Antibiotics are commonly used to fight bacterial infections, however, bacteria can change in response to the use of these medicines, resulting in antibiotic resistance. More broadly, antimicrobial resistance encompasses resistance to drugs to treat infections caused by bacteria, parasites, viruses, and fungi.
The use of antimicrobials in modern medicine has helped advance treatment options over the past several decades. Germs (bacteria, viruses, fungi) are everywhere. Some are beneficial to our bodies and others make us sick.
Antimicrobials are intended to kill germs that make us sick or cause infections, however, germs can adapt and develop resilience to prescribed antimicrobial treatments, resulting in resistant germs. These resistant germs can multiply and spread their learned resilience to other germs.
Eventually, this replicated resilience can create multi-drug resistant organisms (MDROs), decreasing the efficacy of antimicrobials. Once antimicrobial resistance emerges, it can spread into new settings and between countries, restricting our ability to treat diseases effectively.
Antimicrobial resistance spreads readily and often without noticeable transmission. This poses significant threats to modern-day medicine and specifically to populations requiring ongoing medical treatment, such as patients with kidney failure.
Antimicrobials are critical for treating infections in individuals with kidney failure who receive life-saving dialysis treatment. According to the United States Renal Data System, more than 458,125 patients received dialysis treatment in 2017. MDROs are particularly relevant to patients who receive hemodialysis because rates of colonization and infection are among the highest in these patients.
Slowing the spread
Because antimicrobial exposure is the main risk factor for the emergence and spread of MDROs, it is necessary to minimize inappropriate antimicrobial use. Research suggests that among facilities providing hemodialysis treatment to patients with kidney failure, approximately 30-35 percent of antimicrobial doses administered are unnecessary.
Antimicrobial stewardship, which the Centers for Disease Control and Prevention (CDC) defines as “…the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients,” has consistently shown a decrease in inappropriate antimicrobial use. However, according to some infectious disease specialists, the current COVID-19 pandemic poses potential threats that could affect antimicrobial stewardship activities and drive antimicrobial resistance, further contributing to the emergence of MDROs.
For instance, many people who present with mild disease without pneumonia or moderate disease with pneumonia receive antibiotics. The World Health Organization (WHO) reports azithromycin is being widely used with hydroxychloroquine, although it is not yet recommended outside of COVID-19 clinical trials.
The WHO released a clinical management of COVID-19 guide that provides recommendations that include promoting appropriate antimicrobial prescribing and use during the COVID-19 pandemic. Specifically, guidelines suggest not to prescribe antibiotics to suspected or confirmed COVID-19 patients with low suspicion of a bacterial infection, in an effort to immediately avoid side effects of antibiotics among patients and to reduce long-term consequences of increased antimicrobial resistance.
Addressing the threat of MDROs and antimicrobial resistance requires preventing infections in the first place, slowing the development of resistance through appropriate antibiotic use, and stopping the spread of resistance if it develops, according to the CDC.
Advice for the public and healthcare providers
Of course it’s difficult to completely avoid getting an infection, but there are steps you as a patient can take to reduce risk.
First, self-assess your risks. Know what characteristics might put you at higher risk and ask your healthcare provider to explain your risks for certain infections. Feel empowered to speak up with questions or concerns. Take care of yourself. Keep cuts clean and covered until healed, and take care of chronic conditions like diabetes and heart disease. Practice good hand hygiene, get vaccinated, be aware of changes in your health (signs or symptoms of infection), and use prescribed antibiotics appropriately. For healthcare providers, it is important to know how to appropriately prescribe and use antimicrobials. These are the guiding principles of effective antimicrobial stewardship. Antibiotic stewardship programs have been found to be highly effective when implemented alongside infection control measures. However, the efficacy of these programs requires knowledge of antimicrobial use and defining inappropriate prescribing patterns for providers to self-assess their practices. Healthcare providers should follow clinical and treatment guidelines, and adhere to the CDC’s “Core Elements of Antibiotic Stewardship” published in 2020.
With proactive engagement among the general population to implement practices to reduce risks for infection, and healthcare providers committing to quality diagnosis and treatment with the use of antimicrobial agents, we can generate the momentum needed to reduce threats caused by antibiotic resistance and keep the world’s population safer.