Preventing and managing antimicrobial resistance: imperative for chest physicians

Abstract

World Health Day is celebrated every year on the 7th of April as a major advocacy event promoted by the World Health Organization (WHO) for all ministries of health worldwide. The aim is to bring a specific topic of great importance to national and international attention. This year, the selected theme is antimicrobial resistance (AMR), which is a serious threat to the care and control of all infectious diseases. AMR not only affects the three major pandemics of tuberculosis (TB), malaria and HIV, but most other infectious diseases, including widespread hospital-acquired infections, particularly after the emergence of “superbugs” resistant to all currently available major antibiotics 1, 2. The identification of AMR as a serious international health issue comes at a crucial point in the global attempt to contain its impact. Strategies have been defined by WHO in the past decade, but rarely implemented 3. In the past few years, the appearance of multidrug-resistant organisms capable of resisting the most potent latest-generation antibiotics and chemotherapeutic agents has generated substantial apprehension among clinicians and public health experts (fig. 1). Figure 1– Simplified mechanism of the development of antimicrobial resistance. In 2006, the first description of extensively drug-resistant (XDR)-TB, i.e. a disease caused by Mycobacterium tuberculosis strains resistant to the most important first- and second-line anti-TB drugs, prompted international attention 4, 5, particularly following the appearance and spread of XDR-TB amongst people living with HIV in South Africa, which resulted in an unprecedented high case-fatality rate 6. XDR-TB has been reported in nearly 70 countries worldwide, and strains resistant to all first- and second-line drugs are circulating in Europe 7. Multidrug-resistant (MDR)-TB, a disease that is caused by strains that are at least resistant to the two most potent first-line drugs, is present everywhere; the highest percentage …