Antimicrobial resistance (AMR) is recognised as a global health crisis far surpassing outbreaks of single diseases such as Ebola and HIV and on a par with climate change. Despite this, management of AMR has largely failed to stop or decrease its incidence in previously manageable diseases. On the eve of World Antibiotic Awareness Week, scientists at the University of Technology Sydney (UTS) and La Trobe University are offering a new ecological perspective on how AMR is defined, tested and monitored with the aim of getting a step ahead of the resistant material.
AMR happens when microorganisms such as bacteria, viruses, parasites, and fungi develop resistance to medicines that were previously able to cure them.
Dr Carolyn Michael, of the UTS School of Life Sciences, working with colleague Dr Maurizio Labbate and La Trobe University microbial ecologist Dr Ashley Franks, says there has been insufficient focus on monitoring the root cause of the AMR crisis. A quicker, more accurate test is urgently required, the researchers say.
“Monitoring the crisis is largely limited to counting increasing numbers of resistant pathogens. Rather than monitoring pathogens we are proposing monitoring resistance genes that exist throughout the microbial world and not just in pathogens,” Dr Michael says.
“Doing this will let us see rising numbers of resistance genes before they get to a pathogen and also keep an eye on the different types of resistance genes already in pathogens.”
Dr Ashley Franks adds: “The World Health Organisation recognises this is an up-and-coming crisis. What we are providing is a framework for prediction before AMR reaches threshold levels in certain areas.”
The research team proposes tracking resistance gene frequency across the environment, so that the early phases of the rise of resistance genes is detected and managed. This would involve not only monitoring microbial DNA in hospital settings but also sampling in surrounding environments such as shopping precincts and transport hubs and even sewage treatment facilities.
With rigorous stewardship of existing antimicrobials, this protocol would mean the effectiveness of current and future antimicrobials would be preserved. Measuring increases in resistance gene numbers gives clinicians and health authorities information allowing them to recommend which antimicrobials should be used and which must be “rested”.
“What we are proposing is a method that measures the underlying problem and gives a quantifiable solution that can be used to see if measures to control AMR are working,” Dr Michael says.
The researchers also address the critical issue of limiting the flow of resistance genes and antimicrobial stressors to the environment. They propose high-level precautions typical of quarantine wards, sterilisation of effluent and, when necessary, the complete withdrawal of certain antibiotics to which there are high levels of resistance genes.
For microbial ecologist Dr Labbate, AMR is a “One Health” issue that recognises that the health of people is linked to the health of wild and food-producing animals and the wider environment.
“This approach can be used to monitor AMR across all environments and if applied will also help us understand the links between these environments that are contributing to AMR,” he says.
Dr Michael’s diverse background in developing diagnostic technology, working with infectious diseases in developing countries and molecular biology expertise gives her a unique perspective on a crisis that by some estimates will result in 10 million preventable deaths by 2050 if not addressed.
“The ecology of the planet is interconnected and we need a global management perspective to tackle the AMR crisis. I’ve spent a lot of time in clinical settings and I know doctors are frustrated that they have no way of knowing how long the antimicrobials that they rely on to cure their patients will continue to work.
“Global health authorities also need a way to see if their attempts to reduce AMR are working before a newly untreatable disease strikes. What we are proposing is a global protocol that both defines and measures the size of the problem and so offers solutions to handle this critical issue.”
The findings are contained in the article "The antimicrobial resistance crisis: management through gene monitoring", published this week in the journal Open Biology.