By Emma Pettengale, Commissioning Editor, Portland Press
The term antimicrobial encompasses all drugs which target microorganisms, including antibiotics (bacteria), antiprotozoal (single celled parasites), antiviral (viruses) and antifungal (fungi) medicines. Antimicrobial Resistance (AMR) arises when micro-organisms survive exposure to the drug that would normally kill them or stop their growth, hence becoming resistant to its effects. As microorganisms are constantly evolving, increased use of antimicrobials goes hand in hand with increased AMR.
Antimicrobial resistance (AMR) The paper dots are soaked in antibiotics, clear rings (shown left) show the bacteria have been unable to grow and are not yet resistant. On the right, the bacteria have become resistant to 4 of the 7 antibiotics (This image is reproduced from Wikipedia, Dr Graham Beards, Antibiotic sensitivity and resistance).
Getting to the root of the problem
AMR is increased and accelerated by various factors such as over prescription and patient failure to complete the full course of treatment; misuse of medicines, particularly as animal growth promoters; and poor infection control practice, for example not washing your hands thoroughly between patients to avoid contamination.
One of the key factors is the over-prescription of antibiotics. According to NHS England, each year around 1.2 million people in the UK will visit the GP with a sore throat, with 62% of these visits resulting in the prescription of antibiotics. Tests have shown that less than 10% of people who present with a sore throat actually have a bacterial infection, the rest having a viral infection against which antibiotics have no effect.
Resistance to known antibiotics continues to grow, with resistance mechanisms crossing species barriers and some developing combined or multiple resistances to several drugs. There is also growing resistance to last-line antibiotics, the drugs of last resort, with 39.3% of Acinetobacter spp. are resistant to Carbapenems, one of the so-called ‘last resort’ antibiotics (EARS-Net and ESAC-Net 2015), while in 2013, the CDC published the top 18 antibiotic resistant threats to the US, with one of the top was Carbapenem-Resistant Enterobacteriaceae, which causes 9000 drug-resistance infections and leads to over 600 deaths each year. The European Medical Agency estimating that 25,000 people die in Europe every year from infections caused by antibiotic resistant bacteria.
Resistance is a particular concern with antibiotics and many governments around the world are strategizing ways to reduce the growth of AMR, to ensure that we use the current range of antibiotics appropriate and to increase the pipeline for the discovery of new antibiotics. At a UN meeting in September 2016, Heads of State committed to taking a broad, coordinated approach to address the root causes of AMR across multiple sectors, based on the Global Action Plan on Antimicrobial Resistance, a blueprint for tackling AMR developed in 2015 by the WHO.
World Antibiotic Awareness Week
Last week was World Antibiotic Awareness Week, a WHO initiative, aiming to increase awareness of global antibiotic resistance and to encourage best practices among the general public, health workers and policy makers. In addition, European Antibiotic Awareness Day, (EAAD) is an annual European public health initiative that took place on 18 November to raise awareness about the threat to public health of antibiotic resistance and the importance of prudent antibiotic use.
To mark EAAD 2016, the Biochemical Society, Society for Applied Microbiology and the Royal Society of Biology ran the #AntibioticFuture TweetChat with a focus on the future of antibiotics and how to use innovation to solve current problems. Leaders in the field discussed the importance of educating the public, reducing unnecessary prescriptions, improving diagnosis of bacterial infections, finding new antibiotics and reducing their use in animals.
The above societies are part of the Learned Society Partnership on Antimicrobial Resistance (LeSPAR) in collaboration with the British Society for Antimicrobial Chemotherapy (BSAC), the British Pharmacological Society, the Microbiology Society, and the Royal Society of Chemistry. LeSPAR aims to provide a single, unified voice and mobilise the UK’s collective research community in order to enhance understanding and knowledge sharing between academia, industry, and clinicians.
Investigating and addressing AMR through research
So, what at the molecular mechanisms involved in developing AMR? How does resistance spread, between bacterial cells and between different species? How do we discover new antibiotics and what are the latest discoveries?
These are questions Portland Press hopes to address in 2017 as we explore antibiotic resistance and the development of new antibiotics with the publication two special themed issues publishing short reviews from experts. The aim is for these to be accessible for those not yet immersed in the subject, in order both to broaden awareness and also to stimulate those not yet in the field to think about getting involved.
Coming in early 2017, Essays in Biochemistry will publish an issue dedicated to “Antimicrobial Resistance” with Guest Editor Rietie Venter from the University of New South Wales in Australia. The issue will cover topics including biofilm mediated antimicrobial resistance, resistance against antimalarial drugs, novel and innovative methods in diagnostics of drug resistant bacteria and insights into drug resistance mechanisms in Clostridium difficile.
How does antibiotic resistance spread? (Infographic ©ECDC used with permission)
Looking to the future, we will need to change both the way we use antibiotics and how we go about finding new ones.
In 2016, NHS England launched The Sore Throat Test and Treat service, where patients with sore throats are given a throat swab at their local pharmacists, which can determine in 5 minutes if they have a bacterial infection or virus. Only patients who have a bacterial infection, and therefore will benefit from antibiotics, will then be prescribed them. It is estimated this will reduce antibiotic prescriptions by over 75%.
In addition to more wisely using the medicines we have to slow the spread of resistance, we will also need to explore new ways of discovering novel antimicrobials. New antimicrobials have been largely ignored by pharmaceutical companies for decades because they have a poor return on investment – they are taken for a short period of time and cure their target disease. No major classes of antibiotics were introduced between 1962 and 2000, with the last successful discovery of a novel agent in 1987, and in 2015 the BSAC published a report detailing the urgent need for antibacterial drug discovery development.
Illustration of the 30-year ‘discovery void’
In April 2017, our new journal Emerging Topics in Life Sciences will focus on “Antibiotics of the future”. Along with Guest Editor Daniel Walker from University of Glasgow and many leading experts, we will explore novel microbial diagnostics, discuss the latest ideas and newest ways for creating and developing antibiotics, and cover mechanisms of action of the antibiotics of the future. Sign up here to be emailed when it is available online.