Appropriate use of antibiotic agents should be integral to good clinical practice and standards of care. All of us should be aware of our role and responsibility for maintaining the effectiveness of current and future antibiotic agents.
Beginning with the discovery of penicillin by Alexander Fleming in the late 1920s, antibiotics have revolutionized the field of medicine. They have saved millions of lives each year, and have even been used prophylactically for the prevention of infectious diseases. However, we have now reached a crisis where many antibiotics are no longer effective. Antimicrobial resistance is a natural phenomenon that occurs as microbes evolve. However, human activities have accelerated the pace at which bacteria develop and disseminate resistance.
AMR has emerged as one of the principal public health problems of the 21st century. This has resulted in a public health crisis of international concern, which threatens the practice of modern medicine, animal health and food security. The substantial problem of AMR is especially relevant to antibiotic resistance, although antifungal resistance is increasing at an alarming rate. Although the phenomenon of AMR can be attributed to many factors, there is a well-established relationship between antibiotic prescribing practices and the emergence of resistant bacteria. Antibiotic overuse is occurring in multiple sectors (human, animal, agriculture). Bacteria faced with antibiotic selection pressure enhance their fitness by acquiring and expressing resistance genes, then sharing them with other bacteria and by other mechanisms, for example gene overexpression and silencing, phase variation. Most bacteria and their genes can move relatively easily within and between humans, animals and the environment and several interconnected human, animal and environmental habitats can contribute to the emergence, evolution and spread of antibiotic resistance, and the health of these contiguous habitats may represent a risk to human health.
The World Health Organization (WHO) is now leading a global effort to address antimicrobial resistance. At the 68th World Health Assembly in May 2015, the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance. It sets out five strategic objectives:
- to improve awareness and understanding of antimicrobial resistance;
- to strengthen knowledge through surveillance and research;
- to reduce the incidence of infection;
- to optimize the use of antimicrobial agents; and
- to develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
The global nature of antibiotic resistance calls for a global response, both in the geographic sense and across the whole range of sectors involved. In line with a One Health approach, healthcare plays a central role in preventing the emergence and spread of antimicrobial resistance.
Although most physicians are aware of the problem of antimicrobial resistance, most under estimate this problem in their own hospital and prescribe inappropriately antibiotics.
The necessity of formalized systematic approaches to the optimization of antibiotic use in the setting of surgical general surgery units worldwide, both for elective and emergency admissions, has become increasingly urgent.
The Global Alliance for Infections in Surgery has launched a campaign aimed at using appropriately antibiotics across ther surgical pathway.
The first step of this campaign is to publish posters traslated in 13 different languages about principles for both appropriate therapy and prophylaxis in surgery.
Please, disseminate the posters across your hospitals around the world.