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The significant burden of antimicrobial resistance (AMR) cannot be overstated. Recent estimates reflect that 4.95 million people died globally in 2019 related to an AMR infection.

Tristan Timbrook, Pharm.D.

Director, Global Medical Affairs, bioMérieux

Andrea Prinzi, Ph.D., M.P.H., SM(ASCP)

Medical Science Liaison, U.S. Medical Affairs, bioMérieux

AMR is the ability of harmful bacteria and other microbes to overcome the medications intended to kill them. Compared to previous global burden estimates, future projections suggest that AMR-related deaths could exceed cancer-related deaths by 2050. The Centers for Disease Control and Prevention estimates that the economic burden of AMR is $4.6 billion annually in the United States. In the United States in 2020, the rate of AMR-associated deaths and infections increased by 15% as a result of the COVID-19 pandemic. With this trajectory, a post-antibiotic era becomes possible — surgeries, chemotherapies and radiation therapies for cancer, and organ transplants all become increasingly dangerous or even impossible due to infection risks. Moreover, even a simple wound infection could become untreatable and deadly. Therefore, action must be taken to curtail this scenario.

Antibiotic overuse

The primary driver of AMR is the inappropriate use of antimicrobials, a group of drugs that also includes antibiotics. Antimicrobials may be used to presumptively treat a broad range of infectious agents when it is unclear if an infection is present or the organism causing an infection is unknown. This is called empiric antimicrobial use. Without diagnostic tests to help establish a diagnosis for the illness, this type of antimicrobial use can be overused. For example, this may often occur in viral respiratory illness like the flu in the absence of using diagnostics to determine the presence of a viral infection that should receive an antiviral and not a bacterial drug.

As bacteria develop AMR from inappropriate use of antimicrobials, the resistance is propagated. In addition, the spread of resistance is accelerated by regional and international travel, where people can become colonized with resistant bacteria, putting them at risk of future infections or potentially spreading the organism elsewhere. Thus, as geographic or political borders do not limit AMR, solutions must be approached with an equitable One Health (humans, animals, environment) approach. 

In resource-limited settings, antimicrobial overuse is exacerbated by a lack of regulations or oversight of prescribing practices. Additionally, access to diagnostic tests is limited, negatively impacting patient care and critical clinical decision-making. The COVID-19 pandemic has underscored the critical importance of diagnostics in health, and investment in these tests is essential for combating antimicrobial resistance and preparing for the next pandemic. Therefore, a great emphasis and investment in diagnostics is essential. For example, in oncology, diagnostics are routinely used to drive specific therapies in achieving precision medicine. Similarly, for combating AMR, diagnostics can achieve precision medicine, getting the right drug to the right patient at the right time. This includes driving targeted therapies, including newer therapies specifically developed and reserved for multi-drug resistant organisms.  

Health infrastructure

To effectively track and combat AMR, the burden must first be understood. This is exceptionally challenging in settings where a lack of infrastructure prevents efficient data collection and analysis. Efforts to track rates of infections are crucial to infection prevention initiatives, which are a cornerstone of AMR mitigation and control. Recent global data suggest that while excessive antimicrobial use is a significant driver of AMR, locations that lack public health infrastructure or infection control practices are at the greatest risk of morbidity and mortality from infections caused by drug-resistant organisms. Improving AMR surveillance at the local, regional, national, and international levels with diagnostics, data, and analytics such as artificial intelligence to drive real-time decision-making and outbreak response will be critical in the fight against AMR moving forward.

The global burden of AMR is often referred to as the “silent pandemic” because it is not as commonly talked about as other pandemics. Additionally, the impact on human health may not be immediately visualized by the public, although it is responsible for significant cost, disability, and death. Actions to curb AMR, including improved use and access to diagnostic tests, must come to the forefront of our healthcare and public health efforts to protect against a future where antimicrobials are no longer effective.

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