MEVE 019: Unit 15 - Multidrug-Resistant Organisms

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 UNIT 15: MULTIDRUG-RESISTANT ORGANISMS

15.1 Introduction

Antimicrobial resistance (AMR) is one of the most pressing global health challenges of the 21st century. When bacteria, viruses, fungi, or parasites evolve to resist the drugs that once killed them, they become multidrug-resistant organisms (MDROs). These organisms make infections harder to treat and increase the risk of disease spread, severe illness, and death. The rise of MDROs threatens to undo decades of medical progress, making once-curable infections deadly again.

15.2 Objectives

By the end of this unit, learners will be able to:

·         Define multidrug-resistant organisms (MDROs).

·         Understand the causes and extent of antimicrobial resistance.

·         Explore emerging infectious diseases linked to drug resistance.

·         Learn about mechanisms through which resistance develops.

·         Assess the health and economic impacts of MDROs.

·         Recognize global and national management strategies and policies.

15.3 Definition

Multidrug-resistant organisms (MDROs) are microorganisms that have developed resistance to multiple antibiotics or antimicrobial agents, rendering standard treatments ineffective. These organisms can include:

·         Bacteria (e.g., MRSA – Methicillin-resistant Staphylococcus aureus)

·         Viruses (e.g., drug-resistant HIV)

·         Fungi (e.g., Candida auris)

·         Parasites (e.g., drug-resistant Plasmodium falciparum in malaria)

They are often referred to as "superbugs" in public discourse.

15.4 Causes of Antimicrobial Resistance

The development of resistance is a natural evolutionary process, but human activities have accelerated it:

1.      Overuse and Misuse of Antibiotics:

o    Prescribing antibiotics for viral infections.

o    Over-the-counter availability of antibiotics in some countries.

o    Incomplete dosage or unnecessary usage.

2.      Agricultural Use:

o    Antibiotics used in livestock for growth promotion and disease prevention.

3.      Poor Infection Control:

o    Inadequate hygiene and sanitation in hospitals and communities.

4.      Lack of New Antibiotics:

o    Few new antibiotics are being developed due to high costs and low returns.

5.      Global Travel and Trade:

o    Resistant microbes can quickly spread from one region to another.

15.5 Extent

·         Global Spread: AMR is a problem in every region of the world.

·         India: One of the highest rates of antibiotic use and resistance.

·         WHO Statistics: By 2050, AMR could cause 10 million deaths per year, surpassing cancer.

·         Examples of Resistant Organisms:

o    Carbapenem-resistant Klebsiella pneumoniae

o    Multidrug-resistant Mycobacterium tuberculosis (MDR-TB)

o    Extensively drug-resistant Neisseria gonorrhoeae

15.6 Emerging Infectious Diseases

Drug resistance also affects new and emerging infections:

·         Tuberculosis (TB): MDR-TB and XDR-TB (Extensively drug-resistant TB) are growing threats.

·         HIV/AIDS: Resistance to first-line antiretroviral drugs is rising.

·         Malaria: Resistance to artemisinin has been reported in parts of Asia and Africa.

·         COVID-19: Secondary infections during the pandemic raised concerns about antibiotic misuse.

15.7 Mechanism

Antimicrobial resistance occurs through various biological mechanisms:

1.      Genetic Mutation: Spontaneous changes in microbial DNA that reduce drug effectiveness.

2.      Gene Transfer: Resistant genes can be transferred between microbes through plasmids.

3.      Drug Inactivation: Some bacteria produce enzymes that deactivate antibiotics (e.g., β-lactamase).

4.      Efflux Pumps: Some microbes pump out the drug before it can act.

5.      Target Modification: The drug’s target in the microbe is altered, rendering it ineffective.

6.      Biofilm Formation: Communities of microbes protect themselves within biofilms.

15.8 Impacts

Health Impacts:

·         Increased morbidity and mortality due to untreatable infections.

·         Longer hospital stays and frequent treatment failures.

·         Reduced effectiveness of major medical procedures (e.g., surgeries, chemotherapy).

Economic Impacts:

·         Higher healthcare costs for treatment and extended care.

·         Loss of productivity due to prolonged illness.

·         Burden on national health systems.

Societal Impacts:

·         Fear of infection spreads in communities.

·         Rise of stigmatization in high-risk patients (e.g., TB, HIV).

·         Loss of trust in healthcare systems.

15.9 Management and Policy

Global Strategies:

·         WHO Global Action Plan (GAP) on AMR: Focus on surveillance, education, and research.

·         Global Antimicrobial Resistance Surveillance System (GLASS): Monitoring of resistance data.

National Action in India:

·         National Action Plan on AMR (2017–2021): Aims to reduce misuse, improve surveillance, and promote research.

·         Red Line Campaign: Marking prescription-only antibiotics with a red line to discourage misuse.

·         ICMR (Indian Council of Medical Research): Conducts AMR surveillance in hospitals.

Hospital and Community-Level Actions:

·         Antibiotic Stewardship Programs (ASP): Monitoring and regulating antibiotic use.

·         Infection Prevention and Control (IPC): Hand hygiene, disinfection, isolation wards.

·         Public Awareness Campaigns: Educating people about correct antibiotic use.

Policy Recommendations:

·         Strengthen regulatory frameworks for antibiotic sales.

·         Ban non-therapeutic use in agriculture.

·         Invest in R&D for new antibiotics and vaccines.

·         Encourage international collaboration.

15.10 Let Us Sum Up

Multidrug-resistant organisms (MDROs) represent a serious global health threat. Misuse of antibiotics in humans and animals, lack of new drugs, and inadequate infection control have accelerated the problem. The rise in resistant infections has health, economic, and social consequences. Combating AMR requires a multi-sectoral approach involving governments, healthcare providers, researchers, industries, and the public. Only through coordinated efforts can we preserve the efficacy of life-saving antibiotics for future generations.

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