Antimicrobial Resistance “AMR”: A global raising threat to animal and human well-being

Antimicrobial Resistance (AMR) is an increasing health concern globally. It threatens human and animal health, as well as environment, and unfortunately it has not yet adequately controlled. It led to the emergence of so-called “superbugs”, that are challenging health care workers and veterinarians because of reduced effective therapeutic option. Currently, AMR is considered as a leading cause of death.

Antimicrobials are therapeutic substances used to prevent or treat infections. They help animals and humans live longer and healthier lives. They include antibiotics, antivirals, antiparasitics antifungals and antiseptics, as well as disinfectants; that applied to non-living surfaces. Despites its significant importance, misuse and overuse of antimicrobials in humans, animals and plants are the main drivers in the development of drug-resistant pathogens (Fig. 1).

Rapid spread of multidrug-resistant bacteria (MDRB) results in difficult-to-treat infections and increases mortality rates. Drug-resistant pathogens are estimated to be responsible for 25,000 deaths per year in the European Union (EU) and 700,000 deaths per year globally. This number is estimated to reach 10 million deaths per year by 2050 if no action is taken. The global economic losses attributed to AMR is about one hundred trillion dollars annually. Infection with AMRB is more frequent in low- and middle-income countries (LMICs) than in developed countries.

Concerning situation of AMR in Africa, the World Health Organization “African Region” reported that 4.1 million people across Africa could be dead by 2050 if there is no immediate action against AMR. Besides, AMR will result in 5% loss in the GDP (global gross domestic product) of developing African countries, according to the World Bank. So Africa stands at a critical juncture.

In veterinary sector, antimicrobials have been introduced in management of all livestock species, companion animals, farmed fish and bees for various purposes (therapeutic, prophylactic, and growth promotion). Although use of antimicrobials for growth promotion in food‐producing animals has been banned in the European Union and in other countries, but still applied in many low- and middle-income countries (LMICs). Most classes of antimicrobials used in humans are prescribed for animals, such as broad-spectrum beta-lactams and quinolones. Mostly, AMR is linked to irresponsible and excessive use of antimicrobials. Upon acquisition of resistance to antimicrobials, bacteria become more capable for proliferation in animals, humans, and the environment.

Foodstuff of animal origin is a primary source of antimicrobial-resistant bacteria (AMRB) and can serve as potential vehicles for the dissemination of AMRB and resistance genes to consumers. AMRB; particularly Enterococcus spp., Campylobacter spp., Salmonella spp., and E. coli strains; have been reported in food products derived from poultry, swine, goats, cattle, and sheep.

Human can be infected with these pathogens directly by consumption of insufficiently-cooked or raw food, handling of raw food, or indirectly from the environment. Increasing demand for raw (e.g., Sushi) and undercooked food (e.g., rare burgers) may result in an increased risk of exposure to AMR. Also, the non-thermal technologies (high-pressure, ionizing radiation, ultraviolet radiation, and pulsed electric field) for food processing and preservation; which have been developed to improve the microbial safety of food while retaining nutritional and sensory qualities; are thought to participate in development of AMR and/or decreased sensitivity to antimicrobial agents in some pathogens when used at sub-lethal concentrations.

Also, misuse of disinfectants in food processing premises could develop resistance in bacteria to them and consequently have a higher risk of developing AMR.

The transmission of AMR pathogen between animal and human in feed stuff is illustrated in the inserted figure below (Fig. 2).

To combat this global drastic threat, a coordinated multisectoral approach is desired to investigate and address this warning phenomenon. So, several international organizations (The World Organisation for Animal Health (WOAH), World Health Organisation (WHO), and the Food and Agriculture Organization of the United Nations (FAO)) have joined forces to develop a Global Action Plan on AMR.

WHO launched the Global Antimicrobial Resistance Surveillance System (GLASS) to fill knowledge gaps and guide strategies at all levels. GLASS was created to progressively integrate sur­veillance data on antimicrobials used in humans, track antimicrobial use, and understand the role of AMR in the food chain and the environment. It provides a standardized approach to collecting, analyzing, inter­preting, and sharing data by country, region, and area, allowing you to monitor the status of new or existing national surveillance systems, emphasizing the rep­resentativeness and quality of the data collected.

The proper strategy to curb the spread of AMR could be achieved through series of actions represented by 1) banning use of antimicrobials as prophylaxis and growth promoters; 2) Promote accurate diagnosis and solid AMR surveillance systems, achieved by skilled professionals; 3) Raising public awareness about harms of antimicrobials’ overuse and misuse; 4) promote investment in new drugs and improvement of existing drugs; 5) Promote development and use of vaccines and alternatives as probiotics, phage therapy, and anti­bodies; 6) finally, Putting AMR on the international political agenda

In conclusion, spread of AMR is facilitated and enhanced by mismanagement of antimicrobials, improper infection control, movement of resistant bacteria-infected human and animals, agricultural debris, and contami­nants in the environment. Fighting AMR is an urgent global endeavour and must be addressed through a One Health approach. Thus there must be collaboration among human, animal, plant and environmental health sectors. It is worth to note that sociopolitical aspects such as education and global actions are very important tools for tackling AMR.

“We all have a role to play to emite AMR rise”

References:

1. https://www.woah.org/en/what-we-do/global-initiatives/antimicrobial-resistance/#ui-id-3

2. Bennani H, Mateus A, Mays N, Eastmure E, Stärk KDC, Häsler B. Overview of Evidence of Antimicrobial Use and Antimicrobial Resistance in the Food Chain. Antibiotics (Basel). 2020 Jan 28;9(2):49. doi: 10.3390/antibiotics9020049. PMID: 32013023; PMCID: PMC7168130.

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