021).

Ethics in the change in behaviour –

The awareness about AMR needs to be increased. There is a major section of the human population, who are unaware about AMR. Thus, there is a need of various interventions, for changing the behaviours of people, associated with adequate handwashing techniques.

Ethics associated with drug development –

The development of new drugs is associated with ethical considerations. Since, the by-products of antibiotic development have been found to cause water pollution and later contributes to the re-emergence of EMR. There is also a huge burden of AMR, which is put forward to the high-income countries. They need to help the lower income countries in providing the novel drugs, which increases the rate of production than needed.

The research study has been found to conclude on the impacts as well as the action plan discussions in order to control the increasing prevalence of AMR.

1. Awareness about AMR needs to be increased by education, training as well as communication-oriented strategies.
2. Infection incidence reduction by using specific measures of hygiene.
3. Knowledge and evidence strengthening of AMR via the effective surveillance programs as well as the research activities.
4. Optimisation of antimicrobial usages in animals and humans.
5. Economic case development for a sustainable investment which considers the needs of every country in increasing the drug investments. One such example is antimicrobial stewardship or ASP which helps in decreasing AMR prevalence by reducing the overuse and misuse of antibiotics by human beings.

The included studies were not subjected to any quality assessment processes. The authors did not do any quality assessment of the included research studies.

The results were not combined with each other and were separated in the form of specific themes, which were discussed in separate sections. Thus, combining the results was absolutely unreasonable.

The review results were very precise. Specific themes were generated from the research data and they were discussed in relevance to previous research study findings.

Conclusion

The study has achieved the aim and has also determined the rate of global burden associated with AMR. The effects on economy and health were also specifically discussed in the research study. The patient's mortality and morbidity have been discovered to be severe effects of AMR. This sort of conclusion has also been obtained in another research investigation. The increased severity of resistant infections, as well as the host's vulnerability, have been linked to the disease's unfavourable results. Antimicrobial resistance has stymied decades of global attempts to tackle diseases including tuberculosis, HIV, and malaria. The number of HIV cases resistant to treatment is on the rise, particularly in Sub-Saharan Africa, where 60 percent of HIV patients have developed treatment resistance. The research study has also successfully discussed the specific contributors of antibiotic resistance, which are associated with the misuse and overuse of antibiotics that are attributed to the growth prevention of pathogens and disease-causing bacteria. According to the research, AMR is expected to have a significant impact on global commerce if current trends continue. Animals have been discovered to be affected by AMR. In other words, the same will eventually lead to lower animal output and commerce, resulting in higher food material costs. Given the total need for animal proteins, protein scarcity has been identified as a key problem. These kinds of predictions were also made in another investigation. AMR will undoubtedly have a deleterious influence on the cattle population, according to World Bank research. The research study was specifically justified with no particular aims and objectives. The enhancement of surveillance in healthcare systems have been found to be associated with specifically low- and middle-income countries. The research study has also shown a prominent gap in between the progress made in AMR prevention between developing and developing countries. Apart from these, the policy makers must not be aware of the limitations of the research study and the clarity challenges of surveillance methods added to other AMR studies.

References

Alabi, O., Obisesan, A., Taiwo, M. and Adewuyi, R., 2020. co-production of extended-spectrum beta-lactamases and metallo beta-lactamases among multi-drug resistant gram-negative bacteria isolates collected from tertiary hospitals in oyo state, nigeria. fudma journal of sciences, 4(3), pp.230-241.

Al-Yasseri, B.J.H. and Hussain, N.A., 2019. Public knowledge and attitudes towards antibiotics use and resistance in Baghdad, Iraq: a survey conducted in outpatient department of university teaching hospital. The Open Public Health Journal, 12(1).

Baloch, Z., Aslam, B., Yasmeen, N., Ali, A., Liu, Z., Rahaman, A. and Ma, Z., 2021. Antimicrobial Resistance and Global Health: Emergence, Drivers, and Perspectives. Handbook of Global Health, pp.2379-2391.

Belachew, S.A., Hall, L. and Selvey, L.A., 2021. Non-prescription dispensing of antibiotic agents among community drug retail outlets in Sub-Saharan African countries: a systematic review and meta-analysis. Antimicrobial Resistance & Infection Control, 10(1), pp.1-15.

Chokshi, A., Sifri, Z., Cennimo, D. and Horng, H., 2019. Global contributors to antibiotic resistance. Journal of global infectious diseases, 11(1), p.36.

Collignon, P.J. and McEwen, S.A., 2019. One health—its importance in helping to better control antimicrobial resistance. Tropical medicine and infectious disease, 4(1), p.22.

Da Silva Carvalho, C.M., 2021. Knowledge and Perceptions of Antibiotic Resistance Stewardship Among Prehealth and Agriculture Students.

Dadgostar, P., 2019. Antimicrobial resistance: implications and costs. Infection and drug resistance, 12, p.3903.

Efthymiou, P., Gkentzi, D. and Dimitriou, G., 2020. Knowledge, attitudes and perceptions of medical students on antimicrobial stewardship. Antibiotics, 9(11), p.821.

Gilani, S.S.D., Khattak, Y.K., Shah, T., Rasheed, S., Ijaz, T., Habib, A. and Qayum, I., PREVALENCE AND PREDICTORS OF SELF-MEDICATION PRACTICE WITH ANTIMICROBIALS IN PATIENTS VISITING PUBLIC SECTOR AT HOSPITAL KHAIRABAD DISTRICT NOWSHERA.

Majumder, M.A.A., Rahman, S., Cohall, D., Bharatha, A., Singh, K., Haque, M. and Gittens-St Hilaire, M., 2020. Antimicrobial stewardship: Fighting antimicrobial resistance and protecting global public health. Infection and drug resistance, 13, p.4713.

Malik, B. and Bhattacharyya, S., 2020. Emergence and burden of antibiotic drug resistance: an endogenous cycle. Current Science, 118(2), p.189.

Mapanguy, C.C.M., Adedoja, A., Kecka, L.G.V., Vouvoungui, J.C., Nguimbi, E., Velavan, T.P. and Ntoumi, F., 2021. High prevalence of antibiotic-resistant Escherichia coli in Congolese students. International Journal of Infectious Diseases, 103, pp.119-123.

Naylor, N.R., Atun, R., Zhu, N., Kulasabanathan, K., Silva, S., Chatterjee, A., Knight, G.M. and Robotham, J.V., 2018. Estimating the burden of antimicrobial resistance: a systematic literature review. Antimicrobial Resistance & Infection Control, 7(1), pp.1-17.

Prestinaci, F., Pezzotti, P. and Pantosti, A., 2015. Antimicrobial resistance: a global multifaceted phenomenon. Pathogens and global health, 109(7), pp.309-318.

Priyadharsini, R.P., 2019. Antibiotic Resistance: What is there in Past, Present and Future?. Journal of Young Pharmacists, 11(4), p.333.

Rather, I.A., Kim, B.C., Bajpai, V.K. and Park, Y.H., 2017. Self-medication and antibiotic resistance: Crisis, current challenges, and prevention. Saudi journal of biological sciences, 24(4), pp.808-812.

Saleem, Z., Godman, B., Hassali, M.A., Hashmi, F.K., Azhar, F. and Rehman, I.U., 2019. Point prevalence surveys of health-care-associated infections: a systematic review. Pathogens and global health, 113(4), pp.191-205.

San Kong, L., Islahudin, F., Muthupalaniappen, L. and Chong, W.W., 2021. Knowledge and Expectations on Antibiotic Use Among the General Public in Malaysia: A Nationwide Cross-Sectional Survey. Patient preference and adherence, 15, p.2405.

Shamsah, S., Vali, L., Al-Kayyalli, D. and Dashti, A.A., 2021. Isolation of Antibiotic-Resistant Bacteria From The Atmospheric Air In Hospital Wards And Outdoor Areas In Kuwait During Sandstorms.

Sweileh, W.M., 2021. Global research publications on irrational use of antimicrobials: call for more research to contain antimicrobial resistance. Globalization and Health, 17(1), pp.1-12.