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Please make a summary on Challenges, Causes and Responses from the below-mentioned PDF. In the report please mention the page number from where you are writing Challenges, Causes and Responses.
The article is Antibacteria resistance worldwide: causes, challenges and responses by stuart B Levy & Bonnie Marshall.
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The discovery of anti-microbial led to an optimism of curbing many health issues. But, owing to its use, misuse, over-exploitation it has resulted into microorganism with one or more than antimicrobial resistance. Drug resistance has no boundaries and emerging as a pandemic globally raising the concern of health authorities. The current essay gives a brief idea causes, challenges, and responses to different types of Antimicrobial resistance occurring worldwide.
Antimicrobial resistance is not a new concept. Going back through pages of history, it can be known Streptococcus pyrogenes was the first micro-organism to get anti-microbial resistance isolated from military hospitals in the 1930's. Since the list never halted with the addition of a new strain either in single drug-resistant or multi-drug resistant category. This has led to a number of clinical issues over the years. From a mechanism point of view, it is only when antimicrobial or antibiotic and antimicrobial drug resistance determines in an organism present in an environment simultaneously, it leads to antimicrobial drug resistance.
Through specific antimicrobial resistance genes, these micro-organisms propagate beyond their original host and geographical boundaries leading to this pandemic. A number of mobile genetic elements such as naked DNA, plasmid, transposons, and bacteriophages can help in transferring the resistance gene from one organism to other irrespective of species and strain. The genes which are transferred either bears single anti-microbial resistance target or multi-drug resistance through multiple accumulations of resistance genes. Antimicrobial resistance mechanisms have also gone a number of evolutions making it tough for clinicians and researchers to address the problem. In absence of mentioned mobile genetic elements mutations accumulated in particular chromosomes over the period can give rise to resistance. Similarly, a mutation in target enzymes can also lead to mutations observed in E.coli strains resistance against floroquinolones.
Staphylococcus aereus obtained intermediate resistance against vancomycin due to vancomycin use but later on evolved its own mechanism through transposon inheritance from enterococci. Continuous use of antimicrobials or antibiotics for more than 10 days, not only select bacteria of a target for resistance but also other organisms also acquire this resistance. Similarly, the bacteria present in gut microflora may acquire resistance against single anti-microbial plus other unrelated drugs making them multi-drug resistance organisms. Research has shown the resistant genes are linked on same plasmid or transposon giving organism multi-drug resistance ability. For example- sub-therapeutic level of tetracycline administration in feed led to tetracycline resistant E.coli excretion by chickens.
Two weeks later same E.coli excreted by chickens were having multiple drug resistance. Since no exact mechanism is known how this multiple drug resistance occurs by single drug use this poses a huge problem before healthcare researchers and clinicians. It has been reported bacteria's which has resistance against one single anti-microbial drug, tends to acquire different other resistance genes from other species sharing a single environment. The very best example can be floroquinolones resistant gene which emerged through penicillin and tetracycline resistant gene interaction and led to floroquinolones resistant N.gonnorrhoae. Since the mechanism of resistance acquiring vary and new methods are being adopted by micro-organism in coming days the problem will pose a high degree of danger in the context of public health demanding worldwide immediate intervention (Levy and Marshall, 2004).
It is necessary to know, what challenges are posed by these drug-resistant organisms or drug resistance mechanism that despite the huge amount of investments also failed to control this problem. The first challenge posed by these organisms is – the resistance loss is very slow that is antagonistic to resistance acquiring speed. As a result, irrespective of the presence of selected antibiotic or anti-microbial the resistance genes remains in its host species. Similarly, interactions between resistance genes can also lead to MDR (multi-drug resistance) property incorporated into single drug resistance plasmids. Although studies showing a decrease in resistance genes by discontinuing the use of selected anti-microbial has raised some hope among health care researchers, the low level of resistance always remains. At any time, if the selected anti-microbial is re-introduced the chances of resistance increase is always there. Another interesting mechanism of drug resistance lowering has emerged from experiments showing the effect of changing environmental strains surrounding resistance strains.
