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. Such infections often result in an increased number of hospitalizations, more treatment failures, and the persistence of drug-resistant pathogens. Antimicrobial 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.
AMR should focus firstly on local needs and national plans because each country is different. However, resistance is everyone’s problem and all countries have a role in solving the problem. The countries that have crafted inclusive national plans have been successful in controlling AMR. These approaches include cautious use of antibiotics, surveillance of antibiotics by employing the One Health approach, advancement of health care setup, restricted drug promotion, consistent disease control strategies, and stewardship plans. On the other hand, these strategies demand patience and time to be organized. Furthermore, these require a comprehensive endorsement from the government authorities with ample funds.
However, AMR poses a global challenge. No single country, however effective it is at containing resistance within its boundaries, can protect itself from the importation of antibiotic resistance through travel and trade.
The global nature of antimicrobial resistance calls for a global response, both in the geographic sense and across the whole range of sectors involved. Nobody is exempt from the problem.
More than 1.2 million – and potentially millions more – died in 2019 as a direct result of antibiotic-resistant bacterial infections, according to the most comprehensive estimate to date of the global impact of AMR.
The Covid-19 pandemic has highlighted the importance of global collaboration to tackle a global health threat.
Like Covid-19, we know what needs to be done to address AMR, but we must now come together with a sense of urgency and global solidarity if we are to be successful.
Given the complexity of AMR and associated issues with optimizing the treatment of patients with surgical infections, a multidisciplinary approach is paramount, although it is not always possible in real-life clinical practice. The best means of improving antimicrobial prescriptions in general, and in emergency surgical units worldwide is through collaboration among the various specialties within a healthcare institution. Every hospital worldwide should work within its resources to create an effective multidisciplinary team to combat AMR given its budget and personnel constraints.
Keeping patients safe from infection and ensuring that effective antibiotic use is available for future generations should be based on collaboration between all the involved stakeholders in order to gain wider-possible acceptance, share knowledge, and spread best clinical practices.
Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes and reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for ASPs are not definitively established and are likely to vary based on local culture, policy and routine clinical practice, and probably limited resources. Many hospitals remain without formal programs and those that do continue to struggle with gaining acceptance across service lines. Moreover, identifying optimal efforts to impact system change has been challenging.
Hospitalized patients may have multiple risk factors for the acquisition of antibiotic-resistant bacteria, and acute care facilities are incubators for their spread. The intensity of patient care in acute care facilities can create an environment facilitating both the emergence and spread of AMR. It is important that all healthcare workers (HCWs) respect evidence-based measures of infection prevention and control, preventing the occurrence of healthcare-associated infections (HAIs), and, then making every effort to prevent the transmission of microorganisms including antibiotic-resistant bacteria.
HAIs are very common adverse events in healthcare. Patients at high risk of HAIs are those who undergo surgical procedures and patients with medical devices such as central lines, urinary catheters, and ventilators. HAIs are linked with high morbidity and mortality, can require additional diagnostic and therapeutic procedures, prolong hospital stays, and necessitate additional costs. Moreover, many HAIs are caused by antibiotic-resistant bacteria.
However, the importance of the phenomenon is not yet sufficiently perceived among HCWs, resulting in a poor level of responsiveness.
Source control aims to eliminate the source of infection, reduce the bacterial inoculum and correct the anatomic derangements to restore normal physiologic function. Source control is of utmost importance in the management of infections. Intra-abdominal infections and soft tissue infections are the settings where the source control is more impactful. In these settings, appropriate control of the source of infection can improve patients’ outcomes and can reduce antibiotic pressure allowing short courses of antibiotic therapy. However, also in other settings, the role of source control should not be underestimated.
A global action plan to tackle the growing problem of resistance to antibiotics and other antimicrobial medicines was endorsed at the Sixty-eighth World Health Assembly in May 2015. One of the key objectives of the plan is to improve awareness and understanding of AMR through effective communication, education, and training. World Antimicrobial Awareness Week (WAAW) aims to increase awareness of global antibiotic resistance and to encourage best practices among the general public, health workers, and policymakers to avoid the further emergence and spread of antibiotic resistance. WAAW is celebrated from 18 to 24 November every year.
This year, the theme of WAAW is “Preventing Antimicrobial Resistance Together.” All sectors are called to encourage the prudent use of antimicrobials and to strengthen preventive measures addressing AMR, working together collaboratively through a One Health approach.
This year, during WAAW 2022, the Infections in Surgery Global Webinar will be held. It will be free and completely online.