Tackling drug resistance: global crisis requiring local action
To mark World AMR Awareness Week (18-24 November) ESR clinical microbiologist Dr Juliet Elvy explores Aotearoa’s place in the global landscape of drug resistance, and the role of ESR's Antibiotic Reference Laboratory in controlling resistant infections.
Amid countless global challenges, there’s one silently lurking crisis that is threatening the very core of modern medicine – Antimicrobial Resistance (AMR). Referred to by the World Health Organisation (WHO) as one of the top ten global threats facing humanity, AMR poses a grave danger. It’s a phenomenon where microorganisms, often dubbed ‘superbugs’, have developed resistance to most antimicrobials, rendering them ineffective. The root cause? The overuse and misuse of antibiotics.
The urgency of addressing AMR is akin to the climate crisis, a ticking time bomb. Without effective antimicrobials, routine medical procedures, from surgery to cancer chemotherapy and organ transplantation come with heightened risks due to surgical site infections. However, AMR is not limited to a single sector; it affects humans, animals, plants, food, and the environment, necessitating a unified, multi-sectorial approach, often referred to as the 'One Health' approach.
Hence why the theme for this year’s World AMR Awareness Week (WAAW) is 'Preventing Antimicrobial Resistance Together'. This global campaign, led by WHO from November 18 to 24, strives to raise awareness about antimicrobial resistance and promote best practices to prevent the spread and development of drug-resistant infections. Emphasizing the fight against resistance, the campaign’s mantra, ‘Antimicrobials: handle with care’, underscores the importance of responsible use.
In Aotearoa New Zealand, the Institute of Environmental Science and Research (ESR) plays a pivotal role in detecting resistant infections. ESR’s Antibiotic Reference Laboratory provides national surveillance of antimicrobial resistance among human pathogens and the typing of pathogens causing outbreaks. Clinical microbiologists collaborate with ESR’s Antibiotic Reference Laboratory to identify rare and emerging resistant bacteria. Routine monitoring allows us to stay one step ahead of outbreaks, detecting resistant infections, identifying transmission patterns and preventing their spread before it’s too late. ESR aligns its efforts with the WHO’s list of priority pathogens, ensuring the most effective tracking and surveillance.
Drug resistance knows no borders
As New Zealand grapples with the AMR crisis, it’s essential to assess our standing. The nation’s use of antibiotics is relatively high on a global scale, comparable to some of the top antibiotic-consuming countries. Surprisingly, our resistance levels remain relatively low. Our small population density and geographical isolation may be contributing factors.
However, this isn’t something we can take for granted. A recent Vancomycin-resistant Enterococci (VRE) outbreak in Waikato hospital serves as a wake-up call and stark reminder that we cannot afford complacency. Enterococci are bacteria found in human intestines and the genital tract and can cause infections. While VRE, a bacterium resistant to many antibiotics, is not yet endemic in New Zealand, it is crucial to acknowledge the potential threat and take urgent action.
Addressing resistant infections
So, what can we do as a nation to ensure our antimicrobial resistance levels remain low? Ensuring we implement robust surveillance of AMR and antimicrobial usage and have adequate resources to adhere to infection prevention measures, is critical. The COVID-19 pandemic caused a decrease in AMR surveillance data, primarily due to the strain on laboratory resources. Additionally, New Zealand currently lacks ongoing antimicrobial usage reporting, a surveillance tool that is essential for the country to implement.
Aside from a nationwide effort, there are steps we can take as individuals to prevent the spread of resistant infections. Not using antimicrobials when they are not needed and following the basic principles of infectious disease prevention is crucial to prevent outbreaks, and AMR is no different. Making sure we are up to date on vaccinations is also paramount, as it not only protects against known pathogens but also contributes to overall community immunity. Additionally, we must be vigilant when travelling to high-risk countries, as these pathogens know no borders. Maintaining personal health practices goes hand in hand with the broader efforts to combat AMR.
In the face of the AMR crisis, New Zealand has a unique opportunity to lead the way with responsible antimicrobial usage and surveillance. It is crucial that as a nation, we collectively recognise the gravity of this issue and take proactive steps to ensure a future where our healthcare system remains effective. By adhering to basic principles of antimicrobial stewardship, infectious disease prevention and implementing consistent infection control practices, we can navigate the path towards a future where AMR poses a significantly lower risk.