Antimicrobials are medicines that kill or attack germs such as viruses, bacteria, parasites and fungi that cause infections. They include antibiotics, which are commonly used against bacteria, as well as other medicines including antivirals and antifungals.
Antimicrobial resistance occurs when the germs that cause infections develop defences against these medicines. This means the medicines are less effective at stopping infections.
A growing problem
Antimicrobial resistance is not a new threat.
Germs (or microorganisms) have been developing resistance to antimicrobials since the first antibiotics were created in the early 1900s (O'Neill 2014).
However, we depend on antimicrobials to treat the bacterial, viral, fungal and parasitic infections that cause disease and death among millions of people around the world each year.
The rising number of infections which are resistant to antimicrobials is a serious threat to the health of humans worldwide. A United Kingdom review predicts that by 2050, there will be more than 10 million deaths every year around the world due to infections that are untreatable due to Antimicrobial resistance (O'Neill 2014).
There is a very real possibility we will return to a pre-antibiotic era, where even simple infections can prove fatal.
The threat of Antimicrobial resistance extends beyond the inability to treat patients who develop infections.
Many of the greatest advances in modern medicine rely on effective antibiotics to be safely undertaken.
In a world where antibiotics are no longer effective, we would also not be able to treat cancer, perform major operations and organ transplantations or save the lives of many premature infants (O'Neill 2014).
Causes of Antimicrobial resistance
The increase of Antimicrobial resistance is caused in part by overuse of antimicrobials among humans, animals and the environment (Department of Health/Department of Agriculture, Water and Environment, 2017).
In humans, over-prescribing of antimicrobials has provided an ideal opportunity for microorganisms, which naturally evolve over time, to develop resistance. In some cases, these microorganisms are completely resistant to all available treatment options (Department of Health/Department of Agriculture, Water and Environment, 2017).
This resistance is also partly due to the lack of new antimicrobials in production.
Investment in research and development of antimicrobials is limited because developing new antimicrobials is extremely complex, expensive, prone to failure, and has largely been left to profit-focused private industry (World Health Organization 2017).
And at the end of this complex process to develop a new, effective, inexpensive antimicrobial class of medicines, we would try to use it as little as possible. This is because these medicines may only be effective for a short period before resistance again emerges.
In Australia, as elsewhere, there is a clear consensus and urgent need to address AMR as one of public health’s highest priorities.
Tackling Antimicrobial resistance
In 2015, the Commonwealth Government's Department of Health and Department of Agriculture released Australia's first National antimicrobial resistance strategy. This outlines a joint approach to address antimicrobial resistance (Department of Health / Department of Agriculture 2015).
The strategy provides seven objectives:
- antimicrobial stewardship
- surveillance of Antimicrobial resistance and antibiotic usage
- infection prevention and control
- research and development
- international engagement and partnerships
An implementation plan was released in 2016, and a report of achievements for the strategy’s first two years of implementation identified improvements across all seven objectives, but also that there is much more to be done at both the state/territory and national level (Department of Health / Department of Agriculture and Water Resources 2016).
In Victoria, the Department of Health and Human Services focuses on surveillance and responding to Antimicrobial resistance. We have developed guidelines for two highly resistant microorganisms that spread within and between healthcare facilities, along with standard operating procedures for notifiable diseases identified in community settings that have developed resistance:
The first carbapenemase-producing Enterobacterales guideline was developed for Victoria in 2015 and updated in 2018 following an outbreak of Klebsiella pneumoniae within a metropolitan healthcare facility (Department of Health and Human Services 2018).
The Department of Health and Human Services has also developed Antimicrobial resistance standard operating procedures for two of the notifiable conditions that have developed resistance in community settings worldwide, namely gonorrhoea and shigellosis.
The response to these Antimicrobial resistant cases requires communication and education and the need for further antimicrobial testing to ensure the risk of further transmission between people is controlled.
The department, in conjunction with the Department of Jobs, Precincts and Regions, the Environmental Protection Agency and OneHealth sector representatives is currently developing a Victorian strategy and action plan to address Antimicrobial resistance that will be released in 2020.
Find out more
Access the UN Interagency Coordination Group on Antimicrobial Resistance final report No time to wait: securing the future from drug resistant infections for more on the global response to AMR.
Department of Health/Department of Agriculture 2015, Responding to the threat of antimicrobial resistance: Australia's first national antimicrobial resistance strategy 2015–19, Commonwealth Government of Australia, Canberra.
Department of Health/Department of Agriculture and Water Resources 2016, Australia's first national antimicrobial resistance strategy 2015–19: implementation plan, Commonwealth Government of Australia, Canberra.
Department of Health and Human Services 2018, Victorian guideline on carbapenemase-producing Enterobacteriaceae: for health services, State Government of Victoria, Melbourne.
Department of Health/Department of Agriculture, Water and Environment 2017, Antimicrobial Resistance, Commonwealth Government of Australia, Canberra.
World Health Organization 2017, Global Framework for Development & Stewardship to Combat Antimicrobial Resistance, World Health Organization, Geneva.
O'Neill J 2014, Antimicrobial resistance: tackling a crisis for the health and wealth of nations, UK Government, London.