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A Journey from a Wonder Drug to Resistant Strains

In 1928, one fine morning, Dr. Alexander Fleming returned from a holiday to find mould growing on a Petri dish of Staphylococcus bacteria. He noticed the mould seemed to prevent the bacteria around it from growing. Alexander eventually noticed that the mould created a self-defence chemical capable of killing bacteria. He named the substance penicillin. That is how a wonder drug was discovered, one of the world’s first antibiotics, an actual turning point in medical history — A miracle that could completely cure patients of deadly infectious diseases.

“One sometimes finds what one is not looking for. When I woke up just after dawn on Sept. 28, 1928, I certainly didn’t plan to revolutionize all medicine by discovering the world’s first antibiotic or bacteria killer. But I guess that was exactly what I did.”

Sir Alexander Fleming

Since then, antibiotics and other antimicrobial medicines have been used to fight old and newly emerging diseases, improving global disease outcomes and increasing life expectancy.

Unfortunately, as antibiotics became more widely used, bacteria responded by developing various forms of resistance to these treatments creating a severe global problem. The fast growth of antimicrobial resistance (AMR) by microbial pathogens threatens to undermine the public health improvements obtained since the widespread adoption of antibiotics.

Therefore, one of the significant challenges faced by medical science is determining how to treat infections caused by bacteria that have developed antibiotic resistance. By 2050, it is predicted that an additional 10 million people will die annually from drug-resistant diseases. So, creating novel antibiotics that are effective when other medications fail is a vital field of research.

Bacterial Infections

A bacteria is made up of a single complex cell. It can survive on its own, both inside and outside the body.

Most bacteria are harmless. Many bacteria in and within the human body, particularly in the digestive tract, help in food digestion. However, certain bacteria can cause infections. Infections caused by bacteria can damage the throat, lungs, skin, intestines, and several other body regions. Some are mild, while others are severe.

Whooping cough, strep throat, ear infections, and urinary tract infections are bacterial diseases.

A bacterial infection develops when bacteria enter the body, increase, and trigger an immune response. Bacteria can enter the body through an incision in the skin, such as a cut or surgical wound, or the airway, causing infections such as bacterial pneumonia.

Signs and Symptoms of Bacterial Infections

Following are some general signs of most bacterial infections:

AMR: A Global Health Warning

Broad-spectrum antibiotics are commonly used. Antibiotics, which fight bacteria, are well-known, but there are also antifungals, antivirals, and antiparasitics, which fight fungi, viruses, and parasites, respectively.

The more we use these medicines, the less effective they become, and this problem has become a serious global concern known as antimicrobial resistance (AMR). It means that microbes have developed resistance to these antibiotics, meaning these medicines do not always work to treat infections.

The Emergence and Spread of Antimicrobial Resistance

In many places, antibiotics are overused and misused in people and animals and are often given without professional oversight. Examples of misuse include people taking them with viral infections like the common cold and flu, which has led to the emergence and spread of AMR.

Antimicrobial-resistant bacteria have been detected in humans, animals, food, and the environment (water, soil, and air). They can spread between people and animals, from food of animal origin and from person to person. Poor infection control, inadequate sanitary conditions, and inappropriate food handling encourage the spread of antimicrobial resistance.

Infections that have become Resistant

Most bacteria become resistant through a natural genetic mutation or by acquiring resistance genes from other bacteria. It can develop many resistance traits over time and become immune to different types of antibiotics. 

The most serious concern with antibiotic resistance is that some bacteria have become resistant to almost all readily available antibiotics. These bacteria can cause severe diseases, hence a medical emergency that must be dealt with. Important examples are:

Mycobacterium tuberculosis

TB is a commonly severe airborne infection caused by bacteria.TB primarily affects the lungs but can also damage many other organs. Depending on the type of infection, it is often treated for six months to two years using a combination of medications.

MRSA(Methicillin-resistant Staphylococcus aureus)

Over the past four decades, methicillin-resistant Staphylococcus aureus, or MRSA, has evolved from a treatable nuisance to a severe health issue.MRSA is one of the most prevalent infections acquired in hospitals. However, strains are on the rise and can cause serious diseases.

CRE(Carbapenem-resistant Enterobacteriaceae)

CRE is a group of resistant bacteria, including Klebsiella species and Escherichia coli (E. coli).CRE typically affects inpatients and individuals with the weak immune system. The germs can enter the body via medical equipment such as ventilators and catheters. Some CRE infections are resistant to most current medicines and can be deadly.

Streptococcus pneumoniae 

Streptococcus pneumoniae bacteria can cause many diseases, like pneumonia, a condition of the lungs. These bacteria can also cause infections in the ears, sinuses, and membranes that cover the brain and spinal cord. Streptococcus pneumoniae can also cause bacteremia, a condition of the blood. This kind of bacteria is spread by coughing, sneezing, and being close to someone who has it.

VRE(Vancomycin-resistant Enterococci)

Enterococci are bacteria that often inhabit humans’ digestive tract and female vaginal tract. People residing in hospitals and other healthcare centers are prone to contracting VRE.

Furthermore, they arise frequently in individuals vulnerable to disease due to other medical conditions or the presence of special catheters or other devices. Vancomycin is commonly used to treat enterococcal infections, although VRE is resistant.

Mechanisms for Diagnostic Development

Diagnostics are a crucial component of the global effort to stop the spread of the silent AMR epidemic through

  1. They allow for active drug resistance monitoring,
  2. Enabling the optimal utilization of current medications
  3.  Safeguarding and assuring the proper application of novel treatments

A timely and accurate diagnosis using quick testing can reduce the time required for pathogen identification and optimization of antimicrobial treatment.

Antimicrobial-resistant microbes have outpaced current therapies, a public health issue amplified by the COVID-19 pandemic. So there is a dire need to develop some mechanism for diagnostics.

Currently, advancements in biotechnology and machine learning facilitate the development of a deeper understanding of the different spatiotemporal dynamics underlying the adaptation and evolutionary processes of AMR bacteria.

Point-of-Care Testing: Another Revolution

Point-of-care testing is a vital tool in the war against antibiotic resistance.

Doctors traditionally depend on laboratory test and result to diagnose bacterial infections, which might take several days to process cultures. Point-of-care (POC) diagnostics have advanced in recent years. In physician’s offices, emergency departments, and other healthcare facilities, these small yet smart gadgets can provide reliable results to guide therapy decisions in a couple of minutes.

The most recent generation of point-of-care diagnostics employs PCR technology to offer healthcare practitioners the correct information at the right time, allowing them only to prescribe antimicrobials when needed.

Point-of-care diagnostics utilizing PCR technology are altering the healthcare paradigm. In 15 minutes, medical professionals can take a swab from a patient’s throat and use a device to obtain highly accurate Strep A results. Doctors can then confidently prescribe antimicrobials.

Creating Awareness, Combating Resistance

It is the responsibility of each of us to play a role on an individual basis to fight the evil of AMR. There are a few things we can do on our own as preventive measures and to create awareness. The following are some requisite actions:

  1. Handwashing and vaccinations prevent infections.
  2. Wash vegetables and cook food properly to avoid food-borne diseases.
  3. Antibiotics only kill bacteria. They don’t work for the influenza virus.
  4. If your doctor doesn’t prescribe antibiotics, ask about other treatments.
  5. Never use or share unused antibiotics.
  6. Follow your doctor’s antibiotic instructions.
  7. To maximize efficacy and prevent resistance, complete the prescribed antibiotics course.
  8. By using alternatives for antibiotics that can be effective in treatment.

Alternatives for Antibiotics

Way Forward

Antimicrobial resistance is now acknowledged by the scientific community, society, and the vast majority of policymakers as a core issue to resolve.

In hospitals, infection control measures and antimicrobial stewardship programs – administered by multidisciplinary teams of experts such as infectious diseases physicians, clinical pharmacists, clinical microbiologists, etc. – are essential for preventing the emergence and transmission of antimicrobial-resistant microorganisms and ensuring the efficacy of available antimicrobials.

Antimicrobial stewardship needs to be expanded. The necessary action to minimize antibiotic overuse and inappropriate antibiotic prescriptions should include patient education and awareness, information and training for healthcare professionals, improved diagnostics for treatment decisions, treatment guidelines, and prescription audits.

References
https://magazine.medlineplus.gov/article/leading-antimicrobial-drug-resistant-diseases
https://www.healio.com/news/endocrinology/20120325/penicillin-an-accidental-discovery-change edsd-the-course-of-medicine
https://en.m.wikipedia.org/wiki/Point-of-care_testing
https://www.healthdirect.gov.au/bacterial-infections