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Abstract

Considered one of the most significant medical discoveries of the 20th century, antibiotics have transformed healthcare by preventing countless deaths caused by bacterial infections. However, antibiotic resistance is a powerful foe that has emerged because of antibiotic overuse and misuse. Antimicrobial resistance poses an immediate threat to public health around the world, accounting for at least 1.27 million deaths globally and about 5 million fatalities in 2019. The efficacy of antibiotics is seriously threatened by the current global health crisis, endangering our capacity to treat common diseases. Antibiotic resistance is one of the main risks to modern development, food security, and global health, and it is an increasing global concern. Anyone, anywhere in the world, at any age, can become resistant to antibiotics. Worldwide, the prevalence of antibiotic resistance is increasing to dangerously high levels. Every year, around 2.8 million antibiotic-resistant diseases happen in the United States. The CDC estimates that, as a result, more than 35,000 people pass away. More than $4.6 billion is spent on the treatment of infections each year in the United States due to six multidrug-resistant bacteria that are commonly identified in medical settings. Our capacity to treat common infectious diseases is under threat from new resistance mechanisms that are emerging and spreading globally. Given the urgency of the problem, a thorough grasp of the epidemiology, local dynamics, and mechanisms influencing the emergence of antibiotic resistance is necessary.
Healthcare challenges in LMICs: addressing
antibiotic resistance threats, a call for
comprehensive global solutions: an editorial
Tooba Ali, MBBSa, Ashna Habib, MBBSa, Zainab Nazir, MBBSa, Muneeba Ali, MBBSb,
Md Ariful Haque, MBBS, MD,MPHc,d,e,*
Introduction
Considered one of the most signicant medical discoveries of the
20th century, antibiotics have transformed healthcare by pre-
venting countless deaths caused by bacterial infections. However,
antibiotic resistance is a powerful foe that has emerged because of
antibiotic overuse and misuse. Antimicrobial resistance poses an
immediate threat to public health around the world, accounting
for at least 1.27 million deaths globally and about 5 million
fatalities in 2019
[1]
.Theefcacy of antibiotics is seriously threa-
tened by the current global health crisis, endangering our capacity
to treat common diseases. Antibiotic resistance is one of the main
risks to modern development, food security, and global health,
and it is an increasing global concern
[2]
. Anyone, anywhere in the
world, at any age, can become resistant to antibiotics
[2]
.
Worldwide, the prevalence of antibiotic resistance is increasing to
dangerously high levels
[2]
. Every year, around 2.8 million anti-
biotic-resistant diseases happen in the United States
[1]
. The CDC
(Centers for Disease Control and Prevention) estimates that, as a
result, more than 35 000 people pass away
[1]
.Morethan$4.6
billion is spent on the treatment of infections each year in the
United States due to six multidrug-resistant bacteria that are
commonly identied in medical settings
[1]
. Our capacity to treat
common infectious diseases is under threat from new resistance
mechanisms that are emerging and spreading globally
[2,3]
. Given
the urgency of the problem, a thorough grasp of the epidemiology,
local dynamics, and mechanisms inuencing the emergence of
antibiotic resistance is necessary. Antibiotics used to treat an
increasing array of diseases, including gonorrhea, pneumonia, TB
(tuberculosis), and salmonellosis, are losing their effectiveness
[2]
.
Dedicated prevention and infection control initiatives in the
United States decreased mortality from antimicrobial-resistant
infections by 18% nationwide and by nearly 30% in hospitals,
according to the CDCs 2019 AR Threats Report
[1]
.However,
according to the CDCs 2022 special report on the impact of
COVID-19 on antibiotic resistance in the United States, a sig-
nicant portion of that advancement was lost because of the
global epidemic
[1]
. In 2020, the pandemic drove towns, health
departments, and healthcare facilities to the brink of collapse,
making it extremely difcult to continue the progress being made
in the ght against antibiotic resistance
[1]
. Although the United
States is a developed country, antibiotic resistance poses much
more challenging problems for low- and middle-income nations.
In these resource-poor environments, frontline healthcare per-
sonnel face particular challenges in their quest to deliver high-
quality treatment while negotiating the murky waters of antibiotic
resistance. This article analyzes the tactics that can enable
healthcare professionals to tackle antibiotic resistance effectively
and preserve the effectiveness of antibiotics for future generations.
It also digs into the nuances of these difculties.
Urgent challenges and complexities in managing
antibiotic resistance
Low- and middle-income countries (LMICs) are more affected
than high-income countries due to widespread antibiotic misuse,
antibiotic use in agriculture, poor drug quality, inadequate sur-
veillance, and other factors related to inadequate medical stan-
dards, malnutrition, chronic and recurrent infections, and the
inability to afford more expensive and effective drugs
[4]
.Dueto
inadequate systems and knowledge, all of these are becoming more
common in LMISs on a daily basis. In environments with limited
resources, frontline healthcare providers are crucial to the health-
care system in LMICs and must deal with the difcult problem of
antibiotic resistance. The stability of healthcare systems and the
adequacy of necessary treatments are imperiled by antibiotic
resistance. Antibiotic resistance is a worldwide health epidemic
with far-reaching effects, and it presents a tough challenge in an
already demanding situation. The global issue of antibiotic resis-
tance is becoming increasingly pressing, and frontline healthcare
professionals in LMICs encounter difculties in managing this
problem in environments with inadequate resources. These dif-
culties include a lack of nances, inadequate infrastructure,
a
Dow University of Health Sciences,
b
Karachi Medical and Dental College, Karachi,
Pakistan,
c
Department of Public Health, Atish Dipankar University of Science and
Technology,
d
Voice of Doctors Research School, Dhaka, Bangladesh and
e
Department of Orthopaedic Surgery, Yanan Hospital Afliated to Kunming Medical
University, Kunming, Yunnan, Peoples Republic of China
Sponsorships or competing interests that may be relevant to content are disclosed at
the end of this article.
Published online 6 February 2024
*Corresponding author. Address: Department of Public Health, Atish Dipankar
University of Science andTechnology, Dhaka, Bangladesh; Voice of Doctors Research
School, Dhaka, Bangladesh. E-mail: arifulhaque58@gmail.com (M.A. Haque).
Received 5 November 2023; Accepted 26 January 2024
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an
open access article distributed under the terms of the Creative Commons
Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is
permissible to download and share the work provided it is properly cited. The work
cannot be changed in any way or used commercially without permission from the
journal.
International Journal of Surgery (2024) 110:30853087
http://dx.doi.org/10.1097/JS9.0000000000001165
Correspondence
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restricted access to diagnostic equipment, and a lack of knowledge
and training
[5]
. When deciding whether antibiotics are needed, an
accurate diagnosis is essential, but in LMICs, healthcare facilities
usually lack the required diagnostic equipment and skilled staff.
While balancing the requirements of varied populations in
healthcare is a universal problem, LMICs face unique challenges.
The frequency of empirical treatment in LMICs, which is inu-
enced by things like a high patient load and a shortage of medical
staff, diagnostic tools, and pharmaceuticals, is an important topic
that needs more research. Relying too much on empirical treatment
may have the unintended consequence of breeding microorganisms
that are resistant to drugs. Due to the conservative approach
brought forth by this deciency, antibiotics are often provided as a
rst resort, which exacerbates antibiotic resistance and misuse. To
effectively combat antibiotic resistance, frontline healthcare pro-
fessionals must strike a careful balance between meeting patients
needs, prescribing and administering antibiotics in accordance
with best practices, and giving proper care. In addition to main-
taining this delicate balance, frontline healthcare workers in
LMICs frequently struggle with the application and ignorance of
the World Health OrganizationsAWaReframework
[6]
. Antibiotic
resistance can be made worse by improper antibiotic prescription
and distribution, which is a result of a lack of understanding and
execution of the framework
[6]
. Patients who become colonized
with multidrug-resistant organisms (MDROs) have a markedly
increased risk of infection, regardless of whether the infections
occur in medical institutions or the community. This higher risk
can then result in insufcient treatment or even therapy failure,
which can raise death rates in the end.
Furthermore, resistance rates are made worse, and healthcare
systems are severely constrained by the larger socioeconomic
issues that are common in areas with limited resources
[7]
. The
livelihoods and general well-being of the impacted communities
are adversely affected by these problems, which have a knock-on
effect. To lessen the severe effects of antibiotic resistance in these
susceptible environments, it is essential to address these inter-
connected challenges in their entirety. Furthermore, the impact of
health emergencies like COVID-19 has brought to light the fra-
gility of healthcare systems in LMICs
[8]
. These crises, whether
they are past, present, or perhaps future occurrences, could put
additional demand on frontline healthcare professionalsabil-
ities, making the difculties they already confront managing
antibiotic resistance even more severe. The combination of
ongoing antibiotic resistance and health concerns creates a
complex challenge. Healthcare workers must strike a balance
between several opposing needs, such as continuing to use anti-
biotics appropriately while ensuring accurate diagnosis and
concurrent infection management.
Strategies to tackle antibiotic resistance
In LMICs, combating antibiotic resistance necessitates a compre-
hensive and multidimensional strategy. First and foremost, there
should be a focus on expanding healthcare access and encouraging
good hygiene habits to stave off diseases. Healthcare systems must
be strengthened, which includes making infrastructural invest-
ments, hiring qualied medical staff, and guaranteeing that
necessary medications are available. To solve the problems caused
by antibiotic resistance, cooperation between governmental bod-
ies, non-governmental groups, and international organizations is
crucial. Governments and other relevant organizations should
make investments to fortify healthcare systems by enhancing the
facilities, hiring more medical personnel, and guaranteeing the
supply of necessary medications. Campaigns for public awareness
can be extremely important in educating communities about the
proper use of antibiotics and the negative effects of improper use.
ChatGPT can also be extremely helpful in tackling antibiotic
resistance in LMICs by giving patients, healthcare providers, and
the general public easily accessible and customized information.
The applicability, dependability, and inuence of ChatGPT in the
eld of travel medicine were documented by Choudhary and
Priyanka
[9]
in their article. When it comes to advice on proper
prescriptions for antibiotics, dosing schedules, and the signicance
of nishing antibiotic courses, ChatGPT can be a dependable and
accessible resource. Antibiotic sales should be regulated, with
prescription drugs the only way to obtain them in order to prevent
over-the-counter availability.
Moreover, Priyanka et al. reported that nano vaccines have
proven theirabilityto boost theimmune system to combat diseases
and halt the spread of diseases
[10]
. With nano vaccines, the
growing threat of antibiotic resistance in Mycobacterium tuber-
culosis, the bacteria that causes tuberculosis, and other infections
caused by bacteria can be controlled
[11]
. As research in this sector
advances, nano vaccines have the potential to transform our
approach to infectious diseases and address the worrying devel-
opment in antibiotic resistance. Although attenuated or inacti-
vated microorganisms or viruses were previously used to create
vaccinations, a revolutionary method of developing vaccines has
recently been found that relies on a molecule known as messenger
RNA (mRNA) rather than live bacteria or viruses
[10]
.mRNA
vaccinations can activate the bodys immune system to mount a
focused defense against infections, in contrast to antibiotics, which
can lead to the emergence of resistance while only targeting par-
ticular bacteria. The need of the hour is to create and modify
efcient mRNA-based vaccine candidates against major infectious
diseases, as the global scientic community is keeping an eye on
the vaccinesstability, delivery, and associated adverse effects
[10]
.
Encouraging research and development of novel antibiotics,
diagnostics, and vaccines is necessary to guarantee an ongoing
supply of potent instruments for ghting diseases. Moreover,
international collaboration is essential to halting the cross-border
spread of germs resistant to antibiotics. Combining these
approaches will enable LMICs to reduce antibiotic resistance and
ensure that these life-saving drugs remain effective for future
generations.
With nano vaccines, the growing threat of antibiotic resistance
in M. tuberculosis, the bacteria that causes tuberculosis, and
other infections caused by bacteria can be controlled.
Ethics approval
This type of article doesnt need any ethical approval.
Patient consent
No patients were included.
Sources of funding
The authors have not received any funds.
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Author contribution
All authors have equally contributed to the manuscript and have
approved the publication of the nal manuscript.
Conicts of interest disclosure
The authors declare that they have no nancial conicts of
interest with regard to the content of this report.
Research registration unique identifying number
(UIN)
None.
Clinical trial registration
This is not a clinical trial.
Guarantor
Tooba Ali.
Provenance and peer review
Not commissioned, externally peer-reviewed.
Data availability statement
None.
Acknowledgements
None.
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... This is linked to higher morbidity and mortality rates of about 4.95 million people who died by drugresistant infections among 1.27 million deaths by antibiotic resistance in 2019 (Antimicrobial Resistance Collaborators, 2022). The growing issue of antibiotic resistance and the higher recurrence rates of common infections are straining healthcare systems and societies (Ali et al., 2024). Predictions indicate that by 2050, the mortality attributable to antimicrobial resistance may exceed 10 million annually, surpassing that of other major diseases and cancers (de Kraker et al., 2016). ...
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... Furthermore, the use of incorrect antibiotics by medical staff exacerbates the problem of wound-to-wound transmission. Antibiotic-resistant bacteria may be allowed to flourish and proliferate when the incorrect medications are used to treat wound infections [18] . This contributes to antibiotic resistance by impeding not only the healing process for individual patients but also the attempts to maintain infection prevention and control measures. ...
... Further research is necessary on how often empirical treatment is used in low-and middle-income countries. This is influenced by factors such as a high patient load a shortage of medical professionals, diagnostic tools, and medications [12] . To develop targeted interventions that address the root causes, we must thoroughly examine these factors. ...
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Antimicrobial Resistance in Foodborne Pathogens: ecology, epidemiology, and mechanisms Accessed
Frontiers. Antimicrobial Resistance in Foodborne Pathogens: ecology, epidemiology, and mechanisms Accessed 1 November, 2023. https:// www.frontiersin.org/research-topics/23547
Evaluating a research training programme for frontline health workers in conflict-affected and fragile settings in the middle east
  • H Naal
  • T Daou
  • D Brome