Anti-microbial Resistance

What is Antimicrobial resistance?

Tackling antibiotic resistance with CRISPR-Cas13a.

An antimicrobial is an agent that kills microorganisms or stops their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against. For example, antibiotics are used against bacteria, and antifungals are used against fungi.

Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness, and death. It is caused by the evolution of the microbe. The overuse of antimicrobials makes resistant microbes more common.

Antimicrobial medications are used to kill microorganisms(such as bacteria, viruses, fungi, etc.…), which can cause illness and disease. They have made a major contribution to human health. Many diseases that once killed people can now be treated effectively with various types of medication.

Example of antimicrobials:

• Penicillin (an antibiotic).
• Valacyclovir (an antiviral agent).
• Fluconazole (an antifungal medication).
• Praziquantel (an antiparasite medication).

Antimicrobial Resistance Timeline.

What are microbes?

Microbes are tiny organisms that can enter your body. Microorganisms are organisms that can be seen only through a microscope. It exists in its single-celled form or as a colony of cells. The scientific study of microorganisms began with their observation under the microscope in the 1670s by Antonie van Leeuwenhoek. In the 1880s, Robert Koch discovered that microorganisms caused the diseases tuberculosis, cholera, diphtheria, and anthrax. Examples of microbes include:

• Bacteria. (Yersinia pestis which causes the infectious disease Bubonic plague is a Bacterium)
• Viruses. ( Varicella-Zoster Virus (VZV) which causes the highly contagious disease Chickenpox is a virus)
• Fungi. (Trichophyton rubrum which causes the infectious disease Ringworm is a Fungi)
• Parasites. (Plasmodium falciparum which causes the infectious disease Malaria is a Protozoan)

Type of Microorganism.

What are the types of antimicrobial resistance?

Antimicrobial resistance occurs when the medication loses its ability to kill. As a result, the organisms continue to grow and cause infection, even in the presence of the medicine. Important examples are:

• Methicillin-Resistant Staphylococcus Aureus (MRSA) is the most common type of antimicrobial resistance. Staphylococcus aureus is a pathogen commonly found on the skin or in the nose of healthy people. They can cause infection when they enter a cut or a wound. MRSA causes life-threatening bloodstream and surgical-site infections, as well as pneumonia.
• Resistance to Streptococcus Pneumoniae causes illnesses like pneumonia, a lung infection, ear and sinus infections, and meningitis.
• Vancomycin-Resistant Enterococcus (VRE) can spread from one person to another through casual contact or contaminated objects. They are bacterial strains of the genus Enterococcus that are resistant to the antibiotic vancomycin.
• Multi-Drug-Resistant Mycobacterium Tuberculosis (MDR-TB) is caused by TB bacteria that are resistant to at least isoniazid and rifampin, the two most potent TB drugs. MDR-TB treatment regimen consisting of combinations of later-generation fluoroquinolones (moxifloxacin or gatifloxacin), clofazimine, ethambutol, and pyrazinamide throughout the treatment period supplemented by prothionamide, kanamycin, and high-dose isoniazid during an intensive phase.
• Resistance to Antiretroviral (ARV) drugs is an increasing concern in immunocompromised patient populations, where ongoing viral replication and prolonged drug exposure lead to the selection of resistant strains.
• Carbapenem-Resistant Enterobacteriaceae (CRE) is caused by the Enterobacteriaceae family of bacteria a pathogenic. These bacteria are commonly found in the gut of the host organisms. Carbapenem is an antibiotic used to treat antibiotic-resistant infections caused by Enterobacteriaceae. However, with prolonged use, the bacteria can also become resistant to carbapenem.

Antimicrobial resistance.

What does the mutated gene or resistant germ do to the antimicrobials?

• Limit the uptake of the medication.
• Change the medication’s target.
• Deactivate the medication (stop it from working).
• Activate efflux of the medication (kick the medication out of the cells).

Antimicrobial Resistance Mechanism.

What are the causes of Antimicrobial resistance?

• Selective Pressure

In the presence of an antimicrobial, microbes are either killed or, if they carry resistance genes, they survive. These survivors will replicate, and their progeny will quickly become the dominant type throughout the microbial population.

• Mutation

During replication, mutations arise and some of these mutations may help an individual microbe survive exposure to an antimicrobial.

• Gene Transfer

Microbes also may get genes from each other, including genes that make the microbe drug-resistant.

• Inappropriate Use

Patients sometimes do not complete their treatment. Health care providers tend to over-prescribe. Sometimes healthcare providers will prescribe antimicrobials inappropriately, wishing to placate an insistent patient who has a viral infection or an as-yet undiagnosed condition.

• Hospital Use

Poor infection control in hospitals and clinics. Critically ill patients are more susceptible to infections and, thus, often require the aid of antimicrobials. However, the extensive use of antimicrobials in these patients can worsen the problem by selecting antimicrobial-resistant microorganisms. The extensive use of antimicrobials and close contact among sick patients creates a fertile environment for the spread of antimicrobial-resistant germs. Lack of hygiene and poor sanitation.

• Agricultural Use

Over-use of antibiotics in livestock and fish farming increases antibiotic resistance. Scientists also believe that the practice of adding antibiotics to agricultural feed promotes drug resistance.

• Technology

Lack of new antibiotics being developed. These factors contribute to antibiotic resistance.

Causes of resistance.

What are the side effects of Antimicrobial resistance?

• More serious infections.
• Longer recovery times.
• Increased medical expenses.
• The use of more expensive drugs or riskier procedures.
• Possible death.
• Use a different medication.
• Take a higher dose of an antimicrobial.
• Take the medication for a longer period.
• Try multiple medications in combination.
• Experiment with non-medication treatments.

How does the resistance spread?

How to prevent resistance?

There are many ways that drug-resistant infections can be prevented: immunization, safe food preparation, handwashing, and using antibiotics as directed and only when necessary. In addition, preventing infections also prevents the spread of resistant bacteria.

• Preventing infections

Avoiding infections in the first place reduces the amount of antimicrobial that has to be used and reduces the likelihood that resistance will develop during therapy.

• Be aware of your health

Talk to your healthcare provider about how to recognize signs and symptoms of infections, or if you think you have an infection. Identification of the infection at its earlier stage will enhance the success rate of the treatment.

• Improving antimicrobial stewardship

Perhaps the single most important action needed to greatly slow down the development and spread of antimicrobial-resistant infections is to change the way these antimicrobials are used. Up to half of antimicrobial use in humans and much of antimicrobial use in animals is unnecessary and inappropriate and makes everyone less safe. Stopping some of the inappropriate and unnecessary use of antimicrobial in people and animals would help to slow down the spread of resistant bacteria.

• Developing new drugs and diagnostic test

Antimicrobial resistance occurs as part of a natural process in which bacteria evolve, it can be slowed but not stopped. Therefore, we will always need new antimicrobial to keep up with resistant bacteria as well as new diagnostic tests to track the development of resistance. Rapid diagnostic tests that identify drug-resistant bacteria, determine antimicrobial susceptibility, and distinguish viral from bacterial infections can guide effective treatment strategies. Diagnostic laboratory tests can find which microbe is causing an infection and determine whether the microbes present are resistant to certain antimicrobial medications.

• Get Vaccinated

Vaccines are an important step to prevent infections, including resistant infections.

• Bacterial acidity

Scientists believe that decreasing bacterial acidity could help reduce antimicrobial resistance by eliminating bacteria that can survive being treated with antibiotics.

Tips to prevent antimicrobial resistance.

Prevention of resistance (with respect to antibiotics).

Conclusion

Antimicrobial resistance contributes to the failure of various treatments and increasing the patient’s exposure to various diseases. Proper usage of antimicrobials can help in the treatment of numerous diseases by killing or preventing the growth of the microorganism. Awareness of the harmful effects of the extended consumption of antimicrobials is necessary. The development of new antimicrobial drugs and diagnostic techniques could help to battle against antimicrobial resistance.