What is AMR?
Antimicrobial resistance or “AMR” describes how microbes can change over time to become resistant to medications, especially antibiotics. This makes infections harder to treat and increases the risk of disease and severe illnesses.
What are microbes?
Microbes are microscopic organisms that include bacteria, viruses and fungi. Every form of life – including people – are covered in them. Most microbes in/on the human body are harmless and may even be beneficial. The microbes found in and on the human body make up the human microbiome. However, some microbes can cause infections and illnesses, and these are known as pathogens.
Is AMR the same as antibiotic resistance?
Antibiotic resistance occurs when pathogens are given the opportunity to evolve and become resistant to a medication. This can happen for a number of reasons. For example, if you don’t finish a course of antibiotics for a bacterial infection, the surviving bacteria in your body can develop resistance to the drug. Antibiotics only affect bacteria, while other antimicrobials such as antifungals and antivirals specifically target fungi and viruses, respectively. Antibiotic resistance may be seen as a subset of antimicrobial resistance.
How do antibiotics impact our microbiome?
Antibiotics are used to kill bacteria and treat illnesses. But they often don’t specifically target pathogens and can also affect other microbes and reduce the diversity of our microbiome. Over 80% of our immune system resides in the lining of our gut, and our microbiome is in constant contact with it. A healthy, resilient gut microbiome relies on high microbial diversity. When there is high diversity of the microbes in our gut, our immune system is stronger and more stable.
Studies have shown that a prescription of antibiotics decreases the diversity of our gut microbiome by at least 30% and that a less diverse microbiome is associated with a number of human diseases (1) (2). The use, overuse and abuse of antibiotics strongly impacts our microbiome.
Why is maintaining a healthy microbiome important?
A healthy and diverse microbiome is beneficial to health, so it is necessary to protect and develop it. This is especially true for young children as the microbiome is very unstable in early life, and any drastic changes have a high chance of altering their microbiome permanently.
What is antimicrobial stewardship?
According to the CDC, about 30% of antibiotics prescribed in US acute care hospitals are unnecessary or suboptimal (3). These errors can arise when antibiotics are given when not needed, distributed at the incorrect dose, continued when no longer necessary, or the wrong antibiotic is given to treat an infection.
Antimicrobial stewardship is the systemic effort to optimize the use of antimicrobials to enhance patient outcomes while minimizing the rise of antibiotic resistance. It involves selecting the right therapy, dosing, route and duration and discontinuing the antibiotic when it has served its purpose.
To properly use antibiotics, you have to accurately and rapidly identify the microbe that is causing symptoms. This is where fast diagnostic testing can potentially interface into antimicrobial stewardship programs to help providers determine exactly what pathogen is causing the infection to select the most optimal therapy.
What are fast diagnostic tests?
Fast diagnostic tests are medical tests that are quick and easy for healthcare staff to perform. They can be used to quickly and accurately identify the pathogen causing an infection and this information can then be used to prescribe the most appropriate antibiotic, which can help to prevent AMR. This improves the time to effective antimicrobial therapy, reducing unnecessary treatments and shortening length of hospital stay (4). An example of a fast diagnostic test is the QIAstat-Dx syndromic test by QIAGEN, learn more here.
What role can parents play in antimicrobial stewardship?
When seeing a doctor, it might be prudent to ask about the risks and benefits of antibiotics (some antibiotics may have side effects) and other ways to treat illness. If antibiotics are prescribed, ensure that the full course is consumed, even if your child is feeling better. Not doing so may cause the surviving pathogens to build resistance against the medication. It is also important to keep antibiotics out of reach of children to prevent misdosing.
References
- M. P. Francino (2016). Antibiotics and the Human Gut Microbiome: Dysbioses and Accumulation of Resistances. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709861/
- Juliana Durack and Susan V. Lynch (2019). The gut microbiome: Relationships with disease and opportunities for therapy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314516/
- “Core Elements of Hospital Antibiotic Stewardship Programs.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 16 Nov. 2020, https://www.cdc.gov/antibiotic-use/core-elements/hospital.html
- Ramanan, P., Bryson, A. L., Binnicker, M. J., Pritt, B. S., & Patel, R. (2017). Syndromic Panel-Based Testing in Clinical Microbiology. Clinical microbiology reviews, 31(1), e00024-17. https://doi.org/10.1128/CMR.00024-17