FAQ

Antimicrobial resistance is a broad term used to describe resistance to drugs that treat infections caused by different microbes, such as bacteria, parasites, viruses and fungi. ⁽¹⁾

Antibiotic resistance refers only to bacteria becoming resistant when exposed to antibiotics used to treat infections caused by them. ⁽³⁾ 

Many of the global action plans are applicable to resistance mechanisms in bacteria and other microorganisms. ⁽⁵⁾

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Antibiotics are medicines that can kill or inhibit the growth of bacteria that are responsible for causing infections. ⁽⁴⁾ Antibiotics can be effective against one or multiple types of bacteria: ⁽⁴⁾  in the latter case they are referred to as broad-spectrum antibiotics. ⁽²⁾ There are several classes of antibiotics that differ in chemical structure and mechanism of action; these can determine the choice of antibiotic in specific infectious bacteria. ⁽⁴⁾ 

The misuse of antibiotics, inappropriate dosing and length of administration, can lead to the rise and spread of antimicrobial resistance. ⁽⁵⁾

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Antibiotic resistant bacteria, also called superbugs, are microorganisms that constantly find new strategies to overcome the effects of antibiotics. ⁽²⁾ The production of specific proteins by the bacteria determines the resistance mechanisms that change over time leading to persistent infections. ⁽²⁾

As the bacteria become resistant, they can share their resistance genes with other germs that have not been exposed to antibiotics making the antibiotic ineffective. This forms the basis of the phenomenon known as multi-drug resistance which leads to untreatable or difficult to treat infections. ⁽²⁾

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Resistance to antibiotics has been identified throughout the world. New forms of resistance can spread easily between continents through the movement of people, goods and animals. Antibiotic resistance can affect anyone at any stage of their life; particularly vulnerable groups include people with pre-existing conditions, weakened immune systems and the elderly, who are often at higher risk for acquiring infections. ⁽²⁾

As few replacement drugs are in the pipeline, with no coordinated and immediate actions on a global scale, the world is heading towards a post-antibiotic era in which common infections could once again kill. ⁽⁵⁾

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Resistance develops more rapidly because of the inappropriate use of antimicrobial drugs. ⁽⁵⁾ In addition to naturally occurring resistance mechanisms, the misuse and overuse of antibiotics can cause an increase in the spread of resistant germs. ⁽⁵⁾

For example, antibiotics can become a serious concern in the spread of resistance when used for non-bacterial infections, for a shorter period of time and at a lower dose than prescribed, or not considering the correct mechanism of action towards a specific strain. ⁽⁴⁾

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Institutions are constantly monitoring microorganisms to keep the spread of antimicrobial resistance under control. The World Health Organization has drawn up a list of the highest priority needs for new antibiotics. The WHO list is divided into three categories according to the urgency of need for new antibiotics: critical, high and medium priority. ⁽⁸⁾

WHO priority pathogens list for Research and development of new antibiotics ⁽⁸⁾

Among the critical priority, we can find:

• Acinetobacter baumannii, carbapenem-resistant
• Pseudomonas aeruginosa, carbapenem-resistant
• Enterobacterales*, carbapenem-resistant, ESBL-producing

^{*: Enterobacterales include: Klebsiella pneumonia, Escherichia coli, Enterobacter spp., Serratia spp., Proteus spp., and Providencia spp, Morganella spp}

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Staphylococcus aureus is a common bacterium, present on skin and mucosa in 20% to 30% of healthy people. It may sometimes cause infections if it is introduced into the body. It typically causes skin and wound infections but can cause pulmonary, surgical site, bloodstream, heart, bone and other invasive infections. When it is resistant to methicillin and to many other antibiotics, it is called MRSA or “Methicillin-Resistant Staphylococcus aureus”. ⁽⁴⁾

Typically, MRSA that is found in hospitals is resistant to many other antibiotics.

MRSA is mainly acquired through direct contact from human to human or via equipment or medical devices. Antibiotic use is also associated with higher risk of acquiring MRSA. ⁽⁴⁾

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Bacterial infections can be stopped by avoiding the spread of germs and improving infection prevention, both in everyday life and in healthcare facilities, and using antibiotics only when needed. 

Stopping the spread of resistant threats in the community requires tailored interventions by institutions, such as simple and fundamental hygiene rules, routine vaccination, safer sex practices and sterile food preparation. ⁽²⁾

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Antibiotic-resistant germs can spread between people causing infections with or without symptoms ⁽²⁾. In many cases, the symptoms of the diseases caused by superbugs can be very similar to the ones caused by the most common infections; the only difference is in the duration and responsivity to antibiotics. ^{(2) (7)}

When drugs are ineffective against resistant bacteria, infections may persist longer in the body, increasing the risk of spread. ⁽³⁾

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There are few prospects for the development of new antibiotics in the short term as no major new class of antibiotics has been discovered since 1987 and too few antibacterial agents are being developed to meet the challenge of multidrug resistance. ⁽⁵⁾ New concepts are needed for promoting innovation and providing new global technologies to prevent, diagnose and treat resistant infections. ⁽⁵⁾ 

It is imperative that interventions to limit the spread of resistance are implemented globally, so that the current armamentarium of antibiotics is used judiciously. ⁽⁵⁾

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The long-term goal of a global action plan is to ensure continuity of successful treatments and prevention of infectious diseases with effective, safe and quality-assured medicines, that are used in a responsible way and accessible to all those who need them. ⁽⁵⁾

For this purpose, antibiotic stewardship interventions are aimed at improving the way antibiotics are prescribed and used, following procedures both for healthcare professionals and for patients, raising awareness on bacterial diseases and antibiotic resistance importance. ⁽²⁾

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Drug-resistant bacteria can circulate among people and animals, through food, water and the environment as transmission is influenced by trade, travel and both human and animal migration. ⁽⁵⁾

Since resistant bacteria can be found in food products for human consumption, it is fundamental to observe hygiene rules such as washing, cooking and conserving food properly to avoid contamination and spreading. ^{(5) (2)}

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Carbapenems are a specific class of antibiotics that plays a critical important role in the antimicrobial armamentarium. Of the many different β-lactams available, carbapenems possess the broadest spectrum of activity and greatest potency against Gram-positive and Gram-negative bacteria. As a result, they are often used as “antibiotics of last resort” when patients with infections become gravely ill or are suspected of harboring resistant bacteria. ⁽⁹⁾

Carbapenem resistance occurs when a particular group of bacteria are able to overcome the effects of this antibiotic class. ⁽²⁾

Some bacteria in the family of Carbapenem-resistant Enterobacterales (CRE) are resistant to nearly all antibiotics. They represent a major concern for patients in healthcare facilities, like those who require devices or take long courses of some antibiotics. ⁽²⁾

CRE can carry mobile genetic elements that are easily shared between bacteria, producing an enzyme which makes carbapenem antibiotics ineffective and rapidly spreads resistance. ⁽²⁾

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The goal of keeping antimicrobial resistance under control is only achievable if global plans provide rules about disease awareness, drug prescribing and healthcare systems organization that can be applied and implemented by every country. ⁽⁵⁾

Stewardship is a comprehensive approach aimed at optimising antibiotic prescribing and use among healthcare professionals and patients, by sharing practices for optimal selection, dosage and duration of antimicrobial treatments that result in the best clinical outcome. ⁽⁶⁾

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