全球抗生素耐药性分析报告-外文版培训课件

POLITICS

&

SOCIETYAntimicrobial

resistanceOverviewreportDisclaimerDrugresistancecanbedevelopedbybacteria,fungi,andviruses,makinginfectionsmoredifficulttotreat,resultinginanincreasedriskoftransmission,seriousillness,andmortality.Inthisreport,thebroadertermantimicrobial

resistancewillbeused,referringtoalltheseorganismswhilefocusingattentiononbacterialresistancetoantibiotics,asitcurrentlyrepresentsthebiggestthreattohealth.2A

silent

pandemicExecutivesummaryAworldinwhichbacterialinfectionscannolongerbetreatedwithantibioticssoundsapocalyptic,butthisscenarioisalreadyapartialreality.superbugs–multi-drugresistantbacteriathatarenotsusceptibletomanyantibiotics.Forexample,theglobalnumberofhospital-associateddrug-resistantinfectionsiscurrentlyestimatedat136millionperyear.Sincetheintroductionofantibioticsinthe1940sbyScottishphysicianAlexanderFleming,

theirusehassavedmillionsoflivesandextendedtheaveragehumanlifeexpectancyby23years.Theynotonlyfightinfectionbutalsoenableavarietyofmedicalprocedures,suchaschemotherapy,organtransplantations,andothersurgeries,atalowerrisk.•

In2019,

therewere1.27milliondeathsattributabletoAMRworldwide,whiletheassociateddeathsreachedalmostfivemillion.By2050,

thisfigureisforecasttoreach50millionAMR-attributabledeaths.•

Resistantinfectionsrepresentaburdenforbothhealthcaresystemsandeconomiesandleadtohealthcarecostsofupto29,300U.S.dollarsperresistancecase.Lengthsofstayareextendedby7.4daysonaverage,andthemortalityrateincreasesdramatically–withan84.4percenthigherchanceofdyingcomparedtopatientswithasusceptibleinfection.Originallyreferredtoasa“wonderdrug,”antibioticswerebelievedtoselectivelytargetbacteriaresponsiblefordiseaseswithnoconsequencetothehost.However,Fleminghimselfhadconcernsregardingtheirpossiblemisuseandtheriseofresistance,stating:”Itisnotdifficulttomakemicrobesresistanttopenicillininthelaboratorybyexposingthemtoconcentrationsnotsufficienttokillthem.”Thisreportaimstoshapeanunderstandingofhowtheconsumptionofthesedrugshasdevelopedovertime,themainusecases,andthemainpathwaysAntimicrobialresistance,inshortAMR,

isbecomingthemostpressinghealthissueofthe21stcentury.Ithasthepotentialtounderminethemedicalprogressmadein

throughwhichantibioticsaretransferredbetweenhumans,animals,andthethelastcenturyandbecometheleadingcauseofdeathworldwideifnoactionistaken.environment.ThisbaselinehelpscreateaclearerknowledgeofthemaindriversofAMR,

thesettingsinwhichitdevelops,andhowtoputthebreaksonitsdevelopment.•

Humanityhasalreadybeguntopaythepriceofoverusingandmisusingantibiotics,withanincreasinglossinefficacyandtheriseoftheso-called4Sources:

Balasubramanian

R.etal.;HutchingsM.I.etal.;MurrayC.J.L.etal.;OECD;Poudeletal.;Rosen

W.;WOAH;Zaman

S.B.etal.01From

the

discovery

of

antibiotics

to

AMR•

Briefhistoryofantibiotics•

Humanconsumptionofantibiotics•

Animalconsumptionofantibiotics•

Antibioticproduction•

AntibioticpathwaysFrom

the

discovery

of

antibioticsto

the

spread

ofAMRTimelineBeginningoftheantibioticrevolutionPenicillin

approved

forhumansLipopeptides

discoveredGlobalAMR

emergency

declaredThelastclassofantibioticsusedintheclinicalsettingwasdiscovered.Aftertheincreasingresistancetodifferentantibioticswasidentified,theWHOGlobalActionPlanwaslaunchedtotackletheemergency.A.Flemingdiscoveredthefirstantibiotic:penicillin.Duringthesame

year,thefirstresistancewasalsoidentified.U.S.scientistspurifiedpenicillintobeusedfor

thearmedforces.After1945itbecameavailabletothegeneralpublic.1928193319431944198720062015Antibiotic

usein

animalsStart

ofthe“golden

age”Restriction

ofgrowth-promotingantibioticsThefirstantibioticswereintroducedtotreatsickanimals,

andlater

alsotopromotegrowth.Mostantibioticsstillinusetodaywerediscoveredbetween1944and1966.TheEUbansallantibioticsusedtopromotefarmanimalgrowth.6Sources:

European

Commission;ScienceLearningHubHuman

consumption

of

antibioticsAntibiotic

consumptioninlow-and

middle-income

countriesin2000

and

2018Consumptionofantibacterials

for

systemic

use

inEU/EEAfrom

2013

to

2022,

bysectorNowadays,antibioticsarecommonlyusedintheprimarycareandhospitalsectortotreatavarietyofinfections.ConsumptioninDDDper1,000inhabitantsperdayConsumptioninDDDper1,000inhabitantsperday21,625201510521,121,718,8201510546%20,918,320,4

20,219,9Between2000and2018,

theglobalconsumptionofantibioticsincreasedby46percent.Thisrisewasmainlyledbylow-andmiddle-incomecountries,whichshowedaconsumptionincreaseof76percent.19,41714,376%13,116,4

16,414,1

14,29,818,97,418,317,8

17,7

17,41,6901,75

1,79

1,67

1,69

1,65

1,61

1,53

1,611,68Althoughconsumptioninhigh-incomecountriesremainedstableduringthisperiodandhasdeclinedinrecentyears,othervariablesinantibioticconsumptionarenotsoreassuring.Wo

rl

dwi

deLow-

andmiddle-income0countries20182013

2014

2015

2016

2017

2018

2019

2020

2021

20222000Community

(primary

c

are

sector)Hospital

sectorTotalAntibiotic

consumptionlevels

inselectEuropeancountries

in2022InEUcountries,forexample,anincreaseintheuseoflast-lineantibioticsinhospitalswasobserved,aswellasanincreaseintheuseofbroad-spectrumConsumptioninDDDper1,000inhabitantsperday40302010032,927,625,724,323,623,221,9Italy19,418,811,2antibioticsbothinthecommunityandhospitalsector.9,1GreeceBulgariaPolandPortugalNetherlandsRomaniaFranceSpainEUmeanSweden7Notes:(1)Worldwide;2000and

2018;(2)EU/EEA;2013to2022;(3)EU;2022;DDD–defineddailydoseSources:

(1)Browneetal.;ID:1090851;(2)ECDC;ID:1419314;(3)ECDC;ID:1425932;Text:Browneetal.;ECDCOutpatientantibiotic

prescriptionsU.S.focusAntibioticsprescriptionsper1,000persons,

rate4031,184In2022,

atotalof236.4millionantibioticprescriptionswereprovidedbyhealthcareprofessionalsacrosstheUnitedStates,thehighestvalueinthepastthreeyears.Duringthesameyear,thestateofWestVirginiahadthehighestrateofantibioticprescriptionswith1,184antibioticprescriptionsper1,000people.Generally,southernstateshadahighernumberofantibioticprescriptions,withover106millionin2022.Penicillinswerethemostprescribedantibioticclass,followedbymacrolidesandcephalosporins.Number

of

outpatient

oral

antibioticprescriptions

in

the

UnitedStates

from2015

to2022(inmillions)3002001000269,4270,2258,2249,8251,1236,4211,12021201,92020201520162017201820192022Createdwithflourish.studio8Notes:(1)United

States;2022;(2)United

States;2015to2022Sources:

(1)CDC;(2)CDC;ID:1459250;Text:CDCAntibiotic

veterinary

medicinal

products

(VMPs)Distribution

of

antibioticVMPsales

for

food-producing

animals

in

Europe

2022,

byproductform

producing

animals

in

Europe

2022,

byantibioticclassDistribution

of

antibioticVMPsales

for

food-Worldwide,

around66percentofallantibioticsareconsumedbyfarmanimals.Antibioticveterinarymedicinalproducts(VMPs)aremostlyusedforfood-producinganimals–ratherthanpetsorwildanimals–duetotheconditionstheylivein.Food-producinganimalsincludecattle,pigs,horses,sheep,goats,PremixInjectable

productsMacrolidesAminoglycosidesOther

forms*14,9%Sulfonamides6,5%8,5%Other

classes

rabbits,chickens,turkeys,andfarmedfish.13,6%9,4%Over30percentofthoseantibioticsbelongedtothepenicillinfamily,while23.5percentweretetracyclines.MostantibioticsVMPswereadministeredintheformoforalsolutions,followedbypremixandinjectableproducts.Oral

powder19,4%6,8%23,5%TetracyclinesIn2022,

over85percentofantibioticVMPsaleswere32,7%63,4%Penicillinsusedforgrouptreatment.Oral

solution9Notes:(1)Europe;2022;(2)Europe;2022;*otherformsincludesintramammary

productsSources:

(1)EMA;ID:1426032;(2)EMA;ID:1426055;Text:AlliancetoSaveOurAntibiotics;EMA;European

CommissionAntibiotic

veterinary

medicinal

products:

trends

andconsumersIn2022,

Cyprus,Poland,andItalywerethecountriesinEuropeinwhichanimalsconsumedthemostantibioticVMPsinmg/PCU.Inthosecountries,antibioticsVMPsareprescription-onlymedicines.AntibioticVMP

sales

for

food-producing

animalsin

Europe

in

2022,

bycountryTotal

sales

of

antibioticVMPs

for

food-producinganimals

in

31

European

countries

from2017

to2022inmg/PCU*inmg/PCU*150CyprusPolandItaly254,7Since2006,

allantibioticsusedasgrowthpromoters–tohelpfattenfood-producinganimals–havebeenbannedinEurope,andbetween2017and2022a12.7percentdecreaseinthetotalsalesofantibioticVMPswasobserved.Nevertheless,accordingtotheWorldOrganizationforAnimalHealth(WOAH),theuseofantibioticsforgrowthpromotionisstillapracticeinatleast41othercountriesworldwide(seepage24).106.6103.1196,0157,5127,4111,2103,28984.284,710050073,9SpainHungaryBul

gari

a201720182019202020212022Domestic

sales

of

antimicrobial

drugs

for

usein

livestock

in

the

United

States

from2009

to2022Salesin1,000kilogramsIntheUnitedStates,theFoodandDrug20.00015.00010.0005.0000Administration(FDA)madetheuseofantimicrobialsforgrowthpromotionillegalonlyin2017.Forthisreason,adecreaseinantimicrobialdruguseinlivestockbetween2016and2017canbeseen.In2022,thisfigureamountedtoroughly11.17millionkilogramsofactiveingredient.2009201020112012201320142015201620172018201920202021202210

Notes:(1)Europe;2022;(2)Europe;2017to2022;(3)United

States;2009to2022;*PCU–standsforpopulation

correction

unitand

isaproxytonormalizesalesdatabythenumberofanimalsthatcould

betreated

withantibiotics.Sources:

(1)EMA;ID:1461108;(2)EMA;ID:

1458787;(3)FDA;ID:505287;Text:EMA;European

Commission;Wallingaetal.;WOAHThemajor

antibiotics

producersDistribution

of

facilities

producing

40

representative

antibioticAPIs

as

of

2021Severalcompaniesareinvolvedintheproductionofantibiotics,asthereareseveralmanufacturingstagesthatareoftenoutsourced.Activepharmaceuticalingredient(API)manufacturingisthephaseofantibioticproductionwheretheriskofantibioticreleaseisthehighest.IndiaandChinaarethemainproducersofAPIsduetolowerproductioncosts.ChinaUSA34%1%Currently,therearenospecificregulationsorglobalstandardswhenitcomestomanagingthemanufacturingeffluentofantibioticsproduction,despitethepotentialreleaseofantibioticsintotheenvironment.Asaresult,watersourcescontaminatedbyAPImanufacturingwastehaverecordedthehighestconcentrationofantibioticsandmulti-resistantbacteria,creatingahotspotforenvironmentalcontamination.Europe22%India35%RestoftheworldLookingatarepresentativelistof40activeingredientsforantibiotics,IndiaandChinaproducealmost70percentofthem.In2020,

Chinawasbyfarthelargestexporterofactivepharmaceuticalingredientsworldwide.8%11

Notes:Worldwide;2021Sources:

BCG;WellcomeTrust;ID:1420239;Text:AccesstoMedicineFoundation;BCG;HMGovernment;WellcomeTrustAntibiotic

pathwaysPharmaceuticalindustriesandhospitalsHumanconsumptionWWTPHouseholdsDrinkingwatertreatmentplantVeterinarydrugsandanimalagricultureLeachingAntibioticsLandfillAquiferUntreatedwaterFruitsandvegetablesAgriculture12

Notes:WWTP–wastewatertreatmentplantSources:

Bhagatetal.02AMR

and

its

consequences•

Whatisantimicrobialresistance?•

Healthcareandtheeconomicburden•

R&DWorldHealthOrganizationmajorthreatstoglobalhealth,ngincreasinglyineffective,thcareandsocialcosts(seeEurope390,000ereinfectionsarecausedbyR)bacteriahasbeengrowing,entoptions.Asof2019,

onecountrieswerecausedbyhecaseofA.baumanniicentwereresistanttoureisslightlyhigherwhentries.NorthAmerica317,000Asia4,730,000Africa4,150,000LatinAmerica392,000Oceania22,000ctionsagainstantimicrobialen,AMRisprojectedtocauseby2050.Asof2019,

thisfigureathsattributabletoAMR.Theeconomicburden

ofAMRAsmentionedonthepreviouspage,whentheefficacyofantibioticsdecreases,thecostofhealthcareincreases.Thisisbecausetreatingaresistantinfectionresultsinalongerlengthofstaythantreatingasusceptibleinfection.Accordingtoasystematicreviewandmeta-analysisbyPoudeletal.,

theaverageincreaseinapatient’slengthofstayis7.4days,which,by2050,

wouldcumulativelytotal32.5billionadditionaldaysspentinhospitaleachyearduetoresistantinfections.Healthcarecostofresistantinfections:2,371

to29,289

U.S.

dollarsper

resistance

caseLengthofstayextendedby:7.4

days

onaverageMortality:84.4%higher

chance

ofdyingthan

patients

withsusceptible

infectionItisestimatedthatbetween2021and2050theannualcostoftreatingAMRcomplicationsacross34OECDandEU/EEAcountrieswillaverage28.9billionU.S.dollarsperyear.NotonlyarehealthcarecostsdrivenupbyAMR,butthelossofproductivityandlaborforceparticipationalsotakesitstoll,estimatedat36.9billionU.S.dollars(adjustedforpurchasingpowerparity–eachyearinthosecountries.ThetotalworldGDPlossduetoAMRisexpectedtoreachupto100.2trillion

U.S.

dollars

by205015

Notes:Worldwide;2016to2021Sources:

HMGovernment;OECD;PoudelA.N.etal.;WellcomeTrust;WHOTheR&D

dilemma

on

antibacterialsNumber

of

ongoing

R&D

projects

targeting

bacteria

as

of

2021,bypharmaceutical

companyAfterthe“goldenera”ofantibioticdiscovery(seepage6),

theproductionofnewantibioticshasdramaticallysloweddown,with82percentofallantibioticapprovalstakingplacebefore2000andthelastclassofantibioticsbeingdiscoveredinthesecondhalfofthe1980s.35GSKThiscanbeattributedtoboththetimeandfinancialinvestmentsrequired.Thedevelopmentofnewantibioticsoftenrequiresover10yearsofresearchand,onaverage,aninvestmentofonebillionU.S.dollars.AstheaccelerateddevelopmentofantibioticresistancehasloweredtheinvestmentreturnsforthepharmaceuticalR&Dindustry,severalcompanieshavewithdrawntheirresearchintonewantibiotics.30251520J&J15105MSD10Nowadays,75percentofantibacterialandantifungalresearchanddevelopmentactivitiesarecarriedoutbysmall-andmedium-sizedcompanies.In2021,

amongthemajorpharmaceuticals,therewere86activeprojectstodevelopmedicinesandvaccinesagainstpathogenicbacteria.Mostoftheseprojectswereinthediscoveryandpre-clinicalstages,whileonlyfivewereinthepost-clinicalstage.PfizerShionogi7122Sanofi15Otzuka81335430Antibacterial

vaccineAntibacterial

medicine16

Notes:Worldwide;2021Sources:

AccesstoMedicineFoundation;ID:1427106;Text:AccesstoMedicineFoundation;BIO;DRIVE-AB;Uddinetal.03AMR

drivers•

AMRdrivers•

Mostdangerouspathogens•

AMRindifferentsettingsAMR

happens

naturally

but……humanitycanimpacttherateatwhichitisdevelopingisthenaturalprocessbywhichoorganismsenhancetheirresistancetomicrobials,reducingtheeffectivenessoftmentsovertimeandincreasinginfection-edmortality.AlthoughAMRisanLackMaindriversofAMRwavoidableprocess,thereductioninantibioticacyhasbeendrivenbyseveralfactors–allrconnectedandcontrollable.Amongthose,eadingfactorisgeneralantibioticuse,ificallytheirmisuseandoveruse.Poorctionpreventionandcontrol,aswellastheofknowledgeandawarenessofAMR,aretlyrelatedtothisfactor.Limited

access

todiagnosticsandvaccinesPoor

infection

prevention

andcontrolinhealthcarefacilities18Sources:

TheWorld

Bank;WHOESKAPEE:

Thepathogens

representing

the

greatest

threat

to

humansHigh-prioritypathogensEscherichiacoliPseudomonasaeruginosaESKAPEE

pathogensareresponsiblefor70percentofStaphylococcusaureushumandeathsfromAMR.Escherichiacoli,Klebsiellapneumoniae,andEnterobacterspeciesEnterococcusfaeciumStaphylococcusaureusarethemaincontributors.KlebsiellapneumoniaeAcinetobacterbaumannii19Sources:

Kurbatfinskietal.;OECDEscherichia

coliPercentage

of

invasive

Escherichiacoli

isolatesresistanttofluoroquinolone

antibiotics

in

Europein

2021,

bycountryPercentage

of

invasive

Escherichiacoli

isolatesresistanttothird-generation

cephalosporinantibiotics

in

Europe

in

2021,

bycountryE.coliistypicallyfoundinthelowerintestine,

andalthoughmoststrainsareharmless,somearepathogenic.Infectioncausesdiarrhea,dysentery,andothersystemicinfections,andthisbacteriumhasoneofthelargestreservoirsofresistancegenes,

meaningithasbuiltupresistancetomostantibiotics.CyprusGreeceBul

gari

aPolandItaly51,6%Bul

gari

aCyprusItaly37,3%32,8%33,9%33,5%33,1%32,5%23,8%23,1%SlovakiaGreeceIn2021,

itwasfoundbytheEuropeanCenterforDiseaseControl(ECDC)thatover50percentofE.coliinfectionswereresistanttoamoxicillinandampicillin,oftenthefirst-lineantibioticsofchoice,thoughthisratehaddeclinedfrom2017.Fluoroquinoloneresistancevariedbycountry,andin2021wasshowntobehighestinCyprus,withover50percentofE.coliinfectionsbeingresistanttothissecond-linedrugtreatment.21,7%Share

of

invasive

E.

coli

isolates

resistanttoantibiotics

in

EU/EEA

countries

between

2017

and

2021,byantimicrobial

group60%50%40%30%20%10%0%Aminopenicillin(amoxicillin/ampicillin)resistanceFluoroquinolone

(ciprofloxacin/levofloxacin/ofloxacin)resistanceAminoglycoside(gentamicin/netilmicin/tobramycin)resistance*Third-generationcephalosporin(cefotaxime/ceftriaxone/ceftazidime)resistanceCombinedresistancetothird-generationcephalosporins,fluoroquinolones

andaminoglycosides*20172018201920202021Carbapenem

(imipenem/meropenem)resistance20

Notes:(1)Europe;2021;(2)Europe;2021;(3)EU/EAA;2017to2021;*theaminoglycosidegroup

includesonlygentamicin

and

tobramycin

from2020onwardsSources:

(1)ECDC;ID:1416691;(2)ECDC;ID:1416702;(3)ECDC;WHO;ID:1416894;Text:ECDC;MuellerM.etal.;Poirell.etal.;WHOKlebsiella

pneumoniaePercentage

of

invasive

Klebsiellapneumoniaeisolates

resistanttocarbapenemantibiotics

inEurope

in

2021,

bycountryPercentage

of

invasive

Klebsiellapneumoniaeisolates

resistanttoantibiotics

in

EU/EEA

countriesbetween

2017

and

2021,

byantimicrobial

groupK.pneumoniae,consideredthemostcommoncauseofhospital-acquiredpneumoniaintheUnitedStates,accountsforalmost12percentofallhospital-acquiredpneumoniaglobally.ProlongedhospitalizationandhighmortalityratesareoftenassociatedwithinfectionscausedbyK.pneumoniae.Thisbacteriumisalsoassociatedwithotherinfections,suchasurinarytractinfections,cystitis,surgicalwoundinfections,endocarditis,andsepticemia.40%GreeceRomaniaBul

gari

aCroatiaItaly73,7%Fluoroquinolone(ciprofloxacin/levofloxacin/ofloxacin)resistance35%54,5%46,3%Third-generationcephalosporin(cefotaxime/ceftriaxone/ceftazidime)resistance30%25%20%15%10%5%Aminoglycoside(gentamicin/netilmicin/tobramycin)resistance*32,9%26,7%26,2%19,5%11,7%11,6%6,7%In2021,

theECDCfoundthatK.pneumoniaealreadyhadhighresistancetothird-generationCombinedresistancetothird-generationcephalosporins,fluoroquinolones

andaminoglycosides*CyprusPolandSlovakiaPortugalMaltacephalosporins,withalmost35percentofinfectionsresistanttothisgroupofantibiotics.Aboutthesamelevelofresistancewasreachedforfluoroquinoloneantibiotics.Resistancetocarbapenemstoodat11.7percentintheEU/EEAcountriesin2021.However,greatvariationcouldbeobservedacrossEuropeancountries,andinGreece,

almost74percentofinvasiveK.pneumoniaewereresistanttocarbapenemantibiotics.Carbapenem

(imipenem/meropenem)resistance0%0%20%40%60%80%2017201820192020202121

Notes:(1)Europe;2021;(2)EU/EEA;2017to2021;*theaminoglycosidegroup

includesonlygentamicin

and

tobramycin

from2020onwardsSources:

(1)ECDC;ID:1416723;(2)ECDC;WHO;ID:1416973;Text:AshurstJ.V.and

Dawson

A.;ECDC;Effah

C.Y.etal.Staphylococcus

aureusPercentage

of

invasive

Staphylococcus

aureusisolates

resistanttomethicillin

(MRSA)

in

Europein

2021,

bycountryPercentage

of

invasive

Staphylococcus

aureusisolates

resistanttomethicillin

(MRSA)

in

EU/EEAcountries

between

2017

and

202120to30percentofhealthypeoplecarryS.aureusontheirskinandmucousmembranes,andalthoughthispathogenismostlyharmless,itcanalsocauseinfections,typicallyskininfections.Methicillin-resistantStaphylococcusaureus(MRSA)canbeacquiredbydirectcontactwithinfectedpeopleorcontaminatedmedicalequipment.20%18%16%14%12%10%8%CyprusGreeceRomaniaCroatiaItaly42,9%41,9%41,0%34,8%30,0%25,1%24,2%22,3%20,4%19,3%20%Inrecentyears,theECDCobservedaratherstableordecreasingMRSA

infectionrateinEUandEEAcountries.ThisresultedfromseveralcountriesimplementingpreventivemethodsagainstthespreadofMRSA

inthehealthcaresector,suchasscreeningpracticesandhanddisinfectioncampaigns.PortugalSpain6%SlovakiaMalta4%DespiteobservingthispositivedecreaseinMRSA,

thepercentageofresistanceisstillhighinseveralcountriesandspecificstrainsofMRSA

havebeenfoundinfood-producinganimals,representingariskforthoseworkinginclosecontactwiththem.2%Hungary0%0%10%30%40%50%2017201820192020202122

Notes:(1)Europe;2021;(2)EU/EEA;2017to2021Sources:

(1)ECDC;ID:1416736;(2)ECDC;WHO;ID:1416983;Text:ECDC;EFSAAMR

in

hospitalsTherearedifferentwaysinwhichdrug-resistantbacteriacanbeintroducedintoahealthcarefacility:Peopleadmittedtohospitalsarebynatureatagreaterriskofdevelopinginfectionsbecauseoftheiralreadycompromisedimmunestatus,theprevalenceofpathogensinthehospitalsetting,theuseofmedicaldevicesthatcanincreasetheoccurrenceofinfections(suchasurinarycathetersandrespiratoryequipment),

andsurgeries.•

Admissionofapatientwhohasaninfectioncausedbydrug-resistantbacteriaà

Introductionofaresistantorganism•

Bacteriamaydevelopresistanceinresponsetoselectiveantibioticpressureà

EmergenceofanewresistantorganismForcertainat-riskpatientgroups,suchaspeoplewithcancer,antimicrobialresistanceposesanevengreaterthreat,astheirimmunesystemsarealreadycompromisedbythecanceritselfandoftentimesbytherequiredtreatment–suchaschemotherapy,surgery,ortransplantation.Infectionsarethemostfrequentcomplicationandthesecond-leadingcauseofdeathforcancerpatients,whoare•

Transmissionoftheresistantorganismfrompatienttopatientà

ClonaldisseminationTheintroductionofaresistantorganismintohealthcarefacilitiescannotbeavoided.However,

inadequatehygieneandlackofinfectionpreventionandcontrol

threetimesmorelikelytodiefromafatalinfectionthannon-cancerpatients.canincreasethespreadofresistantbacteriathroughclonaldissemination.Moreover,therearecurrentlynorapiddiagnosticmethodstoidentifypathogenicbacteriaandAMRgenes,requiringuptoseveraldaystodetectandcharacterizepathogens.Therefore,theuseofbroad-spectrumantibioticsbeforediagnosisisTheglobalnumberofhospital-associateddrug-resistantinfectionsisestimatedwidespreadinclinicalsettings,whichworsenstheAMRthreat.at136

million

peryear.23Sources:

Balasubramanian

R.etal.;Kaprou

G.D.etal.;LongitudePrize;MonegroA.F.etal.;MulveyM.R.and

SimorA.E.;Nanayakkaraetal.;UICC;WHOAMR

in

livestock

productionTheuseofantibioticsonfarmsiswidespreadandisaimedatimprovinganimalhealthandproduction,especiallyinintensivelivestockfarming,whichischaracterizedbypracticesthatmaximizethenumberoffarmedanimalsinaminimalamountofspace.Iftheanimals’healthiscontinuouslyputatrisk,thisrequiresthesystematicuseofantibiotics.Inthelivestocksector,antibioticsandotherantimicrobialsmaybeadministeredforthefollowingpurposes:foodchainandcontaminatedwater.Ultimately,anyuseofantibioticsinanimalswilleventuallyreachandaffecthumans.Theuseofantimicrobialsforgrowthpromotionisnolongerapracticein68%

ofthe157countriesprovidingdatafortheWOAHannualreport•

Treatmentofsickanimalsà

Therapeuticpurposes107countriesdo

notuseantimicrobialsfor

growthpromotionin202141

countriesuseantimicrobialsfor

growthpromotionin2021•

Administrationtoanimalsatriskofdiseaseoutbreakà

Prophylaxis/diseaseprevention•

Administrationtoclinicallyhealthyanimalsbelongingtoaherdwithsignsofdiseaseà

Methaphylaxis/diseasecontrolAntimicrobialshavealsobeenusedtoaccelerateanimalgrowth.However,

thispracticehasbeenbannedinseveralcountries.9

countrieswithunknownEventually,thelackofeffectiveantibioticstotreatsickanimalscanadverselyaffectfoodproductionaswellashumans,whocancomeintocontactwithresistantbacteriathrough