Addressing the rising global threat of antimicrobial resistance (AMR)

Antimicrobial resistance (AMR) is a global public health threat that occurs when bacteria, viruses, fungi, and parasites no longer respond to the drugs designed to kill them. AMR makes infections more difficult to treat, and bacterial AMR (which is also called antibiotic resistance, or ABR) is now responsible for more than one million deaths per year—a number that is projected to climb to 8.2 million deaths annually by 2050 [1]. AMR is also a threat to the global economy. The World Bank estimates AMR could result in US$ 1 trillion of additional health-care costs per year by 2050 and US$ 1 – 3.4 trillion of gross domestic product losses per year by 2030 [2].

AMR and ABR in the spotlight worldwide

Several international organizations are rising to meet the challenge of escalating AMR. For example, the United Nations General Assembly (UNGA) recently held its second High-Level Meeting on AMR and approved a Political Declaration to review progress on efforts to tackle AMR, identify gaps, and invest in sustainable solutions to strengthen and accelerate multisectoral progress at all levels [3]. The World Health Organization (WHO) also released a report for G7 Finance and Health Ministers detailing progress on incentivizing the development of new antibacterial treatments and highlighting the urgent need for innovative strategies to enhance research and preserve access to essential antibiotics [4].

In addition to the UN and WHO, over 170 countries have national action plans focused on four pillars: infection prevention, access to essential health services, timely accurate diagnosis, and appropriate quality treatment [5]. A small sampling of these initiatives includes:

the African region’s AMR Global Action Plan and the African Union Framework for Antimicrobial Resistance Control 2020 – 2025, which is tailored to meet the specific needs of African nations through a coordinated approach [6],
India’s National Programme on AMR Containment, which aims to establish a laboratory-based AMR surveillance system, strengthen infection control practices, and generate awareness about AMR [7], and
the United States’ Antimicrobial Resistance Solutions Initiative, which invests in national infrastructure to detect, respond, contain, and prevent resistant infections across healthcare settings, communities, the food supply, and the environment (water, soil) [8].

Tools to combat AMR: Surveillance

Population-level testing is vital to combat AMR because it tracks emerging resistance patterns, guides treatment choices, and informs public health strategies. Current surveillance projects aimed at identifying, containing, and reducing AMR’s global impact include:

WHO’s Global Antimicrobial Resistance and Use Surveillance System (GLASS), which monitors AMR trends and promotes standardized data sharing worldwide [9],
The Global Research on Antimicrobial Resistance (GRAM) project, which provides detailed, region-specific AMR insights [10],
The European Antimicrobial Resistance Surveillance Network (EARS-Net), which is administered by the European Centre for Disease Prevention and Control (ECDC) and conducts AMR tracking in the EU [11], and
The National Antimicrobial Resistance Monitoring System (NARMS), which surveils AMR in bacteria from humans, animals, and food in the United States [12].

Tools to combat AMR: Drug stewardship

The misuse and overuse of antimicrobials are key factors driving AMR. For example, the WHO reported that worldwide, even though only 8% of hospitalized COVID-19 patients had bacterial co-infections requiring antibiotics, 75% received antibiotics ‘just in case’ they help [13]. Similarly, the European Centre for Disease Prevention and Control in Europe found that 80-90% of all antibiotic prescriptions primarily issued for respiratory tract infection—but most respiratory illnesses are caused by viruses, which will not respond to antibiotics treatment [14].

Drug stewardship (which is also known as antimicrobial stewardship) help combat AMR by promoting the responsible use of antimicrobials to reduce unnecessary exposure and slow resistance development. Key strategies include prescribing antibiotics and other antimicrobial drugs only when necessary, selecting appropriate agents, dosing, and duration, and encouraging infection prevention measures like vaccination and hygiene.

For example, researchers are examining how education, training, and new approaches to the clinical decision-making environment can improve antibiotic prescription practices while maintaining clinician autonomy and patient satisfaction [15]. Others are working to understand how farmers, veterinarians, and other stakeholders can better collaborate to design and implement strategies to mitigate AMR in agriculture [16]. Using rapid diagnostics to determine a pathogen’s drug susceptibility can also enhance drug stewardship by informing drug selection, dosing, and other clinical decisions [17].

Tools to combat AMR: Diagnostic stewardship

Diagnostic stewardship involves using accurate, timely testing to identify infections and their causes. By promoting proper test selection and interpretation, diagnostic stewardship can reduce the misuse of antimicrobials, support targeted treatment, and minimize the development of AMR.

Culture-based testing is the current gold standard to assess bacterial growth and antimicrobial susceptibility; however, the limitations of culture testing can lead to misdiagnosis and unnecessary and/or inappropriate prescribing [18]. That is why molecular methods, such as real-time PCR and/or genomic sequencing, are also used to identify pathogenic strains and the genetic markers associated with resistance [19]. Compared to conventional culture tests, molecular testing can offer faster results (e.g., real-time PCR can take less than two hours from the extracted sample to results), as well as higher sensitivity and specificity. In addition, rapid genomic sequencing can help pinpoint new bacterial vulnerabilities, track the spread of infections, and guide public health measures [-20]. Of course, molecular testing methods also have limitations, including the inability of PCR to identify resistance gene expression or distinguish between viable and nonviable pathogens [21].

Tools to combat AMR: New drugs

Developing new antimicrobial therapeutics is difficult, costly, and time-consuming, as it takes about 10 years on average for a new antimicrobial agent to advance from discovery to market authorization [22] and will likely require public-private partnerships. Despite these hurdles, researchers are continuing to develop novel antibiotics, synthetic antimicrobials, and alternative modalities like phage therapy, antimicrobial peptides, and vaccines to combat AMR. Much of this work is focused on overcoming specific resistance mechanisms, targeting resistant bacterial proteins, and improving drug delivery [23]. The drug discovery process is enhanced by new technologies such as artificial intelligence (AI), which can accelerate identifying novel compounds and combinations [24].

Collaboration toward comprehensive strategies

Comprehensive strategies that integrate surveillance, stewardship, innovation, and continued policymaking and advocacy are critical to tackle the global crisis of rising AMR. They address AMR’s multifaceted causes, facilitate prudent antimicrobial use, foster new treatments, and strengthen infection prevention. This type of holistic approach can help to minimize resistance spread, preserve the effectiveness of existing antimicrobials, and sustain global health resilience.

To learn more about antibiotic resistance, download this educational infographic:

https://www.thermofisher.com/us/en/home/global/forms/molecular-solutions/antibiotic-resistance-infographic.html

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