AMR: A Silent Pandemic with Global Consequences

Antimicrobial resistance (AMR) is increasing the global incidence of infectious diseases affecting the human population, constituting a significant danger to public health and development. Without effective control, this crisis could cause prolonged illness, increase healthcare costs, significant morbidity and, ultimately, severe economic setbacks by 2050, cautions the World Bank. In Mexico, where a notable portion of deaths result from antibiotic-resistant infections linked to infectious diseases, it is crucial to enforce rigorous AMR stewardship and surveillance to tackle this crisis effectively.

“We need to do something earlier, to address AMR on a multisectoral level and in a more comprehensive way to tackle all aspects of the problem. At the national level, yes, but it wouldn’t work without connecting internationally with all teams globally working to stop AMR,” Al-Maani, Director of the Central Department for Infection Prevention and Control, Ministry of Health in Oman told the World Health Organization (WHO).  

The primary causes of AMR are excessive use and improper handling of antimicrobials, which encompass antibiotics, antivirals, antifungals and antiparasitic drugs. According to a study conducted by Lancet Regional Health, AMR has evolved into a severe public health emergency, with 569,000 deaths linked to it in 2019 across 35 countries in the Americas. A region where more than two out of every five deaths were associated with infection associated with AMR, constituting 11.5% of all global AMR associated deaths. The six leading pathogens behind these deaths are: Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii.

These six superbugs are part of the WHO’s list of 12 highly resistant "priority pathogens". The CDC also monitors a list of 18 drug-resistant bacteria and fungi that have developed resistance to drugs. Among these, the most concerning group consists of multidrug-resistant bacteria, frequently found in healthcare settings like hospitals and nursing homes. These bacteria are particularly worrisome because of their resistance to a broad spectrum of antibiotics, including carbapenems and third generation cephalosporins, the best available antibiotics for treating multi-drug resistant bacteria. 

Mexico has grappled with high mortality rates due to extensive antibiotic consumption, a challenge shared with countries like Haiti, Bolivia, Honduras, and Guatemala. “Inappropriate antibiotic prescribing in Mexico has been widespread and associated with antibiotic resistance. Historically, antibiotic usage in Mexico has been high,” according to a study published in Journal of Antimicrobial Chemotherapy. In fact, in 1997, Mexico was the leading country in Latin America for antibiotic clinical use. This consumption rate has since declined between 10 and 15 DDDs per 1000 inhabitants per day, but there is still a need for innovative strategies to combat the unnecessary sale of antibiotics.

In 2018, Mexico took a significant step by implementing a national action strategy against AMR. Using AwARe-CNIS, the country aimed to monitor antimicrobial usage, aligning with the WHO's recommended consumption levels by 2023. Despite these efforts, Mexico still lacks a comprehensive national surveillance network for AMR. To address this gap, a more standardized and inclusive approach is crucial. Developing local guidelines informed by up-to-date surveillance data from community-acquired infections can significantly enhance their relevance and effectiveness. Failing to implement these measures accurately and in a timely manner could result in Mexico significantly contributing to the escalating global healthcare costs ranging from US$300 billion to over US$1 trillion annually by 2050, according to the WHO.

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