Our 21st Century Apocalyse: The Rise of Antimicrobial Resistance

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Greetings everybody

Hope you have all had an amazing week. It is time for that lovely fix of science you get from me on Friday! This week is all about looking into the world's antibiotic resistance crisis; What is it? Why should we care? And how we have reached a crisis point?. Let's launch into it then.

What is antimicrobial resistance and why should we care about it? 

WHO (World Health Organisation) defines antimicrobial resistance as the change seen in bacteria, fungi, viruses and parasites once exposed to antimicrobial drugs. Antimicrobial resistance carries the potential of plunging the world back into the dark ages of the pre-antibiotic era. What does this mean for me, you, your family and friends? Bad news. If we are unable to keep up with constantly changing microorganisms as they continue to accumulate resistance to antibiotics, deaths from the common cold and flu would rise and once simple and curable bacterial infections will lead to hospitalisation.

Let's talk money for a moment:

An independent report was published releasing the results of the impact Antimicrobial resistance would have on our future economy. I have extracted the main results from the report to read the full report click here.

They calculated the costs based on two inevitabilities in a world where antimicrobial resistance is common:

Increased mortality - deaths directly caused by the resistance of microorganisms would greatly reduce the size of the working-age population.

Increased morbidity -  these were characterised as being prolonged periods of time taken off work due to sickness. In the short-term, this would cause a temporary reduction in the workforce and in severe cases lead to a long term loss in team productivity.

It was estimated that by the year 2050 the world economy would have lost a whopping $2.1 trillion if the levels of resistance remain low. However, if this problem is not handled and resistance increases globally, the loss could peak at $124.5 trillion. If those numbers were not enough to highlight the effect this biological crisis has on the world, it is important to note that they are an underestimate. The report only considered two aspects of the economies challenges, the cost of healthcare (longer stays and an increased demand for intensive care) as well as funding to manufacture new antibiotics were not factored into the analysis.  A number not yet totalled but based on the underestimate... it's a cost best to keep as minimal as possible.

How did we get to this crisis point? 

Antimicrobial resistance is a story that stretches all the way back to the very first microorganisms. Chemical warfare has been a strategy used against rivalling microorganisms in competition for resources for centuries. Ever since the first weapon was used against another, microorganisms had to learn how to evade or neutralise those threats. Those chemicals used by one microorganism to disadvantage another or completely destroy it gave us the inspiration for many antibiotics, antivirals and antifungals on the market today. This widespread exposure of microorganisms to antimicrobials has led to accelerated development of resistance because we have placed the pressure on them to do so. In simple terms, the microbes must 'adapt' or 'perish'. Survival of the fittest. 

Since then, it has been an arms race between humanity's innovation of antimicrobials and the microorganisms ability to acquire resistance to it. If you are a betting person you would not like the 'odds' take a look at the image below showing the number of antibiotics released over the years. 

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In the picture below, a scientist is holding up two Petrii dishes. If you observe them closely you will notice that on each petri dish there are small white circles. Each one of those is a small paper disc dipped in a different antibiotic, the aim is to grow a certain type of bacterium on the plate and see how effective each antibiotic is at killing the bacteria.  The first petri dish shows you that the anitbiotics are effective at killing the bacterium (observe the zone surrounding each circle that is completly clear of any bacteria). Compare this to the second petri dish, the antibiotics are largely ineffective in killing of the bacteria - sadly this is the situation we are heading towards. 

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The overuse and misuse of current antibiotics:

Lack of new innovative drugs is not the only factor playing into the accelerated growth of antimicrobial-resistant microorganisms. Some of the blame falls on individuals within the public. Every time a doctor has prescribed you a course of antibiotics to help you with some form of bacterial infection, you begin taking it religiously out of desperation to feel better. As the symptoms begin to subside you start missing a dosage or two or perhaps, you skip the last day completely. This could leave the last few remaining bacterium behind and these guys are placed under a selective pressure 'adapt resistance' or 'die in the next dosage'. If you were a bacterium which would you pick? Below is an image showing just a few ways become resistant to antibiotics. 

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Antibiotic misuse relates to the scenario where a doctor gives you antibiotics for some form of infection that is so mild, that the body should be left to fight it on its own. For resistance to happen microorganisms must be in contact with some form of an antibiotic. In the case of giving antibiotics for a mild bacterial infection, you  may think what is the real harm. If it becomes resistant then the body will overcome it anyway, right? You would be correct. There would be no worry if the mild infecting bacterium kept the code of resistance to itself. The nasty thing about bacteria is that they like to share these codes for resistance with each other. Suddenly a more severely infecting bacterium has the code to resistance to multiple different drugs that it itself has never come in contact with. 

These are reasons that many have heard before and you will hear more and more as this issue becomes more and more public. I went in search for the lesser known ways of how we got to where we are today. 

The real monster lurking in our sewers:

Antibacterial products discarded into the sewage from our own communities and even hospitals   all collect to form the perfect reservoir for antibiotic resistance to cultivate. This hotspot of antibiotics, pollutants, detergents, and disinfectants creates such a hostile living environment that it truly drives the incentive of each bacterium to develop resistance to multiple chemicals designed to kill them. 

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There are many ways that resistant microorganisms can be transferred onto us. Take a look at the image below to check out a few more. 

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21st Century Problem in need of a Solution... 

We could panic after this post. You would be well within your right but as I have been told by one of my students I am incredibly optimistic. It will be a tough battle to fight, one of the greatest in our history perhaps due to it global impact on both our health as well as our economies. Microorganisms have had to adapt under increased exposure to antimicrobials. I believe that 'Necessity is the mother of invention' as such in the face of an enemy we will overcome it. We are left with two choices 'Adapt' or 'Die'. Which do you choose? 

Over and Out 

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