A hospital is one of the most significant reservoirs for antimicrobial-resistant organisms and antimicrobial resistance (AMR) contributing genes. This is due to the intensity of antibiotic use for treatment and prophylaxis (i.e. prevention) and the vulnerability of patients in hospital settings. There are different types of antimicrobial prophylaxis, including the use of antimicrobials to prevent an initial infection. Doctors can also prescribe antibiotics to prevent recurring infections or to reduce the impact of chronic diseases that may increase the patients’ vulnerability to secondary infections. These preventions are necessary to ensure that the patients recover quickly with minimal complications.
However, examining the antimicrobial usage rate for preventive care shows concerning statistics. The European Centre for Disease Prevention and Control (ECDC) survey of antimicrobial use in hospitals showed that one in three patients in acute care hospitals received one or more antimicrobials on the day of the survey. Out of the patients receiving antimicrobials, about one in seven prescriptions was for surgical prophylaxis to prevent infections at the surgical sites. Overall, more than one in ten antimicrobial prescriptions were for preventive care, representing a very high rate.
The high rate of antimicrobial usage is especially alarming because the consumed drugs are not entirely absorbed and digested, and the excreted drugs can contaminate different hospital environments. The environments include faucets, sinks and wastewater drainage systems (drains, sink/shower traps, toilets, drainage pipes). The listed settings present a unique opportunity for many different pathogens to congregate and interact, promoting the exchange of genetic materials like the AMR conferring genes. The environments are therefore referred to as “hot-spot” reservoirs that enhance AMR emergence.
The above-described process is a vicious cycle that continues to feed itself and expand. For example, if the antimicrobial usage does not slow down, more antimicrobials will be released to various environments, further promoting the expansion and dissemination of AMR. The abundance in AMR means there is an increased potential for morbidity and mortality due to infections. To control the diseases caused by resistant pathogens, doctors will have to use a higher volume and strength of antibiotics, and the cycle continues. Undoing the cycle of AMR emergence is not possible; therefore, we must continue monitoring and preventing further evolution.
So far, the blogs I have written were not the most hopeful insights into the global AMR crisis. The many unregulated production sites in lower-middle-income countries contaminate the surrounding environments and accelerate the AMR evolution. The primary physicians may feel pressured into prescribing antimicrobials by their patients due to the lack of public education on the current global AMR crisis, leading to over-prescription. And finally, in hospital settings, the inevitable high volume of antimicrobial use for treatment and prevention significantly enhances AMR. These processes are all intertwined, making it even more challenging to slow the ever-accelerating rate of AMR. These topics were needed to be covered to emphasize that AMR is not an isolated problem in one field. However, in the following blogs, I will focus more on the positive progress researchers have made to help mitigate the global AMR crisis.
