It is a common belief that MDRO’s (multi-drug resistance organisms) are found and generated in hospitals, but in recent times this may not be entirely correct. Resistance bacteria are present in community and present in our home environment. This trend is dangerous as millions of people are losing battle to antimicrobial resistance (AMR) and MDROs every year. AMR alone is killing more people than cancer and road traffic accidents combined besides economic loss. To combat AMR, it is important to find causes of generation of MDROs and how they enter human body and community environment. Therefore, it is important to realize the contribution by all the following four important factors: humans, animals, food and environment.
Prevention of MDROs and AMR in India is a challenge. India has been referred to as ‘the AMR capital of the world’. While on one hand, emergence of newer multi-drug resistant (MDR) organisms pose newer diagnostic and therapeutic challenges, on the other hand India is still striving to combat old enemies such as tuberculosis, malaria and cholera pathogens, which are becoming more and more drug resistant. Factors such as poverty, illiteracy, overcrowding and malnutrition further compound the situation. Lack of awareness about infectious diseases in the general masses and inaccessibility to healthcare often preclude them from seeking medical advice.
Easy availability of over- the- counter (OTC) drugs, leads to self-prescription of antimicrobial agents or administered without any professional knowledge regarding the dose and duration of treatment.
Pharmaceutical industry has caused tremendous rise in the amount of chemical waste. With the lack of strict supervisory and legal actions, this waste reaches the water bodies and serves as a continuous source of AMR in the environment.
Another important challenge could be the use of antimicrobial agents as pesticides and insecticides in the agriculture industry. Farmers use antimicrobial agents to protect their hard-earned field and animals from pests and rodents. They are unaware about future consequences and impact on environment.
AMR in milk and food animals has been another big challenge. Gram-negative bacilli with extended-spectrum β-lactamases (ESBL) have been isolated from milk samples and poultry. Enterobacteriaceae isolated from fish and Salmonella species from broiler were isolated.
AMR in environment; Antimicrobial-resistant bacteria have been reported from different water sources of India. The major sources are the pharmaceutical waste waters and hospital effluents that are released into the nearby water bodies without adequate treatment.
In large rivers of India, multiple inlets with varying concentration of drug-resistant bacteria have been found. ESBL producers among Gram-negative bacteria isolated and E. coli isolates found from north as well as south Indian rivers.
To combat AMR, there are many steps possible at communityand Government level. Antibiotic stewardship plans for healthcare settings, promoting further research on the drivers of AMR, judicious use of antibiotics, strict vigilance of over the counter(OTC) antibiotics, control of hospital effluent plants, monitoring waste water discharges from pharmaceutical companies, regulation of use of antimicrobial in food and milk animals, improving agricultural practices and educating masses at community level about AMR.
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