Title : The impact of global antibiotic resistance on the healthcare system, public health, environment and society
Abstract:
Treatment of infectious diseases with antibiotics is a marvel of medicine and the most significant clinical developments of the 21st century. However, the rapid spread of antibiotic resistance genes especially in gran-negative bacteria in the healthcare settings, community, and environment pose serious threats on patients’ clinical outcomes, which impacts the well-being of human and society. Resistant bacterial infections can therefore cause clinical, public health, or economic devastations. The magnitude of such negative outcomes has extensively been measured by numerous academic research groups as well as the WHO or CDC in the context of morbidity and mortality resulting in increased resource utilization, higher costs of hospitalizations, and antibiotic treatment protocols which favor by increasing utilization of broad-spectrum empiric therapy. It is widely agreed that the treatment failures with resistant infections are of multifactorial characteristics including bacterial fitness and expression genetic mobile elements. For example, high-risk clones such as K. pneumoniae, E. coli, Enterococcus faecium, and Pseudomonas aeruginosa, are rapidly spreading and carry drug-resistant phenotypes which is difficult to treat. Of significant challenge is the heteroresistance infections, a distinct type of antibiotic resistance that involves the occurrence of a subpopulation of bacteria that are more resistant than the main subpopulation. Although heteroresistance infections are present at very low frequencies, their rapid enrichment is concerning. The HR phenotype has widely been observed in several antibiotics. Because of their inherent instability as well as low frequency, they are particularly difficult to detect and treat efficiently. The impact on healthcare system is rapidly evolving especially in countries with resource-limited laboratory capabilities and the availability of alternative antibiotics. The emergence and spread of epidemic clones of methicillin-resistant Staphylococcus aureus (MRSA), vancomycinresistant Enterococcus faecium (VRE) and Acinetobacter spp. are good examples of additional resistant infections which are currently global health burden causing nosocomial infections. Further, colonization with multidrug-resistant organisms is increasingly common in numerous countries including the high-income countries. As selection of antibiotic resistance is a natural process, therefore, resistance develops more rapidly through misuse and overuse – a challenge in our global public health. While hospitals remain key sites for the transmission of antibiotic resistant infections, effective prevention control measures highly emphasize on the importance of hand hygiene among healthcare workers and disinfection measures by the hospitals’ infection control departments. Contaminated hands with genetic mobile elements may further spread the resistant infections in the communities bringing more challenges to the public health impacts. Particularly, inpatients are at higher risk of developing antibiotic resistance infections compared to outpatients. According to the WHO, patients with methicillinresistant Staphylococcus aureus (MRSA) infection, which is primarily a hospitalacquired infection, are about 62% more likely to die the resistant infection compared with people with drug-sensitive infections. Parallel to the impact on the healthcare system and public health, rapid flow of antibiotic resistant genes from the environment to the clinical setting adds deeper to the enigma of global antibiotic resistance. One common example is contaminated foods which end up in our commensal system (GI tract), where antibiotic resistance emerges from the presence of antibiotic treatment or transferred from genetic mobile elements to gut microbiota. Global health arena is consisted of interconnected groups, individuals, communities, and institutions. The spread of antibiotic resistant genes represents one of the biggest challenges to the future of global health arena. To this note, consequences of antibiotic resistance is significantly profound impacting the health of our society. Our individual public health behavior whether in the hospital levels, or outpatient levels, reflect our determination in prioritizing for mitigation of the spread of antibiotic resistance infections by actively engaging safe practices of public health vis-à-vis the emergence of antibiotic resistance. On the other hand, healthcare practitioners are advised to prescribe antibiotics responsibly based on the evidence of bacterial infections to safeguard the health and well-being of the society at large. It is evident that mitigating antibiotic resistant infections require evidenced-based global initiatives that spans the fields of hospital practice, public health, environmental health.
