Q&A: Antimicrobial resistance is a growing health threat

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This transcript has been lightly edited for clarity

What is antimicrobial resistance (AMR)?

Dr. Kevin Ikuta: Antibiotic resistance is what happens when a bacteria evolves in a way that makes our antimicrobials, our antibiotics, less effective at treating those infections. Antibiotic resistance occurs naturally as a response to exposure to that antibiotic. And so, when we overuse or misuse antibiotics, we kind of select for, and place pressure on, bacteria to become more resistant over time.

What are the key findings of the new research into AMR?  

Dr. Kevin Ikuta: We've seen an increase in deaths due to antibiotic resistance over the last 30 years. And our forecasts suggest that this will really accelerate over the next 30 years. And this tells us that we're at something of an inflection point right now. And a lot of this has to do with the combination of just increasing resistance in the bacteria, as well as an anticipated aging of the population.

So, while AMR is a risk for young children, we've actually seen remarkable successes at preventing deaths and preventing infections in children under the age of five. And what that means is that there have been fewer antibiotic-resistant deaths in that age group, and we anticipate that that will continue over the next 30 years. This will be far outpaced, though, by the increase in AMR deaths in adults, particularly those over the age of 70.

So as people get older, they have more co-morbidities like diabetes or cancer, and have weakened immune systems, meaning that more people are at risk for bad outcomes as a consequence of resistant infections. What's alarming is that we're seeing an increase, we're forecasting an increase in AMR deaths, really across all regions. So this is something that we as a global community should be taking measures to try and mitigate.

How does income level influence the impact of AMR?

Dr. Mohsen Naghavi: We have poor area, same as low-income country, that has high infections, low health system quality and slowly, slowly people getting old.

Then in this area, until 10-15 years, we have worse situation after now because they didn't control infections in the children and young ages, and slowly people getting old. They have two burdens, that they add to each other. Then we have more and more infectious disease in the young and in the old age, and then health system does not have capability to control.

And then we have both situation in the low-income country, in many parts of the middle-income country, but in the high-income country the story is different because they controlled infections, especially in the children, and they have problem just in the old ages. There is one other story for them. But there is no escaping from AMR in any part of the world.

What can be done to minimize the impact of AMR?

Dr. Kevin Ikuta: We really need to encourage global leaders to take decisive action to protect people around the world from the threat of antimicrobial resistance. This includes financing national action plans, investment in infection prevention and control, building up health care infrastructure, including diagnostic capacity, and supporting stewardship efforts which balance antibiotic access with antibiotic excess. We also need to encourage innovations in drug development, particularly for these difficult to treat resistance patterns.

Why is a One Health approach critical to combatting AMR?

Dr. Mohsen Naghavi: AMR is the survival war between us and pathogens. This is one big story around the whole of life. We have to fight with this in our body, in our water that we drink, in our meat that we eat, in the bird in the sky, in the animal in the cave.  

This is a story of One Health. We have to work together. We have to learn to work together against AMR, whole world, different specialty. We have to learn. We have to work together.