Antimicrobial Resistance
Drugs active against microorganisms (antimicrobial agents) include antibiotics, antifungals, antivirals, and antiprotozoals. Unfortunately, the use and misuse of antimicrobials have accelerated the emergence of antimicrobial-resistant (AMR) microorganisms. AMR is a significant issue that substantially threatens future healthcare delivery. The World Health Organisation ranks the rapid development of antibiotic resistance as one of the greatest threats and challenges to human health.
In 2019, The Changing the Culture 2019-2024: One Health. Tackling antimicrobial resistance in Northern Ireland, a five-year action plan was jointly developed by three government departments in Northern Ireland (the Department of Health, Department of Agriculture, Environment and Rural Affairs, and the Food Standards Agency) working with professionals in associated agencies, in recognition of the importance of a ‘one health’ approach to AMR. The action plan was prepared in conjunction with the UK’s 20-year Vision and five-year National Action Plan (NAP), and it provides actions specific to Northern Ireland. It is recognised that the COVID-19 pandemic has impacted the implementation of the UK and Northern Ireland AMR Action Plans.
Northern Ireland’s previous AMR strategy laid out an approach for antimicrobial stewardship in primary and secondary care and emphasised the importance of a hospital-community interface.
To slow down the development of antibiotic resistance, it is crucial to use antibiotics in the right way. Antimicrobial stewardship is a coordinated programme that promotes the appropriate use of all antimicrobial agents, improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by resistant microorganisms. Failure to address the problem globally could result in 10 million deaths alongside a cumulative cost of $100 trillion by 2050.
A recent analysis published in The Lancet by the Antimicrobial Resistance Collaborators presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. It reveals that more than one million people died each year as a result of AMR between 1990 and 2021. The study also estimates that 1.91 million people could potentially die as a direct result of AMR in 2050, an increase of almost 70% per year compared to 2022.
In addition, Antimicrobial resistance is also threatening the achievement of many of the UN Sustainable Development Goals.
Key references and further reading:
- The WHO AWaRe (Access, Watch, Reserve) antibiotic book. Geneva: World Health Organization; 2022.
- Antimicrobial Stewardship: Systems and Processes for Effective Antimicrobial Medicine Use (NG 15). London: The National Institute for Health and Care Excellence. 18 August 2015.
- Start Smart–Then Focus Antimicrobial Stewardship Toolkit for English Hospitals. London: Public Health England. 2023.
- BSAC Antimicrobial Stewardship: From principle to practice. Birmingham: British Society for Antimicrobial Chemotherapy.2018.
- Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. The Lancet, 2024; 404 (10459): 1199 – 1226.