Tackling antimicrobial resistance
Vaccinarsi in Sardegna plays an active role in the fight against antimicrobial resistance, given that vaccination is among the top ten most effective actions for counteracting not only the inappropriate use of antibiotics, but also and above all, the development of resistance to antimicrobial drugs. In this section, it will therefore be possible to consult all available attachments regarding the actions implemented to tackle this important public health problem at a national and international level , with a specific focus on the initiatives promoted by the Region of Sardinia.
Antimicrobial Resistance (AMR) is one of the most important public health problems, affecting both human and veterinary medicine. The phenomenon stems from the ability of a given microorganism to develop and express among its pathogenicity effectors one or more genes of resistance to the activity of a drug (which had originally been effective for the treatment of infections caused by the pathogen in question), be it antibacterial, antifungal, antiviral and/or antiparasitic. This expression of resistance determines the consequent survival of the germ which, by completing its lifecycle, makes the pharmacological treatment of infected patients extremely difficult, expensive and in some cases even impossible, with a consequent significant epidemiological, social and economic impact both in industrialised countries and in economically weaker ones (1).
For several decades, in fact, antimicrobial resistance has represented a growing threat for the treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi, whose expressions of resistance to pharmacological activity have been consolidated over time. It now constitutes one of the main health-care challenges facing Public Health for the coming decades, as warned also by the World Health Organisation (2). It should be noted that in the face of this increase and spread of antimicrobial resistance, a parallel increase in the search for new molecules with antibacterial activity (1,3) has not been confirmed, further exacerbating the problem. Moreover, the increasing incidence of infections with multi-resistant microorganisms (Multi-Drug Resistant Organisms, MDROs) has identified microorganisms resistant to more than one class of antimicrobials, reducing, sometimes drastically, the therapeutic arsenal available to the clinician and causing increases in the complexity of care with a rise in morbidity, mortality, health care costs, and last but by no means least, a particularly problematic and difficult-to-manage social alarm (4.5).
The economic consequences of this phenomenon are staggering: it is estimated that the need to use second- or third-line antibiotics for the treatment of numerous infections (sometimes requiring hospitalisation) already entails additional costs amounting to approximately € 1.5 billion each year for the hospitals of the European Union (6).
Of no less importance is the impact of the problem in the veterinary and agricultural fields, where the spread of resistance could have a serious impact on the health of animals, with the possibility of significant repercussions on reproductive ability, and humans. In fact, in the veterinary sector alone accounts for over 50% of all antibiotics used globally; this represents a risk factor for the selection and spread of resistant bacteria, both commensal and zoonotic. The transfer of multi-resistant bacteria from the environment to humans can take place either by direct contact, through the consumption of animal source foods, or by indirect contact, through multiple cycles of environmental contamination. In this regard, the link between the veterinary and human disciplines is jointly analysed at a European level by the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC). Furthermore, in 2015, the first joint report was prepared by EFSA / ECDC / EMA (“First Joint Report on the integrated analysis of consumption of antimicrobial agent and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals”)which, through an integrated analysis explored the link between the consumption of antibiotics in humans and in farm animals for food purposes and the corresponding resistance in bacteria (7). On a global level, approximately 700,000 people die every year from bacterial infections and it is estimated that by 2050 this could rise to a total of 10 million deaths per year: exceeding cancer deaths, predicted at 8.2 million for the same year. In Europe, the resistance of bacteria to antibiotics is the cause of at least 25,000 deaths per year, a figure destined to increase tenfold within 35 years (6).
Based on this brief outline, which identifies the problem as one of the most thorny in the current healthcare climate, numerous agencies have analysed the phenomenon, recommending specifically-structured action plans to tackle it and developing methods to optimise the fight against infections.
Among the top ten actions specifically aimed at combating AMR, there are a series of parallel and equivalent strategies, such as the introduction of innovative cost-effective technologies, the formulation of policies on risk prevention, the reduction of environmental risks through an adequate level of cleanliness and hygiene, continuous staff training, prompt and accurate diagnosis, the prescription and intake of antibiotics only if and when strictly necessary, and the prevention of all infections.
In these strategic guidelines, it is necessary to include prophylactic vaccination, thanks to which it is today possible to prevent infections caused by Multi-Drug Resistant (MDR) organisms. In fact, based on their extraordinary ability to prevent the main infectious diseases vaccines reduce the development of MDR bacteria infections even in those who cannot undergo vaccination, through the well-known mechanism of herd immunity. They reduce the total number of infections by a given bacterial strain (acting on both susceptible and resistant bacteria) and mitigate the need for antibiotic treatments (for example, controlling through vaccination the main invasive bacterial diseases, and in particular meningitic ones, such as Meningococcus, Pneumococcus and Haemophilus, greatly reduces the use of antibiotics in childhood , despite the knowledge that the disease is probably viral in origin).
Finally, by preventing viral infections such as the flu, they are able to tackle AMR thus reducing the number of diseases with a viral etiology and avoiding the administration of inappropriate antibiotics or treatments necessary to treat bacterial superinfection.
Since 2008, every November 18, the ECDC has celebrated European Antibiotic Awareness Day (EAAD) (8), to raise awareness of the prudent use of antibiotics and in conjunction, by identifying this problem as a health emergency of national significance, the Ministry of Health has implemented a targeted action through the drawing up of the National Plan to tackle AMR (PNCAR) 2017-2020 (9).
On the occasion of this important anniversary, VaccinarsinSardegna reports the main activities carried out on a regional, national and international level and invites users to reflect on the importance of this phenomenon.
Sources / Bibliography
- Antimicrobial resistance: global report on surveillance - World Health Organization - 2014
- World Health Organization. Antimicrobial resistance: global report on surveillance. Geneva: WHO, 2014
- Silver LL. Challenges of Antibacterial Discovery. Clinical Microbiology Reviews 2011;24:71-109
- Magiorakos AP, Srinivasan A, Carey RB et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an International expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18:268-81
- Siegel JD, Rhinehart E, Jackson M, Chiarello L. The Healthcare Infection Control Practices Advisory Committee Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006. Disponibile su: https://www.cdc.gov/mrsa/pdf/mdroGuideline2006.pdf
- Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. 2014.
- PNCAR-Piano Nazionale Contrasto Antimicrobico resistenza 2017-2020.