New Strategies Needed in the Fight against Antimicrobial Resistance

Farah Azouzi

doi:10.37871/jbres1838

ISSN: 2766-2276

Medicine Group. 2023 November 24;4(11):1611-1613. doi: 10.37871/jbres1838.

Subject area(s)

Public Health

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Short Commentary

New Strategies Needed in the Fight against Antimicrobial Resistance

Farah Azouzi*

Laboratoire de Microbiologie CHU Sahloul Sousse Tunisie, LR20SP06, Faculté de Médecine de Sousse Tunisie, Université de Sousse, Sousse 4003, Tunisia

*Corresponding author: Farah Azouzi, Laboratoire de Microbiologie CHU Sahloul Sousse Tunisie, LR20SP06, Faculté de Médecine de Sousse Tunisie, Université de Sousse, Sousse 4003, Tunisia E-mail:

Received: 16 November 2023 | Accepted: 22 November 2023 | Published: 24 November 2023

How to cite this article: Azouzi F. New Strategies Needed in the Fight against Antimicrobial Resistance. J Biomed Res Environ Sci. 2023 Nov 24; 4(11): 1611-1613. doi: 10.37871/jbres1757, Article ID: jbres1757

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Summary

Antimicrobial Resistance (AMR) has become a global threat and has caught high levels. This silent pandemic is challenging healthcare providers as it concerns not only the hospital environment but also community-acquired infections.

According to the CDC, antimicrobial resistance has resulted in a direct increase in health costs to 20 billion dollars every year in the USA. In 2019, the World Health Organization (WHO) reported 4.95 million deaths associated with antimicrobial resistance and 1.27 million deaths directly attributable to it [1]. This trend is rapidly evolving and by 2050, 10 million deaths were estimated to be caused by antimicrobial resistance which would become the leading cause of global human deaths [2].

On the margin of World AMR Awareness Week, the World Health Organization focuses on the prevention of antimicrobial resistance through the collaboration of different actors in human, animal, and environmental health as well as organizations and decision-makers in order to decrease infection incidence and antimicrobial use [3]. These measures are important in a global context, but their implementation varies between countries and may depend on several factors including infrastructure, resources, and geopolitical climate which will deepen the north-south gradient.

The antimicrobial resistance crisis has led to the development of new antibiotics for the treatment of Multidrug-Resistant Gram-negative Bacteria (MDR-GNB) such as carbapenem-resistant Acinetobacter baumannii and carbapenemase-producing Enterobacterales [4]. Nevertheless, the effectiveness of these molecules depends on the drug resistance mechanism and there is no one standard regimen for all MDR-BGN strains. Besides, these new drugs are hardly available regarding high treatment costs in middle- and low-income countries where AMR rates were reported at their highest [5].

Since all these challenges, new strategies are needed to combat antimicrobial resistance. The One Health approach has changed the perspective of the WHO global action plan. It is now recognized that antimicrobial use in veterinary medicine impacts the environmental reservoir of resistance genes, and both are correlated with human health and AMR increase in human medicine. Collaboration between these three domains could prevent the spread of resistant bacteria [6].

Phage therapy is another resource to fight AMR. The first use of bacteriophages in human infections was described before penicillin spread in the health market. One of its first uses was as a treatment of typhoid and paratyphoid fever [7,8] but with the development of antibiotics, phage therapy research and clinical utilization remained restricted to some countries, especially in Eastern Europe [9,10]. Nowadays, with the emergence of multidrug-resistant bacteria leading sometimes to therapeutic impasses and fatal outcomes, several studies evaluated the effectiveness of bacteriophages as treatment of infections and showed in vivo synergy between phage therapy and antibiotics [11].

Vaccination was proved to have a significant impact on antimicrobial resistance rates by reducing the incidence of infections and selection of resistant strains. Recently, COVID-19 vaccination has shifted patients’ prognosis as it significantly reduced intensive care units’ hospitalizations and multi-drug resistant cross infections. A study evaluated pneumococcal vaccine impact in Spain from 1998 to 2022. It showed a 42.2% decrease in annual invasive pneumococcal infection incidence and a decrease in penicillin-resistant strains incidence from 4.91 to 0.7 [12].

In the global antimicrobial resistance surveillance for gonococcus, WHO has reported increasing rates of resistance to gonorrhea first-line antibiotics in 2017 for instance, strains with decreased susceptibility or resistance to ceftriaxone and cefixime were reported by 31% and 47% of countries, and resistance to ciprofloxacin concerned more than 30 to 70% of isolates. In 2016, 86.9 million new cases were estimated per year and most gonococcal infections were reported in the WHO African and Western Pacific regions where preventive measures are difficult to implement [13]. Vaccination seems to be a possible strategy to decrease gonorrhea incidence and thus antimicrobial resistance. GSK has developed a vaccine candidate which is on a Phase I/II first stime study on humans. Regarding the urgent context, the US Food and Drug Administration (FDA) granted the company fast-track designation for the gonococcus candidate vaccine [14].

Multidrug-resistant and extremely drug-resistant Gram-negative bacteria have emerged and spread as major causes of cross infections in hospital settings and intensive care units. They are responsible for severe infections such as sepsis and ventilator-associated pneumonia with high lethality rates. Researchers are exploring new horizons to prevent MDR-GNB infections by exploring possible epitopes and proteins on immunization in murine models [15]. Innovative tools like metagenomics associated with in silico studies and animal models have led to the production of candidate vaccines with promising results [16-18]. In 2021-2022, a first-time-in-human phase I/II randomized controlled study was conducted in Germany to evaluate the safety and immunogenicity of Klebsiella pneumoniae Tetravalent Biconjugate Vaccine [19]. Study results were not published yet but they are eagerly awaited.

Several other therapeutic strategies are envisaged to fight antimicrobial resistance such as inhibition of biofilm formation, antimicrobial peptides, and natural components like essential oil, metal nanoparticles, and quorum sensing disturbance [20]. Nevertheless, further studies are needed to start human clinical trials.

Antimicrobial resistance has become a global One Health priority issue with a serious impact on human, animal, and environmental health. Antibiotics should be used with caution to preserve remaining susceptibility. New strategies are being explored by researchers to identify new therapeutic targets. The prevention of infections through vaccine development seems to be very promising as the first clinical trials have started.