By Jessica Blavignac

Despite extensive scientific research and policy developments, urgent coordinated action is needed to tackle the growing threat of antimicrobial resistance (AMR), often referred to as a the next (silent) pandemic.

Understanding AMR

AMR occurs when antimicrobials are no longer effective against the microorganisms they were designed for, leaving no treatment options to fight infections. AMR occurs naturally as microorganisms like bacteria, viruses, fungi, and parasites change or adapt over time, either by modifying the target of the antimicrobial, or by developing and exchanging resistance. The overuse and misuse of antibiotics in humans, animals and plants is speeding up this process.

How does AMR spread?

Some of the factors contributing to the spread of AMR globally include:

• The use of antibiotics in agriculture, veterinary medicine and food production
• Poor infection prevention and control practices
• Non-optimal use of diagnostic tools for rapid and reliable detection of pathogens and resistance
• Access barriers for efficacious vaccines
• Lack of antibiotics to treat infections caused by multidrug resistant bacteria
• Weakness or absence of surveillance programs to track localized cases of AMR
• Absence of a global, uniform and coordinated response between all countries
• Globalization as the population, animals and food products travel more, spreading resistance more quickly and easily between countries and continents

But scientific experts highlight the main reason for the spread of AMR is overuse and misuse of antibiotics.

Studying AMR’s Impact

It is estimated that more than 5,400 Canadians die every year from infections caused by bacteria that have become resistant to antibiotics. Worldwide, AMR is linked to close to five million annual deaths, more than HIV/AIDS, malaria, or breast cancer.

According to a quantitative model developed for the Council of Canadian Academies using existing data, a panel of experts found that in Canada, 26 per cent of infections are resistant to the drugs generally used to treat them. The same report also states that by 2050, resistance rates are likely to rise to 40% which could result in the loss of 15 Canadian lives daily and $396 billion in gross domestic product (GPD).

AMR has been recognized as a global emergency by the World Health Organization (WHO), Centers for Disease Control, and was discussed at the 17th G20 Heads of State and Government Summit in Bali, Indonesia. International policy bodies and governments have added AMR near the top of their political agenda and have been calling for more research and action plans.

Making Projections for 2023

The cost of AMR to national economies and their health systems is significant as it affects the productivity of patients and their caregivers due to prolonged hospital stays and the need for more expensive and intensive care. Without effective tools for prevention, adequate treatment of drug-resistant infections, and access to existing and new quality-assured antimicrobials, the number of people failing treatment or dying from infections will increase.

A major part in the strategic reduction of AMR lies with diagnostic devices that can inform and support clinical decision-making. This helps ensure that the right antibiotic treatment (dosage and duration) is given to the right patient for the right condition.[1] In particular, new syndromic diagnostic technologies allow microbiology labs to provide this information faster and more accurately than ever before.

The pandemic has shown Canadians the importance of these and several modern, fast, innovative devices that have been deployed by the federal government. This allowed people to get tested close to home, in their area. Diagnostic tests can play a major role for the optimal diagnosis of an individual, for the optimal and cost-effective functioning of health systems and for the benefit of the general public.

In fact, already in the early 2000s, research developments were underway to transform in vitro diagnostics from central laboratory to ‘near patient’ or ‘at bedside’. We are at the cusp of seeing such testing available in Canada, extending beyond clinical biochemistry (e.g. glucose monitoring for diabetes mellitus) to other pathology disciplines, including microbiology and hematology.

AMR is an ongoing and growing problem affecting Canada in several ways. While it is important to look at what we already know and what has been done thus far, we can now look forward to how diagnostic stewardship and near-patient testing will help in the fight against AMR.

Jessica Blavignac is Director of Scientific and Medical Affairs at bioMérieux Canada.