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Yet Another War: Emergence of Drug Resistant Strains of Organisms

Submitted by on July 18, 2012 – 12:05 AM 6 Comments

This era is recognized as a paradigm of medical advancements with a solution to every other ailment. The battle of pathogenicity vs. remedy ran step by step with the evolution of mankind and there was no end. Like one of them, the burning threat in the world of medicine nowadays is the emergence of anti-microbial resistant organisms.

Anti-microbial resistance is a trait in a disease causing organism to resist different drugs targeted to eliminate them. This property can be found in bacteria, neoplastic tumour cells, in fungal cells and even in parasites. Public Health Authorities all around the globe are concerned about this trepidation of increasing anti-microbial resistance.

The first reported case of this calamity was found against the first antibiotic- Penicillin by Staphylococcus Aureus bacteria in 1947.After that lamentable finding this spreads around the globe alarmingly and become a scored issue of mortality and morbidity all over. Moving in its course Staph. Aureus passes through several successive stages of résistance. Which was once susceptible to Penicillin G, this gram positive coccus quickly developed the ability to produce a Beta-Lactamase that inactivated both natural Penicillins and Aminopenicillins.  The development of several semi synthetic penicillin resistant agents like Methicillin resistant Staph. Aureus. Methicillin resistant strains were first reported in the early 1960’s.MRSA then become endemic in many hospitals during the 1980’s and it has recently been appreciated as a cause of community-associated infections. During the past three decades MRSA has created significant epidemiological infection control and therapeutic management challenges.

The story did not consummate here and the evolution of pathogenicity arrayed through faces and sums up to the challenges of Global Health Fraternity. The stream of this terrorism stem its way evolves one after another, instances are Vancomycin Resistant Enterococci (VRE), Extended Spectrum Beta-Lactamase (ESBLs) producing gram -ve bacteria, Klebsiella Pneumoniae Carbapenemase (KPC) producing gram negatives, Imipenem-Resistant or Multi drug resistant organisms Acinetobacter Baumanii and Pseudomonas Aeruginosa. The trend of neoplastic resistance unravels that cancer cells also have the ability to be resistant to different drugs by enzymatic deactivation like one of them is Glutathione conjugation; decreased permeability so that drugs cannot enter tumour cells, altered binding sites, alternate metabolic pathways or increased efflux of drug. This trend of resistance is also observed in Scedosporium Prolificans, a fungus, against anti-fungal agents.

The two leading causes of morbidity in the  Asian sphere are Tuberculosis and Malaria. Already being a burden on heath economy, the emergence of drug resistant Mycobacterium towards the most powerful first line anti-TB drugs Isoniazid and Rifampicin and the other offender Chloroquine resistant Plasmodium have proved to be a challenge to medical practice. Emanating epidemic of Clostridium Difficile Associated Disease (CDAD) is another recent concern.

In response to these concerns, medical experts, professional societies and agencies such as Centers for Disease Control and Prevention (CDC) have proposed initiatives to curtail the spread of antimicrobial resistance in pathogenic bacteria. Several researches have been done to firstly rule out the causes behind this self-modification aptitude and then to discover contrivance to combat them.

Literature suggests that’ imperfect’ interiors of sensitive areas like Intensive Care Units(ICUs), and other critical areas, their head walls, sinks, preparation area, taps, beds got collections of dispersed material stick to them forming biofilms giving habitat to pathogens and favourable media for deadly proliferation. Overcrowding in wards and many more such elements are being an outstanding cause of nosocomial infections and resistant strains. There are weak and absent surveillance and monitoring systems, poor infection prevention and control practices observed in health institutions.

As a recession of economy, depletion of diagnostic tools, medicines and vaccines as well as insufficient research and development culture on new products adds to the intricacy. One adversity of the developing nations are over the counter selling of drugs without proper prescriptions is leading to excessive irrational use of antibiotics. Unawareness in people leads to lack of infection control and inadequate compliance with the treatment regimens and ignorance makes a cumulative effect.

Antimicrobial resistance transpires as a global concern.  Infections caused by resistant microorganisms often fail to respond to the standard treatment resulting in prolonged illness and a greater risk of death. It reduces the proficiency of treatment because patient remains infectious for longer duration thus potentially spreading resistant microorganisms to others. It stood as catastrophic challenge towards the accomplishment of the targets of the health-related UN Millennium development goals set for 2015 as many infectious diseases are getting uncontrollable, threatening health security and damaging trade and over-burdening economy.

Combat Drug Resistance-no action today no cure tomorrow, this motto has been setup by WHO against jeopardy evading health sector. WHO is engaged in supervising the response to Antimicrobial Resistance through policy guidance, support for surveillance, technical assistance, awareness as essential medicine quality supply and rational use and infection prevention and control.

On a personal level, chances of drug resistance can sometimes be minimized by using multiple drugs simultaneously because individual mutations can be independent and may tackle only one drug at a time if the organisms are still killed by the other drugs then the mutations cannot persist, this was used successfully in TB. To limit the development of antimicrobial resistance one should use antibiotics only for bacterial infections, culture and sensitivity for identifying causative organism if possible, use the right antibiotics, avoid relying on a broad range of antibiotics, do not stop antibiotics as soon as symptoms improve follow the full course.

An effective strategy to limit the effect of drug resistance must be multi-faceted and must include education of patients and physicians about antimicrobial use, improved use of immunization and development of alternative therapies(as suggested by LC McDonald – 2006) . Unfortunately increased use of existing antibiotics for prophylaxis may lead to increased resistance- a vicious circle. New antibiotics are urgently needed to which resistance will not develop. Such products would revolutionize infection control and offer reliable prevention of infections. However regardless of the strength of present day control strategies, the battle to control antimicrobial resistance will remain with us as long as we must rely on these drugs as our primary means of treating infections.

About the author:

Hira Farid is a final year student at Sindh Medical College. She is actively involved in research. Has also worked in partnership over  community-based research on Anxiety and Depression. Did clinical electives at university of Illinois ,Chicago USA in cardiac surgery. Wants to pursue a career in cardiothoracic surgery.She can be reached at: [email protected]

About this article: This article is competing for the JPMS International Medical Writing Contest 2012 for the theme: Challenges in Global Health/Public Health

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  • Moin Ashraf

    Nice article , For sure Anti-Biotic resistance is the burning threat in the world of medicine nowadays !!!!!

  • Guest

    well done hira!!

  • Dr Hirafarid

    Thanks for liking peeps

  • Shazia Rehman

    very nice Hira. Antibiotic resistance is really a big threat.. good that u highlighted!!
    Best of luck!

  • doctor

    awareness is empowering!!!

  • Glut44

    Quite interesting< I wonder if an amino like Glutathione can help the body fight disease in a natural way?