Abstract:
Antibiotic resistance is a modern-day crisis. Medical professionals are quickly running out of antibiotics that we can use to treat deadly bacterial infections and our group, the Students for Antimicrobial Stewardship Society, aims to illuminate this for the general public. Here, we outline the factors that have contributed to the rise of antibiotic resistance and what we have failed to do, as a society, to overcome resistance.
Main Article:
Having been inspired throughout my term by the incredible grassroots advocacy undertaken by Canadian medical students, two students and I at U of T have decided to embark on a challenge to raise awareness of a growing concern in Canada and across the globe: antimicrobial resistance.
Let’s start with the basics. Antimicrobials are drugs that destroy or incapacitate infectious microorganisms. Over time, microorganisms that have been targeted by antimicrobial therapy have developed strains that are resistant to the therapy including Methicillin-resistant Staphylococcus Aureus, Vancomycin-resistant Enterococci, and Clostridium difficile.
So why should we care? Antimicrobial resistance poses a significant danger to all patients. In 2013, one in twelve patients was infected with at least one resistant microorganism in hospitals across Canada every day leading to approximately 2,000 deaths per year.1,2 Furthermore, deaths due to C. difficile and its resistant strains have increased four-fold in the past twenty years and show little signs of relenting according to the Public Health Agency of Canada.3 This will only worsen with Canada’s aging population, as patients are more likely to have multiple comorbidities, weaker immune systems, prostheses, and medications, which all increase their susceptibility to infection by resistant microorganisms. In fact, some experts predict that drug-resistant microorganisms will kill an extra 10 million people per year worldwide by 2050 – more than who currently die from cancer.4 As future doctors, resistant organisms are a potentially catastrophic reality that we must act on.
While we cannot change the natural selection processes that cause resistance, there are many other modifiable factors that exacerbate resistance. Stagnation in research and development has led to the creation of only four new classes of antimicrobials since the 1970s. This pales in comparison to HIV drugs for example, where 30 new drugs have been brought to market since the 1980s.5 The reasons behind this phenomenon include patents that expire too quickly to be profitable, the loss of smaller companies that typically create antimicrobials due to mergers and acquisitions by large pharmaceutical companies, and the fact that antimicrobials are used for short-term, discrete periods of time, making them less profitable to invest in.
A second important consideration is prescriber and patient culture. Think of when you were sick last. Many of us may have said to someone “Oh, I was so sick I needed antibiotics!” As a society, we are emotionally attached to antibiotics and use them to validate our medical illnesses, and this has an effect on prescriber and patient behaviour. A 2004 study by Altiner et al. found that physicians prefer to avoid confrontation and assume that their patients want antimicrobials, and report satisfaction in having their patients leave with specific treatment plans.6 What we fail to realize however, is that when we send that patient with a cold home with a prescription for antibiotics because “it can’t hurt” and “he seemed like he really wanted them”, we are bolstering an unnecessary and dangerous threat.
Fortunately, the world is realizing we cannot go on like this. The UK has declared that alongside terrorism and climate change, antimicrobial resistance is a threat to the entire nation’s economy and security. In September 2014, United States President Obama signed an Executive Order directing key federal departments to overcome the rise in resistant bacteria. Finally in November 2014, the Government of Canada published a document entitled Antimicrobial Use in Canada: A Federal Framework for Action.
Eyes are now on the Canadian medical community and its students to join the fight against antimicrobial resistance, which will affect each and every one of us in our careers. The question is, will we rise to the challenge?
References:
- Simor, A. E., Williams, V., McGeer, A., Raboud, J., Larios, O., Weiss, K., et al. (2013). Prevalence of Colonization and Infection with Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus and of Clostridium difficile Infection in Canadian Hospitals. Infection Control and Hospital Epidemiology, 34(7), 687-693.
2. Parliament of Canada. (2014). Proceedings of the Standing Senate Committee on Social Affairs, Science and Technology.
3. Public Health Agency of Canada. (2013). Clostridium difficile Infections.
4. O’Neill, J. (2014). Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations. The Review on Antimicrobial Resistance.
5. Tegos, G., & Mylonakis, E. (2012 ). Antimicrobrial Drug Discovery: Emerging Strategies (1 ed. Vol. 1): Cabi.
6. Altiner, A., Knauf, A., Moebes, J., Sielk, M., & Wilm, S. (2004). Acute cough: a qualitative analysis of how GPs manage the consultation when patients explicitly or implicitly expect antibiotic prescriptions. Family Practice, 21(5), 500-506.
