Introduction
Globally, antimicrobial resistance is becoming a more serious and concerning hazard to healthcare facilities. This has resulted in greater hospital stays, rising healthcare expenses, and increased mortality. It has been found that nearly every common pathogen used in clinical settings exhibits notable resistance to common antimicrobial treatments. Numerous species are known to exhibit resistance to multiple drugs.
What Are Urinary Tract Infections (UTIs)?
Urinary tract infections are prevalent infections that frequently result in clinic or emergency room visits and indoor hospital hospitalizations worldwide. The two most common bacteria that cause UTIs are Escherichia coli and Klebsiella. However, numerous other bacteria, including gram-positive species and fungi, have been discovered to cause UTIs. The microbiology of complicated UTIs can differ slightly, with aggressive organisms such as Enterococci and Proteus being found more frequently, especially among males.
In urinary pathogens, there is a concerning upward trend in antibiotic resistance. This phenomenon was first observed primarily in patients who also had co-occurring conditions like diabetes or reflux nephropathy. In addition, the nosocomial infections exhibited a higher prevalence of resistance. But these days, many diseases acquired in the community are also linked to antibiotic resistance. This is a worldwide phenomenon and is not specific to any one nation.
What Is Antibiotic Resistance?
Antibiotic resistance is a major complicating issue that increases the difficulty of treating these diseases. More and more resistant organisms are forming due to the sharp increase in antibiotic prescriptions given worldwide, often for conditions for which they are unnecessary or of no importance. Antimicrobial resistance occurs when bacteria, fungi, and other microorganisms develop to withstand the effects of medications meant to eradicate them. In other words, the germs are not destroyed and can proliferate. It may be challenging or even impossible to treat resistant illnesses.
What Are the Causes of Antibiotic Resistance?
The reasons that play a role in the development of antibiotic resistance include:
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Overuse of Antibiotics: Epidemiological research has shown that the use of antibiotics is directly linked to the development and spread of resistant bacterial strains. Genes in bacteria can be inherited from relatives or acquired through mobile genetic components like plasmids from non-relatives. The spread of antibiotic resistance between various species of bacteria is possible through Horizontal Gene Transfer (HGT). In addition, resistance might develop spontaneously through mutation. Due to natural selection, antibiotics drive out competitors susceptible to the drugs, leaving resistant microorganisms to proliferate. Antibiotics are overprescribed globally despite warnings about overuse.
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Inappropriate Prescription: An incorrect antibiotic prescription can also lead to antibiotic resistance. Incorrectly prescribed antibiotics have questionable therapeutic value and expose patients to antibiotic-related problems unnecessarily. Subinhibitory and subtherapeutic antibiotic doses (lower concentration of the drug than required therapeutically) can encourage the development of antibiotic resistance through the development of genetic alterations such as changes in gene expression, HGT, and mutagenesis.
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Extensive Use in Farming: Antibiotics are commonly utilized as growth supplements in cattle in both the developed and developing worlds. Humans consume food and are exposed to antibiotics used in livestock. This enters their genetic makeup and causes drug resistance.
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Lesser Availability of New Antibiotics: Developing new antibiotics is no longer regarded as an economically prudent venture for pharmaceutical companies. Antibiotics are not as profitable as medications that treat chronic illnesses like diabetes, mental problems, asthma, or gastric reflux because they are typically administered for brief periods. Pharmaceutical companies would rather invest in chronic illness treatments since they are more profitable. The very low cost of antibiotics is another factor contributing to the lack of economic attractiveness in antibiotic research.
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Regulatory Barriers: Getting regulatory approval can sometimes be a barrier, even for companies passionate about discovering novel antibiotics. The U.S. Food and Drug Administration (FDA) has changed the guidelines for clinical trial design during the past 20 years, making antibiotic clinical studies very challenging. More innovative regulatory strategies are required to ensure the continuous advancement and accessibility of antibiotics in the future.
What Are the Options Currently Available to Treat Resistant UTIs?
Uropathogenic Escherichia coli still exhibits high levels of Nitrofurantoin and Fosfomycin sensitivity. Phenosporins, beta-lactams (such as the combination of Amoxicillin-clavulanate), and Fluoroquinolones are examples of second-line antibiotics.
The first-line treatment for pyelonephritis (an inflammation in the kidney due to an abacterial infection in the urinary tract) and other complex UTIs is a combination of amoxicillin and clavulanic acid. The alternatives for treating beta-lactamase-producing Enterobacteriaceae include Carbapenems, Cefepime, Piperacillin-tazobactam, Nitrofurantoin, and Pivmecillinam.
Ciprofloxacin and cotrimoxazole are not expected to be effective for Enterobacteriaceae that produce Extended-Spectrum Beta-Lactamases (ESBLs). Nitrofurantoin is used to treat these for ESBL-E. coli. On the other hand, oral treatments for ESBL-Klebsiella pneumoniae (K. pneumoniae) include Pivmecillinam, Fosfomycin, and Finafloxacin.
Multi-drug-resistant gram-negative bacteria pose a serious threat to global health care. This is mainly because it increases mortality and has negative effects on the individuals who are affected. Elderly people have a higher risk of developing serious infections since multi-drug resistance rises with age. Treatments for Multi-Drug-Resistant (MDR) pseudomonas are also administered using these combinations. They must be used quite selectively to prevent a circumstance where microorganisms become resistant to them as well.
What Can Be Done to Reduce Drug-Resistant UTIs?
The seven criteria used by the Centers for Disease Control and Prevention (CDC) to evaluate antibiotic-resistant bacterial illnesses were transmissibility, clinical impact, economic impact, incidence, 10-year forecast of incidence, availability of effective treatments, and barriers to prevention. Every microbe was categorized as urgent, serious, or concerning based on its danger. In general, dangers deemed concerning require less monitoring and preventive action, whereas urgent or dangerous ones require more.
Conclusion
The remarkable improvements in health that antibiotics have brought about are at risk because of rapidly evolving resistant microorganisms. Due to the widespread abuse of these medications and the failure of the pharmaceutical industry to produce new antibiotic medications to meet the need, this crisis is of global concern. This calls for a critical need for concerted efforts to explore crisis management strategies, restart research endeavors, and implement new policies. At all levels of healthcare, careful administration of antibiotics is critically needed and should be encouraged.
