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Antimicrobial resistance is the
ability of a microbe to resist the effects of the medication that was
previously used to treat it. This is a rather broad term, and also includes
antibiotic resistance, which describes the instance where bacteria become
resistant to its former method of treatment. Any microbe which becomes
resistant to multiple forms of medication is known as multidrug resistant, or,
a superbug.

 

In 2014, the
World Health Organisation, or WHO, released a report that stated the following
“this serious threat is no longer a prediction for the future, it is
happening right now in every region of the world and has the potential to
affect anyone, of any age, in any country. Antibiotic resistance—when bacteria
change so antibiotics no longer work in people who need them to treat
infections—is now a major threat to public health.” (Who.int,
2014)

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Antimicrobial resistance usually
occurs over time through natural genetic changes. However, this has been
accelerated in recent times due to the misuse and overuse of antibiotics in
modern society. In many places around the world antibiotics are taken without
professional guidance, leading to a large upturn in the rate of growth of
antimicrobial resistance in microbes. Examples of this misuse are when people
suffering from viral infections such as cold or flu take antibiotics to try and
alleviate their symptoms, when they are given to animals as a growth factor, or
when they are given to healthy animals so that they remain healthy.
Antimicrobial resistant-microbes are found in people, animals, food and the
environment we live in, and can be spread from between animals and people
easily.

 

The problem of the superbug is an
ever growing one, in every country, with around 700,000 deaths attributed to
them per anum. A number set to rise with each passing year. Currently it is
estimated that by 2050 the number of superbug related deaths will be in the
region of 10 million per year (BBC
News, 2014). Patients that contract infections due to drug resistant bacteria
are obviously at much higher risk of negative clinical outcomes and even death.
This makes operations such as organ replacements, chemotherapy and major
surgery such as hip replacements or caesarean sections much more dangerous. The
problem of superbugs makes healthcare much more expensive, with lengthier stays
for patients, and a higher demand for intensive care.

 

In terms of drug resistant bacteria, there are numerous
documented species, many of which have arisen from relatively mild infections. Klebsiella pneumoniae, a common intestinal bacterium which has the ability to cause
life-threatening illness if spread to other areas of the body, has now been
documented in almost every corner of the world. K. pneumoniae is a major cause of nosocomial
infections such as pneumonia, bloodstream infections, infections in new-borns
and intensive-care unit patients. Certain strains of E. coli have now developed resistance to one of the most widely
used medicines for urinary tract infections, and this has become very
widespread. In many parts of the world almost 50% of cases have become
untreatable (World Health Organization, 2017).

 

Particularly
worrying in the UK is the development of drug resistant gonorrhoea. Every year
about 78 million people are infected with the disease, making it the second
most common STI in the UK. The disease, caused by Neisseria gonorrhoea, has the ability to cause infertility, and can
also be passed on during pregnancy, making it a particularly nasty bug. Additionally,
some with the disease have absolutely no idea that they have it, around 1 in 10
males, and 75% of women show no symptoms (BBC News, 2017). A recent report from
the World Health Organisation analysed data from 77 countries on gonorrhoea.
The report outlined findings of antibiotic resistance against almost all
antibiotics that are currently used to treat the STI. In the past gonorrhoea
has been treated with both gonococcal fluoroquinolone and cephalosporin
antibiotics (Cdc.gov, 2013).
However now it must be treated with extreme caution, due to the rise of the
drug resistant species. Today it is treated with both injections of antibiotics
and a dose of antibiotic tablets. Despite the best efforts of organisations
such as WHO and the NHS, there are still fears that because of increased
antibiotic resistance, coupled with the fact there is a severe lack of new
available treatments, gonorrhoea could become untreatable in the not so distant
future (nhs.uk, 2017). In fact, there have already been three cases of
gonorrhoea which has been untreatable, in France, Japan and Spain.

 

A common superbug to many UK residents would be MRSA, or
methicillin-resistant Staphylococcus
aureus. Around 1 in 30 people carry the bacterium on their skin, and
usually it’s harmless, within a matter of hours it will be gone. However, for
people staying in hospital, this is a totally different story, and can be
deadly. It is estimated that you are 64% more likely to die if infected with
the resistant strain rather than the non-mutated form (World Health
Organization, 2017). People
most at risk include burn victims, those with feeding tubes or intravenous
drips and those with urinary catheters. However, most healthy people are at
little risk of MRSA infections (nhs.uk, 2017).

 

In 2014 the WHO estimated that there were around 480, 000 new
cases of multi-drug resistant tuberculosis, a form which is resistant to the
two most powerful anti-TB drugs. The resistant strain of tuberculosis requires
a much lengthier and less effective treatment process than the non-resistant
form, which is as to be expected, however, what is surprising is the fact that only half of the cases in which
treatment was administered, was it successful (Who.int,
2014). Drug resistant TB, much like the non-resistant form, is spread through
the air, form one person to another. The bacteria are put into the air when an
infected person coughs or sneezes. People nearby then breathe in the bacteria
and become infected themselves (Cdc.gov, 2017). There is also a so-called,
extensively drug-resistant form of tuberculosis, which is resistant to at least
four of the main anti-TB drugs. This form of the disease has been identified in
105 countries, and an estimated 9.7% of all multidrug-resistant TB cases are
actually exhibiting the extensively drug-resistant form of the disease (World
Health Organization, 2017).

 

In 2016, drug resistant malaria
was observed for the first time in five different countries, Cambodia, Vietnam,
Thailand, Burma and Laos (World Health Organization, 2017).
This strain of P. falciparum has been
documented to be resistant to the first-line treatment which consists of a combination
therapy of artemisinin and one of its five partner drugs. This strain is
outcompeting non-resistant forms of the disease and is becoming dominant in the
Greater Mekong area. Which is not only bad news for affected countries, but for
areas that the bug may spread to, such as Africa. This would be disastrous for
the continent, where more than 90% of the worlds deaths from malaria infections
occur. Whilst not strictly being a problem for the UK, it is a cause for global
concern, with many urging the WHO to declare a Public Health Emergency of International
Concern, something usually reserved for only the most serious outbreaks of
disease, which have the possibility of becoming a global threat (Science | AAAS,
2017).

 

In 2010, it was estimated that 7%
of people starting antiretroviral therapy had been infected with a
drug-resistant form of HIV, with the figure rising to 10-20% in developed
states. Some countries reported figures in the region of 15% for individuals
starting new courses of treatment, and around 40% for those re-starting
treatment. These figures are rather worrying indeed, and of course highlight
the need for immediate action (World Health Organization, 2017).
Particularly in the UK. Out of 14,584 HIV patients surveyed, the BMJ found 1654
patients were found to have one or more mutations that were associated with
HIV-1 drug resistance. This prevalence was found to decline from 15.5% in 2002
to 9.6% in 2007. This was then followed by a slight increase in 2009 to 10.9% (Time
trends in drug resistant HIV-1 infections in the United Kingdom up to 2009:
multicentre observational study, 2012). As well as the obvious social cost, the
increasing levels of drug-resistance seen in HIV also have serious economic
implications. Second and third line treatment regimens are 3 and 18 times more expensive,
respectively, than the first line treatments. The World Health Organisation
have recommended that everyone with HIV should start first line antiretroviral
treatments as soon as possible, even though through increased use of antiretroviral
treatments is expected to correlate with a rise in drug-resistance. In order to
maximise the effectiveness of the first line of antiretroviral treatments, and
also to try and curb the further emergence and spread of resistance, it is
vital that the NHS and other government health bodies alike continue to monitor
levels of resistance (World Health Organization, 2017).

 

Antiviral
drugs are important tools used by government agencies such as the NHS to combat
cases of epidemic and pandemic influenza viral outbreaks. It has been observed
that almost all of the influenza A viruses in circulation, in humans, were
resistant to M2 inhibitors. M2 inhibitors are one category of antiviral drugs
used to combat viral outbreaks. However this is only a slight worry in the UK,
with resistance to the neuraminidase inhibitor,
another antiviral drug, remains low, at around 1-2% (World
Health Organization, 2017).

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