GRAM Report- Global Research on Antimicrobial Resistance Report

Context:

According to the GRAM Report (Global Research on Antimicrobial Resistance report), 1.27 million people died in 2019 as a direct result of AMR (AntiMicrobial Resistance).

What is antimicrobial resistance?

Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death. 

As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.

• Antimicrobial resistance (AMR) is a global health and development threat. It requires urgent multisectoral action in order to achieve the Sustainable Development Goals (SDGs).
• WHO has declared that AMR is one of the top 10 global public health threats facing humanity.
• Misuse and overuse of antimicrobials are the main drivers in the development of drug-resistant pathogens.
• Lack of clean water and sanitation and inadequate infection prevention and control promotes the spread of microbes, some of which can be resistant to antimicrobial treatment.
• The cost of AMR to the economy is significant. In addition to death and disability, prolonged illness results in longer hospital stays, the need for more expensive medicines and financial challenges for those impacted.
• Without effective antimicrobials, the success of modern medicine in treating infections, including during major surgery and cancer chemotherapy, would be at increased risk.

Findings of the GRAM report

• Of the 23 pathogens studied, drug resistance in six (E coli, S aureus, K pneumoniae, S pneumoniae, A baumannii, and P aeruginosa) led directly to 9.29 lakh deaths and was associated with 3.57 million.
• One pathogen-drug combination – methicillin-resistant S aureus, or MRSA – directly caused more than 1 lakh deaths.
• Resistance to two classes of antibiotics often considered the first line of defence against severe infections – fluoroquinolones and beta-lactam antibiotics – accounted for more than 70% of deaths caused by AMR.
• 10-fold: Variation between countries in total antibiotic consumption rates, ranging from as low as 5 DDD to 45.9 DDD per 1000 population per day.
• 46% up: Between 2000 and 2018, global antibiotic consumption rates increased from 9.8 to 14.3 DDD per 1000 population per day).
• 76%: Increase observed between 2000 and 2018 in low- and middle-income countries (from 7.4 to 13.1 DDD per 1000 per day). In high-income countries, consumption rates remained stable.
• 116%: Increase in antibiotic consumption rates in South Asia. The second largest increase was in the North Africa and Middle East region (111%).

Factors leading to AMR

• The main drivers of antimicrobial resistance include the
• Misuse and overuse of antimicrobials;
• Lack of access to clean water,
• Sanitation and hygiene (wash) for both humans and animals;
• Poor infection and disease prevention and control in health-care facilities and farms;
• Poor access to quality, Affordable medicines, Vaccines and diagnostics;
• Lack of awareness and knowledge; and Lack of enforcement of legislation.
• Lack of access to timely and appropriate treatments for infections,
• Self-medication, prescription sharing, over-the counter sale of antimicrobials,
• Non-compliance with the prescribed treatment.
• genetic mutation of bacteria.
• By one species acquiring resistance from another.

AMR in India:

• India, with its combination of large population, rising incomes that facilitate purchase of antibiotics, high burden of infectious diseases and easy over-the-counter access to antibiotics, is an important locus for the generation of resistance genes (such genes help bacteria in surviving on being exposed to antibiotics).
  • The multi-drug resistance determinant, New Delhi Metallo-beta-lactamase-1 (NDM-1), emerged from this region to spread globally.
    • Africa, Europe and other parts of Asia have also been affected by multi-drug resistant typhoid originating from South Asia.
  • In India, over 56,000 newborn deaths each year due to sepsis are caused by organisms that are resistant to first line antibiotics.
  • A study reported by ICMR (Indian Council of Medical Research) from 10 hospitals showed that when Covid patients acquire drug-resistant infections in hospitals, the mortality is almost 50-60%.

Measures Taken to Address AMR (India):

• National Programme on AMR containment: Launched in 2012. Under this programme, AMR Surveillance Network has been strengthened by establishing labs in State Medical College.
  • National Action Plan on AMR: It focuses on One Health approach and was launched in April 2017 with the aim of involving various stakeholder ministries/departments.
  • AMR Surveillance and Research Network (AMRSN): It was launched in 2013, to generate evidence and capture trends and patterns of drug resistant infections in the country.
  • AMR Research & International Collaboration: Indian Council of Medical Research (ICMR) has taken initiatives to develop new drugs /medicines through international collaborations in order to strengthen medical research in AMR.
    • ICMR along with Research Council of Norway (RCN) initiated a joint call for research in antimicrobial resistance in 2017.
    • ICMR along with the Federal Ministry of Education and Research (BMBF), Germany has a joint Indo-German collaboration for research on AMR.
  • Antibiotic Stewardship Program: ICMR has initiated antibiotic stewardship program (AMSP) on a pilot project across India to control misuse and overuse of antibiotics in hospital wards and ICUs.
    • DCGI has banned 40 Fixed Dose Combinations (FDCs) which were found inappropriate.

Global Measures:

• World Antimicrobial Awareness Week (WAAW):
  • Held annually since 2015, WAAW is a global campaign that aims to raise awareness of antimicrobial resistance worldwide and encourage best practices among the general public, health workers and policy makers to slow the development and spread of drug-resistant infections.
  • The Global Antimicrobial Resistance and Use Surveillance System (GLASS):
    • WHO launched the GLASS in 2015 to continue filling knowledge gaps and to inform strategies at all levels.
    • GLASS has been conceived to progressively incorporate data from surveillance of AMR in humans, surveillance of the use of antimicrobial medicines, AMR in the food chain and in the environment.

Way Ahead

• Lowering of antibiotic consumption is not sufficient because the spread of resistant strains and resistance genes are the dominant contributing factor.
• Providing sanitation, clean water and good governance, increasing public health expenditure and better regulating the private health sector are all necessary to reduce antimicrobial resistance.

GRAM

GRAM is the flagship project of the University of Oxford Big Data Institute–IHME Strategic Partnership. GRAM was launched with support from the United Kingdom Department of Health’s Fleming Fund, the Wellcome Trust, and the Bill & Melinda Gates Foundation.

The purpose of the Global Research on AntiMicrobial resistance (GRAM) Project is to generate accurate and timely estimates of the magnitude and trends in antimicrobial resistance (AMR) burden across the world.

Importance: This data can be used to inform treatment guidelines and agendas for decision-making and research, detect emerging problems and monitor trends to inform global strategies, as well as facilitate the assessment of interventions over time.

Source: Indian Express

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