Tired Tired of of Thinking? Thinking? Come Come to to a a Conclusion

Antimicrobial resistance (AMR) is considered as one of the ten global public health and development threats that humanity is facing. It is a critical One Health concern with implications for human, animal, plant, and environmental health.

AMR occurs when microorganisms such as bacteria, viruses, paraKsiEtEeVVsIINoNrMfAuARnRTgTiIINNbecome

resistant to antimicrobial treatments to which they were previously susceptible. Antimicrobials – antibiotics, antippvhhirarasaeslesoo,f crop production. Their effectiveness is now in jeopardy because a number of antimicrobial treatments that once worked no longer do so because microorganisms have become resistant to them. Microorganisms

resistance to commonly uTThsheedbbaanndtdiUmUririaicahhrHoHbeeieapplsddidaidrienindrdeefededrsrsiniengdg,

to becIotItmwwaeassaalislnsoocsrsteitliallltshtiheneYgYeleayarsrsorofefCsCoiosllltulausnsioitonn—to antimicrobials to which they were susceptible. Microbial pathogens develop resistance against antimicrobial drugs making them ineffective for treatment of infections.

curing infections caused by microbial pathogens. Inability of antimicrobials to cure infections due to resistance problems can cause havoc in the public healthcare system.

Antimicrobial resistance threatens human and animal health and welfare, the environment, food and nutrition security and safety, ecoenetetoermsrswiwcililllbdbeeavabeblleloetpotmosestatnayty,ininMaMnuumdmbbaeai

serioTuThsheetIChICrCaealaslostosnneteoeedpdssatotnocdcoeonmnsisdidceerprifirfIneInvddieainasthsihoounuldl,d preparedness, and response. It could make antimicrobials ineffective and useless and can kill more than 10 million people by 2050. Nearly 250000 people are dying annually in the European Union and 700000 globally due to AMR and more likely causing

g.IneInsstoetfeaa1dd.2ooftfarapilplpieoeaanssinidngogtlhtlaheerasannitnit-iPPaakkisistatanneexxtrteremmisiststs, annual health expenditure by 2050 sinking the global GDP by 1.1–3.8%. The cost of treatment is rising due to ineffectiveness of antimicrobial treatment by AMR. In the EU alone it is estimated that AMR costs EUR 1.5 billion annually in healthcare costs and productivity losses.

AMR disproportionately affects low- and middle-income countries. The World Bank estimates that an additional 24 million people would be forced into extreme poverty by 2030 if

As per estimates by 2050, AMR may pose economic crises similar to the 2008 financial crisis. AMR threatens susttwawoioncacobouluenntdtrerieivesesIlnoIndpdmiaiaeananntddgPoPaaklskisiosttafanUnnttoioted

Nations, especially targets for good health and well-being (Goal 3).

Understanding the basis of AMR is of utmost importance. Devising interventions that can support antimicrobials and can help in overcoming the“m“OOneneneahhcaaessototfoAhhaMavveReawasistlotlombmaeacnchhefeofdorretdhtheiesnsee

rhtheeoaonrneesswmwhahono’d’ydggoconaneueasaewwshhoitifeterArsshMhaadRdee

unregulated use or misuse of antimicrobials in animals, humans and agriculture, application of antimicrobials in animals as prophylactics or feed additives and use of antimicrobials in animals destined for human use. Societal pressure, inappropriate use of antimicrobials, inadequate diagnostics, and hospital use coupled with agricultural use of antimicrobials aid in development of AMR. The application of antimicrobials is central to resistance development both in animals, humans and the environment. Unrestricted use, under dosage, overuse and inappropriate use of antimicrobials in animals and humans predisposes to AMR. Antimicrobial consumption will increase in animals by 99% in 2030 and in humans by 13%. There was a significant surge in the global consumption of antibiotics (increased by 65%, 21.1–34.8 billion DDDs (defined daily doses) during 2000 to 2015, which was mainly driven by low- and middleincome countries. India is the largest consumer of antibiotics (12.9 × 109 units (10.7 units/person)) followed by China (10.0 × 109 units (7.5 units per person)). BRICS countries (Brazil, Russia, India, China, and South Africa) have shown 76% of the overall rise in antibiotic use during the decade 2000 to 2010. Among BRICS countries 23% of the rise in the retail antibiotic sales was attributed to India, while around 57% of the increase in the medical sector was in China. The rise in antibiotic use has multifaceted reasons but unregtuhleartedis soymstemthsingantdhaitnseefefemctsivtoeness

further aggravates the problem of AMR as constant exposure of pathogens to antimicrobials results in resistance.

Natural selection and mutation helps microbial pathogens to develop this resistance which is transmitted from one generation to another. This selection process is exacerbated by humans through inappropriate use

.in healthcare settiMnMogosstttohthriningignssinitnhMMerrPfPo’s’oscdclalascshssstaatiarntretedfdaocouiutltia-ass

of antimicrobials and ultimately uselessness. The initial antimicrobial resistance is believed to be through random gene transfer events by bacteriophagedhreiavdewnratprpaendsadrouucntdioonth. of resistance against antimicrobial drugs due to selection of resistant

hDDorizontal mi c rob e s wa s foll o wed by transfer of genes among microbial species producing resistant phenotypes. Despite discovery of novel antimicrobials, microbes kept developing resistance through different mechanisms. With the advent of new antimicrobials from 1950 to 1970, AMR could not be noticed on that large scale however continuous use of the same antimicrobials and less or no discovery of newer antimicrobials for a long time led to crises of AMR. FDA has approved only 17 new systemic antibiotics and 1 related biologic in the last 12 years (2010-2022). Only 1 in 30 drugs reach clinical trials or testing in people phase and even if approved they are reserved for severe infections only with restricted use. So there is pressure of utilising already available antimicrobials which results in development of resistance.

Microbes have developed resistance to multiple drugs (MDR) and there is also Extended-Spectrum Drug Resistance (XDR) and Pandrug Resistance (PDR). The ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa,

species) are the notaAbplerobpaocstenreiawl a‘AthFSogPeAnIsmhmavui-ng developed antimicrobial resistance. Similarly Candida auris fungus, human immunodeficiency virus and

Plasmodium falciparum parasite are other examples of resistant microbial pathogens.

Understanding the basis and mechanisms of resistance is of utmost importance for devising intervcacenanbtbeieroeraencahschedeadanta:dtn: of AMR. Devising techno interventions that could support antimicrobials and help in combating AMR are the need of the hour and requirements for safeguarding the future. This involves efforts at regional, national and global levels. The main approaches that should be under focus

lnuadteurjeuadnicdioduresamanodf lwimritiitnegd othfat arhrnhytymimeedidcaranondbddidaeelssccrirbiibeneddlilfaiefneiinimnaamlmso,orerernneaagtutuur-aral lwawarayys—c—reaeanwwianaygythtohafatthahanadtdinmnootihtchirniongbgtiotaoldsdoofwowirtihth AsscMcieienRnc,cee?d?evelopment of novel antimicrobAiAayylosou,unnagglmtmearanndadrterieavamemsiningtgoisishahonowtwiImIccoiocmmreoet-oto bvvieiaewlws,mmymysosccnhhoiotool rlrierneppgoortrastsnoodffthtshauatrtdvdaeayiylalanandndcaaeggee owwfhAheenMnIRIg,glalanwncaceeraeatnttehtshesemmanoodcccaoasusiotiornneaalllcylyhthtohenessee AddaMayysRsy,yeeclllolowllwainibngogirnianataipoplnalassstitacictsslneleaevtveieo. international levels and implementing the initiatives of one health.

Considering the importance and need for combating AMR, quadripartIifItftehthejeoddiisnistseeccstitenincgrgoeoftfaaarfrfioraogtgtatoaunugghahtntmmteimeaanin-yy-cthtrhionibngigaitiltpporoienisntietsedtdamnmeceeinintwhthaeesddiriceroeccntitosiontnitouofftvevedegg-weetiattarhiraiangnilsiosmmbaanlndodarakgkianinddninseeasstsitotonaalslllaiannimcimlaualdslsgignrergeaatt WaannoddrslsmdmaHalll.el.SaSclciteihenncOceerppgroraovnvididseeaddtmimoeneww(iWtihthHaanOn)in,in-FssiogigohhdttianintotdolalAatetgerrarialciltuityly.t.TuThrhaeattOisis,r,ygyoaounuiczcoaoutulidlodnbbee ossefeatatheteddUininthittheeldalapNpoaoftfsiscocineiensnc(ceFeaAanndOdb)b,eetthotoetatUalllylNyaatt Environment Programme (UNEP) and the World Organisation for Animal Health (WOAH) to drive multistakeholder engagement in AMR.

The United Nations General Assembly in 2022 resolved to hold a UpplNalacGceeAwwhHheeriergehyyo-olueugvgoeotlttMitrierededotoifnfthtghinionknkiningAg.”.M” R in 2024 which will be an opportunity to commit to clear and new targets and practical steps to address AMR. This event will allow Heads of Government and State, Government Ministers and political leaders the opportunity to discuss effective approaches to addressing AMR at a local, national and global level with regards to funding, policy development and international and multi-sectoral collaboration.

On a similar pattern, Sher E Kashmir University of Agricultural Sciences and Technology of Kashmir (SKUAST-K) is organizing JK AgriMed Science Congress (2023-2024) from 27 to 29th February 2024 involving experts from Agriculture and allied sciences and medical sciences with the aim of convergence of expertise in agricultural and medical science in order to discuss and focus on the issues and challenges that the bioeconomy and healthcare will be facing in future including antimicrobial resistance.

The author is Assistant Professor, Principal of SERB, DST and BIRAC projects on infectious diseases of livestock Views expressed in the article are the author’s own and do not necessarily seetsasnce of Kashmir Observer. The opinions and observations are of the author and not of the institute he works for