more_vertAbdul Ghafur explains that we need to move beyond national boundaries to tackle antimicrobial resistance
The Chennai Declaration, a roadmap devised by medical specialist groups from across India to tackle antimicrobial resistance, and published in December 2012, states the following:
Microbes are global citizens; their spread across the earth not being restricted by the national boundaries or national flags. If we intend to challenge microbes and tackle the situation, we have to pursue the behaviour and tactics of bugs, by becoming global citizens and thinking beyond national boundaries. High quality infection control set-ups in developed countries may not be fruitful unless countries with high resistance rates and less stringent infection control facilities take serious measures to control resistance.1
High-income countries spend a good share of their health care budget on establishing and improving infection control standards in their hospitals, whereas in the developing world, infection control is often neglected due to a lack of awareness, lack of infrastructure and financial constraints.2 International travel is a well established mode of global dissemination
of multiresistant microorganisms, or “superbugs”. Carbapenem-resistant Enterobacteriaceae that produce the enzyme Klebsiella pneumoniae carbapenemase (KPC) originated in the United States, spread to Mediterranean countries and then to the rest of the world.3 In contrast, the Indian subcontinent gave rise to bacteria carrying the enzyme New Delhi metallo-β-lactamase (NDM-1), which have since been introduced to other countries including the US and the United Kingdom.3
Microorganisms teach us a very basic and important lesson: unite or perish! Unless we initiate a global and united effort to tackle the issue of multiresistance in microorganisms, they will have the final victory. The developed world should assist developing countries by sharing technology and resources to help improve infection control measures and microbiology laboratory facilities. Urgent international diplomatic efforts are needed to convince countries without antibiotic stewardship policies to formulate and implement such policies. Barriers to the implementation of antibiotic control policies (such as overcrowding, poor sanitation, large populations and inadequate health care infrastructure) must not discourage serious initiatives in regions with high antimicrobial resistance rates.1,4
Australian health authorities should be commended for now requiring hospitals to have a formal antimicrobial stewardship program in place to achieve accreditation. But even countries with excellent infection control setups must tighten their policies to keep up with the ever-increasing superbug challenge. We need to improve compliance with hospital antibiotic policies. The job of an infection control physician sometimes requires intruding into the lives of colleagues and providing unsolicited advice on the use of antimicrobials. This demands a diplomatic but persuasive approach, requiring both assertiveness and sensitivity, and a willingness to face criticism. Successful implementation of an antimicrobial policy depends on gaining the support of the hospital administration, and serious efforts are needed to educate and convince our colleagues of the importance of these policies. Basic infection control measures such as hand hygiene and isolation precautions should be strictly adhered to.
In countries without strict antibiotic policies, where incorrect antibiotic prescription is very common, pharmaceutical companies should be willing to modify their marketing strategies to encourage sensible antibiotic use. The use of antibiotics as growth promoters in livestock production is a well known factor contributing to the development of resistance, and is still inadequately tackled in many countries despite major international efforts to reduce such use.
Initiatives such as ReAct — Action on Antibiotic Resistance, World Alliance against Antibiotic Resistance, (WAAR), Antibiotic Action and the Chennai Declaration have made significant contributions to tackling antimicrobial resistance by mobilising political will at international and regional levels. The Chennai Declaration instigated interaction between all involved stakeholders: medical societies within India, Indian government bodies such as
the Drug Controller General’s office, the Medical Council of India, the National Accreditation Board of Hospitals and Healthcare Providers, the World Health Organization, the media and the public.5 We hope this will initiate a dialogue with health authorities that will lead to the formulation of
a national antibiotic policy, mobilising medical societies
and creating extensive media discussion. The WHO can coordinate and strengthen such initiatives, help those countries most affected by the ever-increasing resistance challenge and help governments in developing countries to implement the Chennai Declaration recommendations after incorporating necessary modifications applicable to their own regions.