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This content is taken from the BSAC & European Wound Management Association's online course, Antimicrobial Stewardship in Wound Management. Join the course to learn more.

Skip to 0 minutes and 10 seconds Having looked at the agents we use in wound care and the issue of antimicrobial resistance, let us get a better understanding of the scale of the problem that we are facing. Antimicrobial resistance is indeed a global threat. Although scientists and medics understood the implications of antimicrobial resistance long ago, it is only relatively recently that politicians and the public in general are becoming interested in the situation. A report published by the WHO in 2014 looked into the causes of antimicrobial resistance. The factors that have led to the emergence and the spread of antimicrobial resistance strains are due to a wide range of inappropriate use of antibiotics in health care settings, agriculture and in food-producing animals.

Skip to 1 minute and 5 seconds Additionally, we have had poor sanitary processes involved in the handling and storage of food, and the improper disposal of wastes that contain antimicrobial agents. Essentially, we now realise that it is better to prevent an infection rather than to have to treat it. The global threat of antimicrobial resistance has clearly been identified in Europe and in the States. The European Union developed a five- year plan back in 2008. And that has been extended. Much has been written by the Centre for Disease Control in Atlanta on antimicrobial resistance. The WHO have published an action plan as well. And these three documents can be accessed in the Downloads and the See Also sections below.

Skip to 1 minute and 59 seconds In the WHO’s action plan of 2015, they identified five main objectives. The first is to make people aware of the situation, to educate them, talk about it, and train them to manage the situation. We certainly need to monitor antimicrobial resistance and to understand it more carefully so that we can – We need to conduct more research in this field. Next, we need to increase our efforts towards effective hygiene practices and infection prevention methods. We need to optimise the use of antimicrobials in humans and in animals. Finally, we need to develop scenarios where countries can cope with these measures and invest more towards the development of new medicines and diagnostic techniques. One very interesting report was published in 2014.

Skip to 2 minutes and 57 seconds It was part of a series of five reports which were developed by Lord O’Neill in the UK. The sixth report was a summary of the five reports. The one that I highlighted here was published in 2014. And it was very interesting. They used computer modelling to predict the impact of antimicrobial resistance in the future. They had to make certain assumptions while doing so. And they looked at the number of antimicrobial infections that would lead to death. It is estimated that 700,000 people die of infections every year. But by the year 2050, which is only a generation away, they calculated the annual death rate due to antimicrobial-resistant infections would rise to 10 million individuals per annum.

Skip to 3 minutes and 54 seconds With that amount of death, there would be a severe impact on the economy. And that was estimated to be a loss of $100 trillion. Many people thought that this was an overestimation.

Skip to 4 minutes and 12 seconds However, in 2017, the World Bank did an analysis of the impact of drug resistance on our economic future. They came up with two scenarios. The first was that if we had a low impact due to antimicrobial resistance. But even so, they determined that there would be a decrease of 1.1% in gross domestic product by the year 2000– 2030, beg your pardon. And an annual shortfall of $1 trillion. The second scenario was that if we had a high impact, they estimated a loss of 3.8% in gross domestic product, and an annual shortfall of $3.4 trillion by 2030. These two calculations really bring to our attention the adverse impact of antimicrobial resistance might have on future generations.

Skip to 5 minutes and 14 seconds Recently, an intra-agency coordination group has been formed by the United Nations. Their message emphasises that the global crisis due to antimicrobial resistance is significant. I recommend you to read the report, which can be found in the Downloads section below.

Scale of the problem of antimicrobial resistance

The massive increase in the number of antimicrobial resistant pathogens is a major public health problem and global threat that we face today.

Organisations such as the US Centers for Disease Control and Prevention (CDC), the European Centre for Disease Prevention and Control (ECDC) and the World Health Organisation (WHO) are trying to spread awareness on infections caused by multidrug-resistant (MDR) bacteria.

The widespread use of antimicrobials in animals and the food chain is a significant contributing factor to antimicrobial resistance. The excessive use of antimicrobial agents in the treatment of infections in humans and animals has caused the accumulation of these compounds in the environment, providing an opportunity for selection and survival of resistant pathogens.

Within a healthcare setting, several factors intertwine and contribute to increasing antimicrobial resistance: high consumption of antibiotics, constant influx of a variety of pathogens, and a considerable number of immunocompromised or severely ill patients. This is an ideal setting for exchange of resistance genes and spreading of these microbes.

In this video, Professor Rose Cooper explains WHO’s objectives to tackle AMR. She also discusses O’Neill’s review on antimicrobial resistance, IACG’s report on drug-resistant infections, and WHO’s action plan. These three documents can be accessed under the downloads section below.

After watching the video, think about the WHO objectives. Which do you think are relevant to practitioners involved in wound care? Discuss with your fellow learners in the comments section.

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Antimicrobial Stewardship in Wound Management


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