Understanding your role in detecting, reducing and preventing the development of antimicrobial resistance (AMR) is key to combating this growing threat. Once we realize how our actions can impact AMR, we can then take appropriate actions to stop and reduce the development and spread of AMR. Acknowledging that certain current clinical, industrial, agricultural and veterinary practices may directly or indirectly lead to AMR is key to resolving the problem. The proper stewardship of our vital drugs is indisputably the most immediate way AMR—and the high financial cost of AMR—can be curtailed and ultimately reduced. The key to curbing resistance is to ensure that every patient receives the right antibiotic at the right time at the right dose for the right duration.
No single role within the public health continuum can solve the monumental problem of antimicrobial resistance. To have a positive and lasting impact everyone must work in concert to curb the overuse and misuse of antimicrobial agents, with the goal to ultimately reduce the spread and rates of antimicrobial resistance.
When varied groups work together, AMR reduction can happen and the results can be truly remarkable. Hospitals with coordinated and fully integrated antimicrobial stewardship programs, for example, have achieved amazing reductions in AMR. These programs have not only resulted in improved antimicrobial use but have demonstrated decreased overall spending on antibiotics by hundreds of thousands of dollars. In fact, entire nations that have adopted this holistic approach—where everyone has a role and every part matters.
Why do you matter? How can you specifically contribute?
In the same way physicians should prescribe the optimal antibiotic to treat human infections, animal health professionals should do the very same. Sub-therapeutic doses of antibiotics should not be given to animals prophylactically. Antibiotics should not be used in animal feed to promote “larger, plumper” food products. Animal health professionals also play a key role in the surveillance of antibiotic-resistant zoonotic and animal pathogens. They must be engaged in employing the newest diagnostic technologies that identify these pathogens and AMR quickly.
Continued public and private support of academic research is essential not only for the discovery and development of new antimicrobial agents, but additionally to understand the underlying host responses to infections; define alternative pathways to control infections; and develop new improved rapid diagnostic technologies. Diagnostic technologies should not only detect the causative pathogen and its drug susceptibility profile, but identify host susceptibilities to infections, host response biomarkers and differentiate between types of infections, such as viral versus bacterial. Despite continued funding cutbacks, we ask for continued perseverance of researchers, both academic and clinical involved in this critical and lifesaving challenge.
Critical to the combat of AMR is a global understanding of the magnitude of the problem and dissemination of information through public communication. Everyone needs to be educated and everyone in turn can be an educator; clinical care providers, laboratorians, public health administrators, government officials, advocacy groups, teachers and even the general public. Education is everyone’s responsibility including the parent teaching their children to wash their hands and cover their cough.
Legislator, Policy Maker
The CDC estimates that drug-resistant bacteria cause two million illnesses and approximately 23,000 deaths each year in the United States alone. The White House has called for “a whole-of-government approach” over the next five years to reduce resistance with government officials playing a key role in encouraging the development of rapid diagnostic tests, new antimicrobials s and the implementation of the “One-Health” approach to disease surveillance. The goal of this approach is to improve detection and control of antimicrobial resistance by integrating data from multiple monitoring networks. Legislators and policy makers must continue in their efforts to drive this national program and sustain financial resources essential for the required programs.
C-Suite, Information Technology, Human Resources, Purchasing
Healthcare administrators have a fiduciary responsibility to the hospital and a responsibility to the patient to provide excellent care to their community. Administrators makes decisions that are at the forefront of the battle against AMR. There is a growing body of evidence that investment in antimicrobial stewardship, advanced diagnostics, information technology and staff training can dramatically reduce this problem. Administrators have the power to make the decisions to implement programs and provide funding to support initiatives that can aid in combating antimicrobial resistance.
If new medications are not developed and the spread of resistance is not contained, our communities could face the possibility of truly untreatable infections.
The pharmacist is the bridge between the clinician and the patient in ensuring that the most appropriate antimicrobial is used, in the most optimal dosage. The pharmacist must be in close contact with the microbiology laboratory so they can rapidly identify patients on antimicrobial therapy that may be inadequate, ineffective at a particular dose, or too broad spectrum for the particular pathogen. The pharmacist should be an essential member of the stewardship team, by interacting with the clinical team, not only in the selection of initial therapies, but also in developing therapeutic strategies that are appropriate, cost effective and tailored so as to reduce the risk for the development of AMR. The key to curbing resistance is to ensure that every patient receives the right antibiotic at the right time at the right dose for the right duration.
Laboratory Director/Manager/Supervisor, Laboratory Technician, Laboratory Assistant
Laboratory Professionals are on the front lines in the battle against AMR. The Laboratory has the often difficult responsibility of providing accurate and actionable information that is essential for clinicians to properly treat their patients. The importance of this role cannot be limited to a 9-5 shift or the typical Monday-Friday work week. A blood culture signals positive in all hours of the day and night. If no one is present to take action, there can be a serious delay in pathogen identification and antimicrobial susceptibility test results. The Laboratory’s responsibility is to share this vital information with the appropriate caregivers as soon as possible so that the overuse or misuse of antimicrobials is limited to the briefest possible time interval. Clinical laboratory scientists must serve as sentinels keeping watch on the emergence of resistance pathogens in our health care institutions, by providing critical yearly antibiograms that report resistance rates within their institutions and also individual units. Laboratorians must work to prevent any delays in reporting antibiotic resistance or the discovery of potential outbreaks that could result in the spread or emergence of resistance pathogens. Laboratory professionals must ensure their laboratory adapts quickly to the challenges faced by the emergence of new pathogens, increase resistance rates, novel resistance mechanisms, and provide the most accurate antimicrobial susceptibility testing.
Executives, Sales, Marketing, Manufacturers, Customer Service Operations, Field Service Engineers, Implementation, Research & Development
In the last 10 years, the science of microbiology has taken an enormous leap forward with tools and diagnostic platforms that can dramatically reduce the time it takes to diagnose infectious diseases. Previously, diseases that could take weeks to diagnose (such as tuberculosis) can now be diagnosed within several hours using advanced molecular based technologies (syndromic testing with PCR) or proteomic diagnostic techniques (MALDI-TOF). Not only are these technologies rapid but in many instances more accurate than conventional test methods. The shorter the time to pathogen identification and detection of AMR, the more likely the patient is treated appropriately and fewer patients are treated ineffectively when infected with resistant organisms. Alternatively, sensitive, rapid diagnostics can also decrease the use of broad spectrum antibiotics, that can lead to health care associated infections such as Clostridium difficile. It is imperative that diagnostic and medical device professional’s continue to invest and develop technologies that quickly identify pathogens and AMR. Diagnostic and medical device professionals should ensure participate in the education of their customers about the advances in microbial identification and demonstrate how these advances reduce morbidity and mortality, while preserving precious financial resources.
Physicians, Nurses, Nurse Specialists and Practitioners, Physicians’ Assistants, Clinical Support Teams
There are several steps that clinical staff can take to curtail and reduce AMR. Essential action items include the prompt initiation of infection control practices, when indicated, and the judicious use of antibiotics, including a commitment to prescribe the narrowest spectrum antibiotic that is consistent with good medical practice. Establishment and use of an antimicrobial stewardship program is helpful in the latter, especially when clinical decision teams consist of treating physicians, pharmacists, clinical care staff and microbiologists. Frequent and timely communication of critical results among health care providers is essential to achieve the goals of stewardship. The rapid exchange of information relating to test results (pathogens, antimicrobial susceptibility data) can have a profound impact on patient management. It is essential to share this information and any other findings that could result in appropriate antimicrobial escalation or de-escalation, switching from IV to oral therapy, or to discontinuation of some or all antibiotics. Failure to rapidly communicate these results can delay appropriate changes in antimicrobial therapy for hours or days, thereby potentially promoting the development of AMR and increasing the risk subsequence consequences of antimicrobial therapy, such as the development of Clostridium difficile disease.
The role of the general public or patient is to stay well informed about the issues of AMR. Antibiotics are often very necessary to treat infections, but not all infections. A survey by the CDC and Pew Health Group revealed that nearly 40% of Americans believed antibiotics could treat viral infections, which is incorrect. For example, most respiratory infections (85%) are caused by viruses yet antibiotics are generally prescribed. Requesting antibiotics from your doctor for colds, the flu, and other viral infections will not help you fight these infections but can lead to the development or acquisition of drug resistant pathogens that could do the you harm in the future. It is important that patients advocate for themselves, but do so intelligently. Don’t insist on antibiotics if the doctor tells you they will not help. If you are prescribed antibiotics, take the complete course and never give antibiotics prescribed to you to someone else or take antibiotics prescribed for someone else.
Everyone plays a role in the fight against antimicrobial resistance. Understanding your role and how you, specifically, can contribute in the fight against antimicrobial resistance is the first step in combating it. If you don’t fit within any of the above roles, define yours. Understand what it is you can do to help combat AMR, and take the pledge today. Every part and every role matters, and together our roles make a difference.