A major public health concern is the development of antimicrobial resistance (AMR) in pathogenic bacteria, which is likely to lead to worsened sickness, greater death, and increased treatment costs with constrained treatment alternatives. If this problem is not addressed, there is no question that the death toll will be substantially higher than the anticipated 10 million deaths per year by 2050 in the 2014 AMR Review.
The capacity of bacteria to defend themselves from the effects of antimicrobials that were formerly successful in killing or reducing the growth of such microbes is known as antimicrobial resistance. Antimicrobial resistance permits microorganisms to proliferate indefinitely, even after being exposed to antimicrobial agents. If germs develop resistance, it will lengthen the healing duration, exacerbate the illness, require more treatment, and maybe raise the death risk.
Bacteria and fungi are more routinely detected and examined for AMR. A few parasites have also acquired resistance to the treatments available to them. Antibacterial resistance (ABR) is the development of resistance against "antibiotics" by bacteria. If a fungus develops resistance against "antifungals", then it is termed "antifungal resistance (AFR)". Similarly, "antiviral resistance" and "anthelmintic resistance" refer to the development of resistance of viruses and helminths to their respective treatment methods.
Antibacterial Resistance (ABR) is the most significant type of AMR since many harmful bacterial species have gained resistance, resulting in serious illnesses. Resistance in fungi, viruses, and parasites is small in comparison to bacterial resistance, although it is becoming more common.
Table of Contents
- Four AMR mechanisms in general cause the development of AMR.
- Global Priority Pathogens, World Health Organization, 2017. Antibiotic-resistant bacterium list
- Priority 1: Critical
- Priority 2: High
- Priority 3: Medium
- Antibiotic Resistance Threat List, CDC 2019.
- Urgent Threats
- Serious Threats
- Concerning Threats
- Watch List
Four AMR mechanisms in general cause the development of AMR.
- The ability to adjust or deactivate a medicine
- Reduced medication absorption or affinity
- Drug efflux has increased.
- Modifying the cellular components that are the drug's target location
- Microbe resistance might be restricted to one kind of antibiotic or to numerous types of antimicrobials. If the resistance is limited to one type of antimicrobial (structurally and mechanistically similar/same), it is referred to as resistance to that class. For example, if a bacterium is resistant to penicillin and its derivatives, it is simply called "penicillin-resistant bacteria".
- The "SUPER BUGS" are MDR pathogens.
- MDR is further subdivided as "Extremely Drug-Resistant (XDR)" and "Pan Drug-Resistant (PDR)". Antimicrobials from at least two structurally unrelated antimicrobial classes will be toxic to XDR pathogens. PDR pathogens will be resistant to all antimicrobials now available.
- AMR has been identified as one of the top ten worldwide public health hazards by the World Health Organization (WHO). In 2017, the WHO published a study titled "Global priority list of antibiotic-resistant bacteria to drive research, discovery, and development of novel antibiotics" that included a list of diseases.
- The US Centers for Disease Control and Prevention (CDC) published a list of resistant bacteria and fungi in its 2019 AR Threat Report in 2019. This list covers bacteria from the WHO's 2017 list as well as other pathogens of concern in the United States.
Global Priority Pathogens, World Health Organization, 2017. Antibiotic-resistant bacterium list
Priority 1: Critical
- Carbapenem-resistant Acinetobacter baumannii (CRAB)
- Carbapenem-resistant Pseudomonas aeruginosa (CRPA)
- Carbapenem-resistant, Extended spectrum -lactamase (ESBL) producing (3rd generation cephalosporin-resistant) Enterobacteriaceae
- (Among the Enterobacteriaceae, E. coli, Klebsiella pneumoniae, Proteus spp., Serratia spp., Providentia spp., Morganella spp., and Enterobacter spp. pose the greatest threat.)
Priority 2: High
- Vancomycin-resistant Enterococcus faecium
- Methicillin-resistant, vancomycin-intermediate, and resistant Staphylococcus aureus
- Clarithromycin-resistant Helicobacter pylori
- Fluoroquinolone-resistant Campylobacter spp.
- Fluoroquinolone-resistant Salmonella
- 3rd generation cephalosporin-resistant, fluoroquinolone-resistant Neisseria gonorrhoeae
Priority 3: Medium
- Penicillin-non-susceptible Streptococcus pneumoniae
- Ampicillin-resistant Haemophilus influenzae
- Fluoroquinolone-resistant Shigella spp.
Antibiotic Resistance Threat List, CDC 2019.
Urgent Threats
- Carbapenem-resistant Acinetobacter (Carbapenem-resistant A. baumannii is species of major concern)
- Drug-resistant Candida auris
- Clostridium difficile
- Carbapenem-resistant Enterobacteriaceae
- Drug-resistant Neisseria gonorrhoeae
Serious Threats
- Drug-resistant Campylobacter
- Drug-resistant Candida
- ESBL-producing Enterobacteriaceae
- Vancomycin-resistant Enterococci (VRE)
- Multidrug-resistant Pseudomonas aeruginosa
- Drug-resistant non-typhoidal Salmonella
- Drug-resistant Salmonella serotype Typhi
- Drug-resistant Shigella
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Drug-resistant Streptococcus pneumoniae
- Drug-resistant Tuberculosis
Concerning Threats
- Erythromycin-resistant group A Streptococcus
- Clindamycin-resistant group B Streptococcus
Watch List
- Three diseases on this list are rare yet have the potential to spread.
- Azole-resistant Aspergillus fumigatus
- Drug-resistant Mycoplasma genitalium
- Drug-resistant Bordetella pertussis
