Antimicrobial resistance – a global concern

Posted on March 31, 2015

Antimicrobial resistance (AMR) is a global concern that affects both human and animal health.  Harmful microbes have become increasingly resistant to antimicrobial agents during recent years, with the result that common bacterial infections are no longer effectively treated in affected human and animal populations. The severity of AMR has become such a pressing global issue that the World Health Organisation (WHO) and the World Organisation for Animal Health (OIE) have embarked on Antimicrobial Stewardship (AMS) campaigns in an effort to counter this alarming threat. They have called for the full co-operation of government sectors and society to participate in a global action plan.

While some may think animal health only concerns the animal lover, the well-being of animals goes far beyond our four-legged domestic friends. AMR in animal health has the potential to seriously affect a country’s food security. Bacteria also have the ability to cross species barriers and resistant bacteria can have adverse effects on both humans and animals.

In South Africa, work to combat the problem of AMS in animal health is centred on the teaching and research activities of the Faculty of Veterinary Science at the University of Pretoria (UP). The Faculty’s Prof Moritz van Vuuren and Prof Vinny Naidoo have been involved with other collaborators in developing international and local technical guidelines for the responsible use of antimicrobial drugs. In collaboration with the Medicines Committee of the South African Veterinary Association, the Faculty has also produced a booklet that contains all the vital information on AMR and its risks to humans and animals. Copies of the booklet were distributed to all veterinary practices across South Africa.

Van Vuuren explains that while the undergraduate curricula of the health sciences at some universities have started incorporating AMS, further efforts will need to be made in the veterinary science undergraduate curriculum as this is becoming an ever-increasing issue, not only in South Africa, but globally.

For now, however, it is most important that attention be focussed on research and informing the relevant sectors. As professor of Microbiology in the Department of Veterinary Tropical Diseases, Van Vuuren is especially focussed on the factors that drive the appearance and spread of resistant genes. Some of the Department’s recent research projects have focussed on:

  • resistance profiles of enteric bacteria isolated from non-human primates at the wildlife–human interface,
  • resistance profiles of commensal bacteria isolated from impala in the Kruger National Park that drink from water sources that flow from industrial areas and through the Park,
  • comparative studies of minimum inhibitory concentrations and mutant prevention concentrations of antimicrobial drugs, and
  • developing molecular tests for fast identification of resistant bacteria in animal samples.

AMR refers to a micro-organism’s ability to resist drugs that were originally effective in killing it or inhibiting its growth. (Micro-organisms include bacteria, fungi, viruses and parasites.) Van Vuuren explains that while AMR applies to all micro-organisms, international concerns are particularly focussed on bacterial resistance to antibiotics. If the AMR trend continues at its present rate, common bacterial infections will no longer be treatable with the existing antibiotics. The implications, Van Vuuren says, are a ‘terrifying prospect.’

What this means is that existing antibiotics are becoming increasingly ineffective, making the treatment of common bacterial infections all the more difficult. While AMR can occur spontaneously in bacteria, Van Vuuren notes that it is through the worldwide overuse and misuse of antimicrobial drugs in both the human and animal health industries that we are entering days that resemble a time when antimicrobial drugs were non-existent. The Faculty of Veterinary Science would like to be an active voice in AMS, not only in making the concept of AMR known among veterinary practitioners, but also in highlighting factors that contribute to the development of resistance. Poor infection control practices, inadequate sanitary conditions and inappropriate handling of food encourage the spread of AMR.

In 2014, the Faculty of Veterinary Science was involved in the first ever AMR summit organised by the South African Department of Health. Van Vuuren delivered a paper entitledAppropriate use of antimicrobials in animal health’. Furthermore, Prof van Vuuren, Prof Naidoo and Prof Johan Schoeman are members of different working groups of the South African Antibiotic Stewardship Programme (SAASP).

While the threat of a global crisis is imminent, certain measures can be taken to prevent a crisis. Various sections of society can contribute to combatting AMR. Members of the public can make a meaningful contribution by using antibiotics only when they are prescribed by a certified health professional and complete the full treatment course, even if they feel better.

Health workers, pharmacists, animal health technicians and veterinarians have a responsibility to enhance infection prevention and control. Prescribing and dispensing of antibiotics should only be done when other options for the prevention and management of disease are not available. When the use of an antibiotic is indicated, the correct drug should be used for the particular infection, it should be administered at the correct dose and dosing interval via the appropriate route of ingestion, and for the correct duration.

Policy makers play a major role and should help to strengthen surveillance of AMR and support the capacity of laboratories to participate in surveillance programmes. They should promote infection control and prevention, regulate the appropriate use of medicines and promote cooperation and information sharing among all stakeholders. Policy makers, scientists and industry leaders can help to tackle AMR by fostering innovation and promoting research and the development of new vaccines, diagnostic tools and treatment options.

- Author Louise de Bruin

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