Antimicrobial resistance is the ability for microorganisms to resist being killed by antimicrobial drugs like antibiotics. This means that it becomes harder for us to treat diseases that may have previously been easily curable. Commonplace medical procedures could become increasingly dangerous, and the health systems that we rely on may be increasingly compromised.
What is antimicrobial resistance?
Antimicrobial resistance is when pathogens (harmful microbes like certain types of bacteria, fungi, virus etc.) evolve resistance to the treatments that we typically give them by mutations in their DNA. In other words, microbes are gaining an edge in the arms race between us and them, and we seem not able to develop drugs fast enough to counter the threat. Not all pathogens have developed this resistance, but those which do are known as super bugs, such as MRSA. Antimicrobial drugs include antibiotics, antiviral drugs and antifungal drugs, for example. Antibiotic resistance will often be referred to here, as it is a subset of antimicrobial resistance, referring to drugs used to kill bacterial infection, as this is, for many, the most pressing form of antimicrobial resistance.
Antimicrobial resistance is a naturally occurring process, caused by natural selection - microbes with favourable mutations that benefit their survival will inevitably occur as a result of evolution. For many pathogenic microbes, this evolutionary advantage is being resistant to antimicrobial drugs, and therefore, that is the main cause.
However, many factors contribute to speeding up the rate, and increasing the seriousness of antimicrobial resistance. Inappropriate use of antimicrobial drugs increase the exposure of pathogens to antimicrobial drugs, and therefore, increases the potential for natural selection to occur. This increased exposure is from doctors prescribing them when not needed, their easy availability in some countries without a prescription, and the failure fully to take a course. However, other factors hugely influence it too. For example, the widespread use of antimicrobial drugs in animal feed further provides opportunities for mutations, as the concentration is typically not enough to kill mutated pathogens, and therefore, they can evolve even quicker. Finally, the lack of identification of new antimicrobial agents has meant that resistance may have ever more serious consequences, as there are no new drugs to replace those that the pathogens have gained resistance to.
Stuart Levy writing in the Journal of Antimicrobial Chemotherapy
Prevalance of antimicrobial resistance
If antimicrobial resistance only occurred on a small scale, it would be a purely medical problem with no real relevance to sustainability. However, the increasing prevalence of the issue worldwide, and yet the fact the effects will only intensify in the future, makes it a vital issue of sustainability. While the impacts that really make it so important to any discussion of sustainability will be discussed below, here, the extent to which antimicrobial existence exists will be discussed. It truly is a global problem, with 700,0000 dying yearly today of it, in almost every country on earth. This number is only predicted to increase, unless we develop new methods for dealing with it.
Antimicrobial resistance could have world shattering impacts. The fact that 700,000 dying each year is just the preliminary impact is very telling, with some estimates putting the death toll potential at 10 million yearly, greater than the number who die from cancer. But the impact is even more than that, for antimicrobial resistance may destroy the health systems we have in place. Diseases we took for granted as easily curable may suddenly be death sentences, and even the most mundane operations may suddenly become deadly. Essentially, many of the major advances in medicine over the last 100 years may be rendered futile, as these procedures would simply be too risky. Furthermore, the potential for deadly epidemics would increase even more, and the potential for countries in poverty to improve health outcomes, which hitherto have been through better availability of drugs, may become progressively harder. It is a bleak picture, and its not just the human impact that matters - it could be economically catastrophic too. The death rate and increased illness as a result of this problem would reduce the economic productivity of the population, and the impact on the agricultural sector, especially in the meat industry, will be huge. These are some of the potential and current impacts already occurring from antimicrobial resistance.
With such a clearly pressing issue, a great many people are concerned with solutions, and hence, a great number of approaches have been suggested. These can broadly fit into two categories - de-escalation, and new solutions. De-escalation holds that we have not reached a tipping point and therefore, if we cut down our usage of antibiotics, resistance will slow down and therefore the threat will be reduced. They hold that any new solution will inevitably be swamped by the mutations of microbes, and therefore, de-escalation is the only solution. Many, however, believe this leaves humanity too vulnerable, and that we must participate in the 'arms race', and keep up with the pace of evolution. These solutions include developing new synthetic antimicrobials using similar techniques that we have used (although many believe this to be insufficient), or to try to discover more natural antimicrobials, although this solution feels to many to be based too much on hope. Furthermore, many have attempted the introduction of bacteriaphages, although this only combats the issue of antibiotic resistance, rather than antimicrobial resistance as a whole.