How is antimicrobial resistance affecting the spread of

infectious diseases worldwide?

By: Shahria Afrin

Introduction

The impact of accelerating resistance on our ability to treat microbial infections has led to
predictions that we are on the brink of a 'post-antibiotic era' in which many common infections
will no longer have a cure and, once again, kill unabated. According to the World Health
Organization, antimicrobial resistance (AMR) is the ability of bacteria, parasites, viruses, and
fungi to withstand the effects of antibiotics, antiprotozoal, antiviral, and antimycotic drugs, which
makes treating the infections they cause increasingly difficult. This global spread poses a
significant threat to international health security.

Global perspective

The increasing burden of infectious diseases and resistance to antimicrobials is a global issue.
Two World Health Assembly resolutions in 1998 and 2005 developed a strategy to reduce this
burden by focusing on prevention and optimization of antimicrobial use, research, innovation,
and political commitment. To raise global awareness, the 2011 World Health Day theme was
“Antimicrobial Resistance." By 2050, drug-resistant infections could cause up to 10 million
deaths annually, accounting for over 85% of infection mortality. In the USA, infections with AMR
bacteria cost the healthcare system over $20 billion annually.
Table 1.0 - Death (in thousands) caused by infectious diseases

Region Infectious and Respiratory All infectious All causes

parasitic infections causes
diseases

East Asia and 5299 571 1870 13070

Pacific

Europe and 152 109 261 5 669

Central Asia

Latin America 324 160 484 3277

and the
Caribbean

Middle East and 216 110 326 1914

North Africa

South Asia 2 987 1435 4422 13557

Sub-Saharan 5702 1 094 6 796 10 837

Africa

World 10838 3830 14 668 56 242

Low- and 10 686 3 481 14 167 48 351

middle-income
countries

High-income 152 349 501 7891

countries

(Data from the Global Burden of Disease and Risk Factors.)

Infectious disease mortality was greatest in Sub-Saharan Africa (6.8 million deaths), followed by
South Asia (4.4 million deaths), accounting for 76.4% of all infectious disease deaths.

National perspective

Because Bangladesh is part of South Asia, it comes into the group with the second highest
death rate by infectious disease (according to Table 1.0). Bangladesh has implemented a
national drug policy from 2005–2010 to address rising drug resistance. The policy aims to
improve drug administration, increase public awareness, and regulate drug accessibility.
Standardization of drugs can reduce antibiotic misuse. The National Action Plan for AMR
containment in Bangladesh aligns with WHO GAP guidelines, aiming to curb the development
and spread of AMR.
Different perspective

The World Health Organization (WHO) states that AMR affects countries worldwide, with
low-income countries experiencing higher rates of infectious diseases due to a lack of access to
clean water, healthcare, and sanitation resources. South Africa and India have the highest AMR
rates, while Canada, the United States, Colombia, Cuba, Panama, Costa Rica, Chile,
Venezuela, Uruguay, and Jamaica have the lowest rates. The FAO, OIE, and WHO report
highlights significant gaps in addressing antimicrobial resistance in 154 countries, with higher
progress in high-income countries. It calls for sustained commitment across all sectors.

Causes and effects

The growth of multidrug-resistant bacteria, also known as superbugs, has elevated it to the point
of being a worldwide epidemic. Antibiotic overuse or misuse, inadequate sanitation, limited
healthcare access, increased global travel, and environmental pollution contribute to the spread
of AMR in humans, animals, and agriculture, while climate change and habitat destruction
further exacerbate the problem. WHO states that “AMR is a natural process that happens over
time through genetic changes in pathogens.” AMR leads to treatment failures, increased death
rates, and disease prolongation. It burdens healthcare systems, causing overcrowding, medical
supply shortages, and higher expenses. It also causes economic burdens, societal discontent,
and environmental pollution, contaminating areas with contagious diseases.

Solution

Social media is crucial for raising awareness about infectious diseases, hygiene practices, and
healthcare access support. Encouraging good hygiene and healthy eating can help build
immunity against infections and reduce the chances of AMR. Including ginger or garlic in meals
can strengthen the immune system due to its qualities, which have long been used in herbal
medicine. Taking antibiotics as prescribed and teaching antibiotic usage are essential.
Participating in school community club activities, donating hygienic amenities, and volunteering
in community clean-up efforts presented by Dhaka City Corporation can help fight the issue.
Research is crucial in combating antimicrobial diseases, and student internships at facilities like
the Child Health Research Foundation can aid in this fight. For future research, we should
explore additional facilities in Bangladesh with labs accepting student internships, such as
ICDDR,B.

Evaluation

The World Health Organization's (WHO) website is a specialized agency of the United Nations
responsible for international public health, backed by scientific evidence and expert consensus.
It operates with transparency and accountability, regularly publishing reports, guidelines, and
research findings. The WHO collaborates with governments, non-governmental organizations,
and other international agencies worldwide, ensuring accuracy and reliability. The UNEP
website is the leading environmental authority, providing guidance and support on
environmental issues. It relies on scientific evidence and expert input, collaborates with
governments, and aims to engage policymakers, practitioners, educators, and the general
public in environmental conservation and sustainability.

Reflection

Researching AMR's influence on infectious diseases has given me a better appreciation of its
complexities and importance. Historically, cavemen's immune systems were far better than
those of modern humans. A healthy diet, regular exercise, appropriate sleep, and good
cleanliness are crucial for a strong immune system. We had great immune systems as
cavemen, which we can bring back again. Initially, I thought that only researchers, doctors, and
scientists were responsible for creating a treatment for AMR. However, now I feel that we can
take part too. As a global community, we should collaborate to improve and develop ourselves
so that our bodies can tackle infectious diseases while limiting microbial adaptation and
resistance. If we are healthy, we do not require antibiotics, reducing the danger of developing
AMRs. I wholeheartedly support WHO's stance on "No action today, no cure tomorrow."
Together, we can put an end to this.

Bibliography

Image source:
M. (2022, May 12). Premium Vector | Tablet capsule medicine icon illustration. healthcare and
medical icon concept isolated. Pinterest. https://www.pinterest.ph/pin/564990715763414483/

Antimicrobial resistance: No action today, no cure tomorrow.(2011, April 7).

https://www.who.int/director-general/speeches/detail/antimicrobial-resistance-no-action-today-no
-cure-tomorrow

Reardon, S. (2014, April 30). WHO warns against “post-antibiotic” era. Nature.
https://doi.org/10.1038/nature.2014.15135

Antimicrobial Resistance and Infectious Disease | Johns Hopkins Bloomberg School of Public
Health. (n.d.). Johns Hopkins Bloomberg School of Public Health.
https://publichealth.jhu.edu/departments/environmental-health-and-engineering/research-and-pr
actice/research-areas/antimicrobial-resistance-and-infectious-disease

Antimicrobial resistance. (2023, November 21).

https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance#:~:text=As%20a%20r
esult%20of%20drug,through%20genetic%20changes%20in%20pathogens.

Antimicrobial Resistance: Addressing a Global Threat to Humanity. (n.d.).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317217/

What Exactly is Antibiotic Resistance? (2022, October 5). Centers for Disease Control and
Prevention. https://www.cdc.gov/drugresistance/about.html
Antimicrobial resistance: a global threat. (n.d.). UNEP - UN Environment Programme.
https://www.unep.org/topics/chemicals-and-pollution-action/pollution-and-health/antimicrobial-re
sistance-global-threat#:~:text=Antimicrobial%20resistance%20threatens%20human%20and,dev
elopment%20and%20equity%20within%20societies.&text=According%20to%20recent%20estim
ates%2C%20in,to%20drug%2Dresistant%20infections%20globally.

The WHO policy package to combat antimicrobial resistance. (n.d.).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3089396/

The WHO policy package to combat antimicrobial resistance. (n.d.).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3089396/#B1

World Health Organization. (2001). WHO global strategy for containment of antimicrobial
resistance. Retrieved from
https://iris.who.int/bitstream/handle/10665/66860/WHO_CDS_CSR_DRS_2001.2.pdf?sequence
=1

Köseoğlu E., & İnal T.C. (2019). The Effects of the Education Given to University Students
About Rational Use of Antibiotics on Their Awareness. European Journal of General Medicine,
16(1), 104-110. Retrieved from
https://cms.galenos.com.tr/Uploads/Article_27808/EAJEM-18-104-En.pdf

The Lancet. (2021). Global burden of 369 diseases and injuries in 204 countries and territories,
1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150259/#:~:text=Mortality%20from%20infectiou
s%20diseases%20was,disease%20deaths%20(Table%202)

Ventola C.L. (2015). The antibiotic resistance crisis: part 1: causes and threats. Pharmacy and
Therapeutics, 40(4), 277-283. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/

Institute for Health Metrics and Evaluation (IHME). (2020). Antimicrobial resistance poses threat
to all 35 countries in the Americas. Retrieved from
https://www.healthdata.org/news-events/newsroom/news-releases/antimicrobial-resistance-pose
s-threat-all-35-countries-americas

Nature. (2023). The fight against antibiotic resistance. Retrieved from

https://www.nature.com/articles/d41586-023-00284-x#:~:text=Overuse%20of%20antibiotics%20
in%20agriculture,cannot%20be%20treated%20with%20antibiotics

UNICEF. (n.d.). Water, Sanitation, and Hygiene (WASH). Retrieved from

https://www.unicef.org/wash
He D., & Gao Z. (2017). Epidemic Model with Heterogeneous Treatment and Heterogeneous
Infection Rates. Journal of Applied Probability and Statistics, 12(1), 21-35. Retrieved from
https://pubmed.ncbi.nlm.nih.gov/28164821/

World Bank. (2019). Drug-Resistant Infections: A Threat to Our Economic Future. Retrieved
from
https://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-e
conomic-future

United Nations Environment Programme. (n.d.). Antimicrobial Resistance: A global threat.

Retrieved from
https://www.unep.org/topics/chemicals-and-pollution-action/pollution-and-health/antimicrobial-re
sistance-global-threat#:~:text=Increased%20use%20and%20misuse%20of,following%20contact
%20with%20resistant%20microorganisms

National Center for Biotechnology Information (NCBI). (2008). Globalization, Climate Change,
and Human Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1914368/

Abdallah H.M., & Alzayat A.A. (2021). Prevalence of antimicrobial resistance among
Gram-negative isolates in an adult intensive care unit at a tertiary care center in Riyadh, Saudi
Arabia. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567979/

Mahajan P. (2021). The Emerging Role of Bacteriophage Therapy for Ventilator-Associated

Pneumonia: A Case Series. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176237/

Centers for Disease Control and Prevention (CDC). (n.d.). The Burden of Antibiotic Resistance.
Retrieved from https://www.cdc.gov/drugresistance/about.html

National Center for Biotechnology Information. Health disparity and mortality trends of infectious
diseases in BRICS from 1990 to 2019.
(n.d.).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943566/#:~:text=The%20highest%20STI
%20ASMRs%20were,relatively%20high%20respiratory%20infection%20ASMRs.

Antimicrobial resistance poses threat in all 35 countries in the Americas. (n.d.). Institute for
Health Metrics and Evaluation.
https://www.healthdata.org/news-events/newsroom/news-releases/antimicrobial-resistance-pose
s-threat-all-35-countries-americas#:~:text=The%20countries%20with%20the%20lowest,and%2
0Canada%20having%20the%20lowest.

Saha, P., Hasan, S., Halder, A., Chowdhury, P., Nath, A., Saha, D., ... & Ghosh, S. (2021).
Antimicrobial Resistance in Bangladesh: A Systematic Review. Cureus, 13(7), e16648.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9166953/
Alam, M. M., Khaleque, A., Akter, F., & Alam, M. K. (2021). Antibiotic Resistance Patterns of
Bacteria Isolated from Blood Samples in a Tertiary Care Hospital of Bangladesh. Cureus, 13(8),
e17134. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9823818/

Rahman, M. M., Rahman, M. S., Islam, M. M., Nahar, A., Al Mamun, A., Islam, S., ... & Akter, J.
(2014). Antibacterial effects of natural spices on multiple drug resistant Escherichia coli isolated
from drinking water, Bangladesh. Annals of Clinical Microbiology and Antimicrobials, 13(1), 18.
Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106649/#:~:text=Ginger%20also%20shows%20
antimicrobial%20and,potential%20against%20pathogens%20%5B16%5D.

Jahan, F., & Akram, M. (2013). Garlic (Allium sativum) supplementation with standard
antidiabetic agent provides better diabetic control in type 2 diabetes patients. Pakistan Journal
of Pharmaceutical Sciences, 26(2), 339-344. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609356/#:~:text=Natural%20spices%20of%20g
arlic%20and,and%20further%20evaluation%20is%20necessary.

Countries step up to tackle antimicrobial resistance. (2018, July 18).

https://www.who.int/news/item/18-07-2018-countries-step-up-to-tackle-antimicrobial-resistance