::Antimicrobial resistance


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Antibiotic resistance tests: Bacteria are streaked on the dish on which antibiotic impregnated white disks are placed. Bacteria in the culture on the left are susceptible to the antibiotic in each disk, as shown by the dark, clear rings where bacteria have not grown. Those on the right are fully susceptible to only three of the seven antibiotics tested.<ref>Kirby-Bauer Disk Diffusion Susceptibility Test Protocol, Jan Hudzicki, ASM</ref>

Antimicrobial resistance (AMR) is when microbes are less treatable with one or more medications used to treat or prevent infection.<ref name=WHO2014>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> There are three main ways by which resistance can occur: natural resistance to certain types of bacteria, genetic mutation, or by acquiring resistance from another bacterium.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> This phenomenon can happen spontaneously due to mutations of the microbes themselves, to a build up of resistance over time, or to misuse of antibiotics or antimicrobials.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Resistant microbes become increasingly difficult to treat, requiring alternative medications or higher doses, both of which may be more costly or more toxic to the individual. Some infections become completely untreatable due to resistance. All classes of microbes develop resistance: fungi – antifungal resistance, viruses – antiviral resistance, protozoans – antiprotozoal resistance, and bacteria – antibiotic resistance. Microbes which are resistant to multiple antimicrobials are termed multidrug resistant (MDR); in the press, these organisms are often referred to as superbugs.<ref name=cdcgetsmart>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Antimicrobial resistance is an increasingly problematic issue that leads to millions of deaths every year.<ref name="WHO 2014">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Antibiotics should only be used when needed and only when prescribed by health professionals.<ref name="Swedish">{{#invoke:citation/CS1|citation |CitationClass=book }}</ref> When antibiotics are being prescribed, the prescriber should closely adhere to the five rights of drug administration: the right patient, the right drug, the right dose, the right route, and the right time.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Narrow-spectrum antibiotics should be used rather than broad-spectrum antibiotics when possible to effectively and accurately target specific organisms.<ref name="NPS2013">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Cultures should be taken before treatment when indicated and treatment potentially changed based on the susceptibility report.<ref name="CDC Mission">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:Citation/CS1|citation |CitationClass=journal }}</ref> For people who will be self-administering these medications in the home setting, emphasis must be placed on education about proper use of the drug. In practice, health care providers should try to minimize spread of resistant infections by using proper sanitations techniques including handwashing or disinfecting between each patient, and should encourage the same of the patient, visitors, and family members.<ref name="CDC Mission"/>

The rising trend in drug resistance can be attributed to three primary areas: use of antibiotics in the human population, use of antibiotics in the animal population, and the spread of resistant strains between human or non-human sources.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Any use of antibiotics can increase selective pressure in a population of bacteria, causing vulnerable bacteria to die thereby increasing the relative numbers of resistant bacteria and allowing for further growth. As resistance to antibiotics becomes more common there is greater need for alternative treatments. Call for new antibiotic therapies have been issued, but there is continuing decline in the number of approved drugs.<ref>{{#invoke:Citation/CS1|citation |CitationClass=journal }}</ref> The Centers for Disease Control and Prevention (CDC) has developed a monitoring program for the top 18 drug-resistant threats in the United States, categorized by level of concern; examples of common types of drug-resistant bacteria include: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant S. aureus (VRSA), extended spectrum beta-lactamase (ESBL), vancomycin-resistant Enterococcus (VRE), multidrug-resistant A. baumannii (MRAB).

A World Health Organization (WHO) report released April 2014 stated, "this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. Antibiotic resistance—when bacteria change so antibiotics no longer work in people who need them to treat infections—is now a major threat to public health."<ref name="">"WHO's first global report on antibiotic resistance reveals serious, worldwide threat to public health" Retrieved 2014-05-02</ref> There have been increasing public calls for global collective action to address the threat, including a proposal for an international treaty on antimicrobial resistance.<ref>{{#invoke:Citation/CS1|citation |CitationClass=journal }}</ref> Antibiotic resistance is not properly mapped across the world, but the countries that are affected the most are poorer countries with already weaker healthcare systems.<ref name="Swedish"/>

Antimicrobial resistance sections
Intro  Definition  Causes  Environmental impact  Prevention  Mechanisms  Organisms  Applications  Society and culture  See also  Footnotes  References  External links  

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