Antimicrobial resistance (AMR) is a serious threat to global public health and requires action from each and every country. Antimicrobial agents are used for treatment of infections caused by bacteria, parasites, viruses and fungi. These microorganisms frequently develop resistance to drugs and no longer respond to treatment. This means that infections are difficult to treat and control and they add to economic and social burdens. This problem is critical, leading to severe infections with higher death rates, particularly in hospitalized patients.
Why does antibiotic resistance occur?
New resistance mechanisms in bacteria are emerging and spreading across the world. Some bacteria are naturally resistant to antibiotics and other develop resistance through genetic changes. Misuse, overuse and inappropriate use of antibiotics accelerate this process.
Antibiotic are misused when they are taken for treatment of viral infections, without professional assessment of patients, under patient pressure, inappropriate surgical prophylaxis, and when used as growth promotors in animals and others.
Well-described resistance among bacteria causing urinary tract infections, skin and soft tissue infections, and STIs is widespread. This leaves limited treatment options for common infections.
In hospital settings, antimicrobial-resistant organisms exist in the environment and are transmitted from patient to patient by the hands of hospital personnel. Hand washing campaigns emphasize the importance of infection prevention and control in hospitals.
The Global Action Plan (GAP) for combating AMR has been released by WHO, and provides assistance to countries to develop their national action plans, and strengthen their health surveillance systems to prevent and manage infections with antibiotic-resistant organisms. This program supports a standardized approach to the collection, analysis and sharing of data on AMR through the Global Antimicrobial Resistance Surveillance System (GLASS).
Since 2015, WHO has promoted World Antibiotic Awareness Week in November as a global campaign.
In addition, the importance of AMR reached Heads of State in New York in September 2016, when the United Nations General Assembly endorsed a political declaration of taking a coordinated approach to AMR at all levels, including ’One Health’.
What is One Health?
One Health is a holistic approach that recognizes the connection between the health of humans, animals, and the environment, in the context of AMR. One Health is more than just a name – it is a commitment by the different disciplines to work together and communicate their knowledge to relevant platforms.
The Global Health Security Agenda (GHSA) emphasizes AMR as one of the key elements in efficient disease prevention, control and outbreak response.
South African response
A national response to AMR in South Africa was articulated through development of a National Strategy Framework for AMR for the 2014-2024 period. One of the main strategic objectives is to optimize surveillance and early detection of AMR. Key responsibility for AMR surveillance is undertaken by NICD. NICD has developed two-tier surveillance reporting, one by laboratory-based surveillance for AMR (LARS) via GERMS-SA, and another by electronic surveillance (e-surveillance) from the corporate data warehouse supplying data from routine NHLS laboratories. These data reports are available on an NICD dashboard (www.nicd.ac.za). The Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses (CHARM) at NICD uses the GERMS-SA laboratory-based surveillance platform to conduct intermittent surveys for antimicrobial-resistant bacterial bloodstream infections, and reports are available on the NICD website.
The National Department of Health responded to the GLASS call for surveillance and allocated NICD as the coordinating body and focal point for AMR reporting to WHO.
On the One Health approach, NICD is collaborating with the National Department of Agriculture, Forestry and Fisheries on surveillance for AMR.
The South African Medical Research Council (SAMRC) by funding research supports South African drug discovery and development work on drug-resistant bacterial infections.
Finally, combating AMR does not stop at this level – further education, training, and integration of knowledge about AMR into society are the ways forward.