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Clinical Impacts of Antimicrobial Resistance

Analyze and critically evaluate the emerging clinical impacts of antimicrobial resistance

 

Antimicrobials have revolutionized how patients with microbial infections are treated. It is one of the most vital clinical developments of the latter day and has saved millions of lives (Marston, Dixon, Knisely, Palmore, & Fauci, 2016). As such, their discovery was a turning point in human history. However, the continued evolution of antimicrobial resistance (AMR) in both the hospital setting and the community does occur nowadays and is on the rise. Resistance occurs when a microbe such as a bacteria, fungi, parasite, or virus, no longer reacts; (either through dying (bactericidal) or becoming weak (bacteriostatic)) to a medicine that previously treated it effectively (Bisen & Raghuvanshi, 2013).  The mechanisms in which this phenomenon develops include microbe mutation, gene transfer by picking up resistant genes from other microbes, and phenotypic change where the microbe alters its characteristics to become resistant to the antimicrobial (Rice, 2009) (Trauner, Borrell, Reither, Gagneux, & Trauner, 2014) (Davies & Davies, 2010). A substantial concern is that antimicrobial resistance could lead to a post-antimicrobial era in which antimicrobials would no longer be effective. This would mean that common infections and minor injuries that became straightforward to treat could again, become deadly (Barriere, 2015).

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The emergence of antimicrobial resistance is the greatest challenge and hindrance to the effective treatment of antimicrobial infections. It most commonly affects patients and the healthcare system hence posing significant clinical impacts on the two. Therefore, this essay will analyze and critically evaluate the evolving clinical impacts of antimicrobial resistance without pinpointing the analysis to a specific geographical area of study due to availability of limited, relevant data. These clinical impacts include treatment failure, prolonged or additional hospitalization, and increased risk of spreading antimicrobial resistance. A sound conclusion will also be drawn from this analysis and evaluation.

To begin with, treatment failure is a clinical impact of antimicrobial resistance. Treatment failure is simply the inability of an antimicrobial to control or manage the disease caused by the resistant microbe. Because the first line treatment fails, the need for an alternative antimicrobial as treatment inevitably arises (French, 2005) (Bisen & Raghuvanshi, 2013). A substitution of treatment means patient will experience new side effects of the treatment. It is common knowledge that all medicines have side effects (Aronson, 2016) hence, a patient may be exposed to harmful adverse reactions although his/ her life is dependent on the treatment. This requires frequent monitoring and longer treatment period so that a successful management outcome is achieved (French, 2005). Additionally, second and third – line treatments are costly since they are along the last resort of treatments, hence a financial impact to the patient (Collignon, 2015). The same point is supported by the Centers for Disease Control and Prevention, articulating that healthcare providers are forced to use antimicrobials that may be more toxic to the patient and frequently more expensive although less effective (Frieden, 2013).

The effect analyzed above leads to the clinical impact of prolong hospitalization. Longer hospital stays depict fatal results from a longer disease course (Friedman, Temkin, & Carmeli, 2015). Moreover, it reflects a poor quality of life with a higher risk of exposure to serious disability. People infected with drug-resistant microbes are more likely to have longer hospital stays and may pass way, as a result of infection. The theory behind prolong hospitalization also posts the threat of getting infected with a new disease or illness in the healthcare facility, especially when infection control is not an area that is executed accurately by that specific facility.

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Lastly, antimicrobial resistance increases the risk of spreading a disease to others and in turn, increasing their risk of becoming resistant to certain microbes. Increasing antimicrobial resistance potentially threatens the safety and efficacy of surgical procedures and immunosuppressive chemotherapy. Friedman, Temkin, & Carmeli (2015) estimated that between 38.7% and 50.9% of pathogens causing surgical site infections and 26.8% of pathogens causing post – chemotherapy infections are resistant to standard prophylactic antimicrobials in the United States of America. Within the healthcare system, there are cases in which antimicrobial resistance may therefore limit available and often lifesaving treatment options. Colonization with multidrug-resistant microbes now has implications for clinical decisions about management strategies in patients who may require procedures such as bone marrow transplantation (Friedman, Temkin, & Carmeli, 2015).

To conclude, the clinical impacts of antimicrobial resistance is rapidly progressing. Antimicrobial resistance significantly affects patients and it is an issue that needs to be taken seriously. It seems global efforts to combat this threat are underway, but many health experts say such efforts need to produce results faster. If the trend of microbes becoming resistant to antimicrobials continues to spread, the world we live in may find itself back in the pre – antimicrobial era of medicine, before today’s miracle drugs ever existed. Antimicrobial resistance causes increased mortality rate and disease complications, increased expense, prolonged hospitalization and higher risk of toxicity due to exposure to new side effects. Antimicrobial resistance is a continuing and growing issue. There are few new classes of antimicrobials likely to be available in the next few decades. Therefore, it is necessary to preserve the usefulness of those antimicrobials that we currently have by decreasing their overall use, and especially the use of broad-spectrum agents. It is also necessary to improve our ability to prevent infections and the spread of resistant bacteria wherever they are found. This means improving practices of infection control, hygiene, animal husbandry and the development and delivery of effective and safe vaccines. Failure to do this will result in huge numbers of people entering a ‘post-antimicrobial era’ for too many common infections.

References

  • Aronson, J. (2016). Meyler’s side effects of drugs : the international encyclopedia of adverse drug reactions and interactions (16th ed.). Netherlands: Elsevier Science.
  • Barriere, S. (2015). Clinical, economic and societal impact of antibiotic resistance. Expert Opinion on Pharmacotherapy, 16(2), 151-153. doi:https://doi.org/10.1517/14656566.2015.98307
  • Bisen, P., & Raghuvanshi, R. (2013). Antimicrobial Resistance. In P. Bisen, & R. Raghuvanshi, Emerging Epidemics: Management and Control (pp. 585-614). Hoboken, NJ: John Wiley & Sons, Inc. doi:https://doi.org/10.1002/9781118393277.ch21
  • Collignon, P. (2015). Clinical impact of antimicrobial resistance in humans. Revue Scientifique et Technique (International Office of Epizootics), 31(1), 211-220. doi:https://doi.org/10.20506/rst.31.1.2111
  • Davies, J., & Davies, D. (2010). Origins and Evolution of Antibiotic Resistance. Microbiology and Molecular Biology Reviews, 74(3), 417-433. doi:https://doi.org/10.1128/MMBR.00016-10
  • French, G. (2005). Clinical impact and relevance of antibiotic resistance. Advanced Drug Delivery Reviews, 57(10), 1514-1527. doi:https://doi.org/10.1016/j.addr.2005.04.005
  • Frieden, T. (2013). ANTIBIOTIC RESISTANCE THREATS in the United States, 2013. Centers for Disease Control and Prevention.
  • Friedman, N., Temkin, E., & Carmeli, Y. (2015). The negative impact of antibiotic resistance. European Society of Clinical Microbiology and Infectious Diseases, 416-422.
  • Marston, H., Dixon, D., Knisely, J., Palmore, T., & Fauci, A. (2016). Antimicrobial Resistance. The Journal of the American Medical Association, 316(11), 1193-1204. doi:https://doi.org/10.1001/jama.2016.11764
  • Rice, L. (2009). The clinical consequences of antimicrobial resistance. Current Opinion in Microbiology, 12(5), 475-481. doi:https://doi.org/10.1016/j.mib.2009.08.00
  • Trauner, A., Borrell, S., Reither, K., Gagneux, S., & Trauner, A. (2014). Evolution of drug resistance in tuberculosis: recent progress and implications for diagnosis and therapy. Drugs, 74(10), 1063–1072. doi:https://doi.org/10.1007/s40265-014-0248-y


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