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Waste water treatment facilities hotspot for spread of antibiotic resistance

New Delhi: Our environment, including waste water treatment facilities, is key in the spread of antibiotic resistance, say the authors of a new report published in Lancet Infectious Diseases.

According to the researchers, selection pressure has made almost all disease causing bacteria resistant to antibiotics commonly used to treat them. Nearly 1000 resistance related B-lactamases that inactivate antibiotics have been identified – a 10 times increase since 1990.

This global report, compiled by 26 leading experts in this field from around the world, includes Dr Chand Wattal, chairperson, department of microbiology, Sir Ganga Ram Hospital, New Delhi and Dr Ramanan Laxminarayan, vice president, research and policy, Public Health Foundation of India (PHFI) and research scholar at Princeton Environmental Institute, Princeton University, US.

The report presents a comprehensive look at the growing problem of antibiotic resistance, its major causes and consequences and identifies key areas in which action is urgently needed.

Antibiotic resistance happening in human beings due to connection to environment is of particular concern in the report. “The environment is key in the spread of resistance,” said the report’s lead author Dr Laxminarayan.

Antibiotic resistance arises when bacteria evolve mechanisms to withstand the drugs which are used to fight infection. Recent decades have seen vast increases in the use of antibiotics across medicine and agriculture, and in the absence of adequate regulatory controls, treatment guidelines, and patient awareness, this has led to a huge global surge in antibiotic resistance, according to a statement by Sir Ganga Ram Hospital.

“Many drivers of antibiotic consumption are grounded in human medicine. However, antibiotic use in veterinary medicine and for growth promotion and disease prevention in agriculture, aquaculture, and horticulture is also a major contributing variable,” said Dr Wattal.

In the report it is observed that there is a very low antibiotic resistance in polar bears on the isolated Arctic area than the higher resistance found in animals living closer to human settings.

The authors call for a bolder intervention outside hospitals and toward an ecological antibiotic stewardship – recommending the development of strategies focused on the control of non-human sources of antibiotics, resistant bacteria, and resistant genes, such as in agriculture and waste water from the pharmaceutical industry.

“For example, waste water treatment facilities can be a hotspot. The chlorination of drinking water can, in fact, concentrate some antibiotic resistant genes,” said Dr Wattal. “One of our key recommendations is for increased research on how to reduce and neutralize manmade antibiotic pressure and how to control the resistance pool in hotspot environments.”

Another are of concern in the report is about the resistance being spread worldwide, including India.

In India, E-coli isolated from urine cultures of pregnant women in their first trimesters in the community (n=1815) showed highest overall resistance to ampicillin, nalidixic acid and co-trimoxazole, as 75 per cent, 73 per cent and 59 per cent respectively, between 2004 and 2007. Thirty per cent showed resistance to injectable antibiotics, such as amino-glycosides (represented by gentamicin).

In a study of bloodstream infections, the proportion of E-coli producing ESBLs increased from 40 per cent in 2002 to 61 per cent in 2009 and the proportion of K pneumonia with carbapenem resistance increased from 2.4 per cent to 52 per cent.

The report concludes that the serious threat to public health caused by the rapid loss of antibiotic effectiveness calls for global concerted actions. The authors advocate for a health systems thinking approach in the efforts to contain antibiotic resistance. Treatment for bacterial infections is a fundamental prerequisite for fulfilment of health related Millennium Development Goals and access to effective antibiotics should be included in the discussions of the post- 2015 Developmental Goals.

The report calls for governmental coalitions to create global funding mechanisms for needs driven research and development of antibiotics, alternative treatments, diagnostics and vaccines. It says that a global code of conduct should be developed for antibiotic use and implementation of strategies against antibiotic resistance.

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