What is antimicrobial resistance (AMR)?
Antimicrobial resistance happens when microorganisms (such as bacteria, fungi, viruses, and parasites) change when they are exposed to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics). Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”. As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.
Antimicrobial resistance occurs naturally over time, usually through genetic changes. However, the misuse and overuse of antimicrobials is accelerating this process. In many places, antibiotics are overused and misused in people and animals, and often given without professional oversight. Examples of misuse include when they are taken by people with viral infections like colds and flu, and when they are given as growth promoters in animals and fish.
Antimicrobial resistant microbes are found in people, animals, food, and the environment (in water, soil and air). They can spread between people and animals, and from person to person. Poor infection control, inadequate sanitary conditions and inappropriate food-handling encourage the spread of antimicrobial resistance.
Why is AMR a global concern?
· New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases, resulting in prolonged illness, disability, and death.
· Without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarian sections or hip replacements) become very high risk.
· Antimicrobial resistance increases the cost of health care with lengthier stays in hospitals and more intensive care required.
· Antimicrobial resistance is putting the gains of the Millennium Development Goals at risk and endangers the achievement of the Sustainable Development Goals.
Key Global AMR Trends:
- Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.
- AMR is an increasingly serious threat to global public health that requires action across all government sectors and society.
- Without effective antibiotics, the success of major surgery and cancer chemotherapy would be compromised.
- The cost of health care for patients with resistant infections is higher than care for patients with non-resistant infections due to longer duration of illness, additional tests and use of more expensive drugs.
- Globally, 480 000 people develop multi-drug resistant TB each year, and drug resistance is starting to complicate the fight against HIV and malaria, as well.
- Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a direct result of these infections.
Key AMR Trends: India
The overall burden of resistance is hard to assess for the general population but is likely focused on neonates and the elderly, both of whom are more prone to infections and vulnerable to ineffective treatment.
- Although accurate estimates of the overall burden of resistance are not available, it is estimated that 58,000 neonatal deaths are attributable to sepsis caused by drug-resistance to first-line antibiotics each year.
· In India, Escherichia coli isolated from the community showed high overall resistance to ampicillin, naladixic acid, and co-trimoxazole (75%, 73%, and 59%, respectively) between 2004 and 2007.
· Resistance to fluoroquinolones among invasive Salmonella Typhi isolates in India increased from 8% in 2008 to 28% in 2014.
· Resistance to nalidixic acid in S. Typhi is increasing (resistance is about 20%–30%) because of widespread use of other quinolones.
 World Health Organisation (WHO), Antimicrobial Resistance, Factsheet, November 2016; available at: https://www.who.int/mediacentre/factsheets/fs194/en/
 Laxminarayan, Chaudhury, Antibiotic resistance in India: Driver and opportunities for action, PLOS Medicine, March 2016; Available at: https://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1001974