Dr. Shashi Sudan Sharma
Sustainable access to effective antibiotics is essential for the functioning of all health systems. Antibiotic resistance is threatening a fundamental component for universal health coverage.Otto Cars – Founder of ReAct
Imagine a battlefield. A battlefield where the human race is fighting against the subtle and the invisible yet having the capacity and power to wipe out the entire human race from the scene of the earth, a battlefield where we know we can only delay the defeat, a battlefield where the enemy is getting the answers as quickly as the weapons to get them eliminated are made by the human race, a battlefield where the attacks are tremendously and awfully much more than the defenses against the enemy. This is the battle against superbugs.
The bugs or the microbes have moved in parallel to the human evolution through time and space and have caused sufferings to the humanity by causing varied diseases of antiquity that are still imbibed deep in the memories of collective consciousness of the entire human race. There have been excruciating pains through wounds of the past that attained the magnanimity of being grave pandemics that existed through centuries in the form of dreadful diseases like tuberculosis, Leprosy, Syphilis, Anthrax, Small pox, Cholera, Influenza, AIDS and the rest that add to make the list much longer. Humans remained totally unaware of the agents that caused these diseases for centuries of their existence on the planet until the 19th century that marked the discovery of most of them and in the third decade of 20th century the key to these locks was obtained by Sir Stephen Fleming in the form of an accidental discovery of what came to be known as antibiotics. This was a hope that made humans overtly enthusiastic about the elimination of all bugs from existence. The story however turned some uglier pages sooner or later when these bugs rather started transforming to superbugs to bring another dimension of misfortune to the human race. The overt use and misuse of these weapons called antibiotics had turned the bugs stronger as if the monsters were refusing to die.
Superbugs have covered a distance less through history and more through global spread. There travel through time may be short but they have emerged very fast just over a century through a mechanism of their escaping the attacks by antibiotics known as antimicrobial resistance (AMR) which has emerged as a global crisis and calls upon urgent action. Excessive use of antimicrobials not only in humans but also in animals has led to the emergence of selected multidrug-resistant microorganisms, which led to untreatable infections, more in vulnerable patient population. Healthcare facilities are high risk environments for the development and spread of drug resistance and frequently have the highest burden of multidrug resistant organisms.
WHO has declared that AMR as one of the top 10 global public health care threats being faced by humanity. Antimicrobial resistance (AMR) is a global health and development threat that requires urgent multi-sectoral action in order to achieve the Sustainable Development Goals (SDGs). In 2001, the WHO member countries agreed on global strategy for containment of Antimicrobial Resistance. During World Health Assembly in 2015, all the member countries committed themselves to the Global Action Plan (GAP) on AMR and agreed for the development and implementation of multi-sectoral National Action Plans (NAP).
In the same year WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) to continue filling knowledge gaps and to inform strategies at all levels. GLASS progressively incorporates data from surveillance of AMR in humans, surveillance of the use of antimicrobial medicines, AMR in the food chain and in the environment. GLASS provides a standardized approach to the collection, analysis, interpretation and sharing of data by countries, territories and areas. It monitors the status of existing and new national surveillance systems, with emphasis on representativeness and quality of data collection. India got enrolled in GLASS on 21st July 2017.
Government of India launched a “National Program on AMR Containment” during the 12th five-year plan (2012-2017) which is being coordinated by NCDC.
The main objectives of this program are:
* Establish a laboratory-based AMR surveillance system in the country to generate quality data on antimicrobial resistance.
* Carry out surveillance of antimicrobial usage in different health care settings.
* Strengthen infection control practices and promote rational use of antimicrobials through Antimicrobial stewardship activities.
* Generate awareness amongst health care providers and community on antimicrobial resistance and rational use of antimicrobials.
The GMC, Jammu is one of the earliest enlisted centre for this program and the department of Microbiology has been part of this laboratory based AMR surveillance since 2018 under which seven high priority pathogens and identified emerging AMR alerts are to be reported to the national AMR surveillance coordinating centre at NCDC from where data is sent to Global AMR Surveillance System (GLASS), using WHONET, a microbiology data management software.
Another important component of this program is to monitor the Antimicrobial Consumption Trends. GMC, Jammu has been one of the earliest National Antimicrobial Consumption Network (NAC-NET) site under this program. The monitoring of trends of Antimicrobial Consumption in our hospital started in 2019 and data is being shared to AMC Program Management Unit of NCDC via antimicrobial consumption tool since then.
Another method for monitoring trends of Antimicrobial Consumption is PPS and today we are rolling it out in GMC, Jammu. Soon prescription audit and linking of Antimicrobial consumption and resistance data will be done. This would be a breakthrough in the journey of profound growth experienced over the past so many years by this institute of repute and excellence. We as the institute of service and integrity are standing in ethical solidarity for the benefits and protection of our community and the world at large. However all the steps taken will be fruitful only when each one of us as the wise world citizens contemplate on their own roles and responsibilities and do whatever is needed to correct the situation. This becomes more valid when the standard reports from WHO alarms us about just 32 type of antimicrobials in the pipeline with just 8 antimicrobials that could get through to reach the market as against countless number of strains of bacteria that are becoming superbugs each coming day. How long these 8 soldiers will last to fight the battle is the question of the hour.
“If we use antibiotics when not needed, we may not have them when they are most needed” – Dr. Tom Frieden, Former Director U.S. CDC
(The author is Principal GMC, Jammu)
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