International
International Awareness Days

Spread awareness – stop resistance!

European Antibiotic Awareness Day on 18 November 2023 and World Antimicrobial Awareness Week from 18-24 November 2023

11/4/2022
Experts have been warning for a long time that we could be facing a post-antibiotic age in the future, in which humanity can no longer count on the effectiveness of antibiotics. This would be a disaster for global health, because even everyday infections could suddenly become life-threatening. Already, about 700.000 deaths worldwide each year are due to resistant organisms, and this number could rise dramatically. However, whether and when this horror scenario will occur depends on many factors. How prudently will people use antibiotics in the future? How quickly will resistant germs spread? How quickly will the development of new active substances progress? Every year in November, the World Antimicrobial Awareness Week (WAAW) and the European Antibiotic Awareness Day (EAAD) raise awareness of this problem and call for the prudent use of antimicrobial agents – and this year is no exception.

Europe and the world: two campaigns – one goal

Inprinciple, both the EEAD, launched in 2008 by the European Centre for Disease Prevention and Control (ECDC), and the WAAW, initiated in 2015 by the World Health Organization (WHO), have a common goal: „Spread Awareness, Stop Resistance – Handle Antibiotics with Care!“–to promote the prudent use of antibiotics through education and thereby prevent antimicrobial resistance. However, while the EAAD still focuses on antibiotics –i.e., medicines against bacterial infections –the WAAW has expanded its message since last year to include medicines against viruses, fungi, and parasites (so-calledantimicrobials).

And this year, WAAW is going one step further by joining forces with the Food and Agriculture Organization of the UN (FAO), the United Nations Environment Programme (UNEP) and the World Organisation for Animal Health (WOAH) to call on not only the healthcare sector, but also related sectors such as food and agriculture to work together to prevent resistance [1].

What does antimicrobial resistance (AMR) mean?

Antimicrobial Resistance (AMR) occurs when pathogens no longer respond to antimicrobial agents, become so-called drug or even multi-drug resistant organisms (MDROs). As a result of drug resistance, antibiotics and other antimicrobial agents become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness and death [1].

Resistance affects not only bacteria, but also viruses, fungi, and parasites

Bacteria, viruses, fungi, parasites – they are all capable of becoming resistant to antimicrobial drugs. This process is natural, but it is mainly driven by the misuse of medicines. In addition, poor hygiene contributes to the spread of resistant pathogens in the first place.

In terms of bacteria, pathogenic E. coli, Klebsiella and MRSA, but also the pathogens oft tuberculosis and gonorrhoea are of worldwide concern. Bacteria can either be insensitive to certain antibiotics in the first place because they do not possess the necessary target structure (e.g. the cell wall) or become resistant because they gain the ability to degrade the active substances enzymatically (e.g. through β-lactamases) due to mutations or the exchange of genetic material with other pathogens [2]. According to a WHO report, E. coli, the most frequent cause of bloodstream infections worldwide, is already almost 60% resistant to so-called reserve antibiotics in poorer countries [3].

However, there are also numerous examples of resistance to antiviral medicines among viruses, as the case of HIV and Influenza [4] clearly shows. Resistant parasites of the Plasmodium genus are also of great importance for tropical and subtropical regions, making treatments against malaria significantly more difficult [3].

Among the fungi, against which only a few antifungal medicine classes exist, increasing azole resistance in Candida and Aspergillus is clinically problematic [5].

Specific prevention: A more conscious use of antimicrobials is essential

In order to prevent the further increase in antimicrobial resistance and its dramatic consequences in the future, a correct and prudent use (in German language) of these medicines is essential. For example, the dosage, beginning and duration of the treatment must be correct, and the spectrum of action must be appropriate for the pathogen in question. In addition, it is of course important to avoid infections in general in order to prevent the spread of resistant pathogens - e.g., through hygienic measures such as good hand and surface hygiene, as well as trough vaccinations. The extent to which the COVID-19 pandemic will have an impact on resistance in the long term is also currently being discussed [6], but can only be assessed conclusively. The WHO fears at least a pandemic-related increase in the use of antimicrobial drugs and thus a higher risk of resistance development. At least one community-based British study, which observed a sustained reduction in antibiotic prescriptions from the first lockdown until the end of 2020 [7], gives hope - even if the reasons for this remain unclear. In addition, in the year 2020 fewer cases of drug-resistant bacteria than expected were reported (in German language) to the Robert Koch Institute (RKI), which – if not due to a missed transmission – could indicate fewer nosocomial infections during this period. But there is no reason to breathe a sigh of relief when it comes to resistance, because researchers in Germany have just found bacteria that are already resistant to a new combination of two antimicrobial substances that is not yet routinely used (in German language) [8].

The fight against MDROs can only succeed if we work together

In any case, it is clear that the fight against multidrug-resistant pathogens (MDROs) can only succeed if we work together. Everyone can make a contribution, whether as a consumer, patient, or professional. You too can help to raise awareness. Join us in supporting EAAD and WAAW! „Spread Awareness, Stop Resistance – Handle Antimicrobials with Care!“ and „Clean Hands!”.

#MissionInfectionPrevention #AntibioticAwareness #AntimicrobialAwareness #HandHygiene #PreventingAntimicrobialResistanceTogether

Sources:

  1. Weltgesundheitsorganisation WHO (2022) Antimicrobial resistance (who.int).
  2. Witte W, et al.(2004) Bakterielle Erreger von Krankenhausinfektionen mit besonderen Resistenzen und Multiresistenzen – Teil I: Diagnostik und Typisierung. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz; 47: 352-362.
  3. Weltgesundheitsorganisation WHO (2021) Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2021.
  4. Lampejo T.(2020) Influenza and antiviral resistance: an overview. Eur J Clin Microbiol Infect Dis; 39(7): 1201-1208.
  5. Perlin DS, et al. (2017) The global problem of antifungal resistance: prevalence, mechanisms, and management. Lancet Infect Dis; 17(12): e383-e392.
  6. Monnet DL, Harbarth S. (2020) Will coronavirus disease (COVID-19) have an impact on antimicrobial resistance? Euro Surveill; 25: 2001886.
  7. Zhu N, et al. (2021) Investigating the impact of COVID-19 on primary care antibiotic prescribing in North West London across two epidemic waves. Clin Microbiol Infect; 27(5): 762-768.
  8. Nordmann P, et al. (2021) Recent Emergence of Aztreonam-Avibactam Resistance in NDM and OXA-48 Carbapenemase-Producing Escherichia coli in Germany. Antimicrob Agents Chemother. 65(11):e0109021. doi: 10.1128/AAC.01090-21

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