Global Health Challenges: Antimicrobial Resistance
Alexander Fleming revolutionized medicine in 1928 when he accidentally discovered penicillin. After the isolation and purification of this compound, infections that had proved fatal could now be effectively treated. The ensuing antibiotic revolution resulted in the isolation and synthesis of numerous additional antimicrobial drugs. Infectious diseases became less deadly and many life-saving medical procedures such as organ transplantation and cancer treatment became possible. In the US, for example, life expectancy rose from 47 years in 1900 to 74 years in 1980.
Antimicrobial resistance (AMR), the ability of microbes to resist the effects of drugs to which they were initially sensitive, poses a major threat to this progress. At least 2 million people in the US are now sickened by AMR infections each year, and more than 23,000 are killed. Furthermore, AMR infections have cost the US health system an extra 20 billion dollars so far. AMR can naturally occur through exposure to microbes that produce antimicrobial agents in the environment that inhibit the growth of sensitive microbes. Other sources of AMR include over-prescription and improper use of antibiotics for people, feeding antibiotics to livestock, the application of antimicrobial substances on crops and the presence of antibiotic waste in the environment. All these practices inadvertently select for microbes that can grow in the presence of these substances.
It is estimated that if no action is taken by 2050, the burden of AMR deaths could reach 10 million lives each year globally, costing over 100 trillion US dollars. One death due to AMR would occur every three seconds and many medical procedures would no longer be practical. Invasive surgeries, cancer chemotherapy or organ transplantation would all leave the patient too vulnerable to infection.
The “one-health” approach recognizes the complex interrelations between humans, animals and the environment when addressing the AMR challenge. It is imperative that we find ways to effectively steward the use of current antibiotics while supporting the search for new drugs. Additionally, new ways of combatting AMR that do not involve antibiotics are imperative including the use of the bacterial gene editing system, CRISPR and the use of bacteriophages (which are viruses that infect bacteria). This is a serious problem that has a direct impact on people, animals and the environment globally.