It’s sometimes called the ‘Silent Pandemic,’ and has emerged as the third-leading cause of death globally, according to a 2022 study that provided the first comprehensive picture of its lethality.
The issue of antimicrobial resistance – including antibiotic and antifungal resistance – is poised to become one of the greatest threats to global human health, said Mehreen Arshad, MBBS, assistant professor of Pediatrics in the Division of Infectious Diseases and leader of the Buffett Institute for Global Affairs Antibiotic Resistance Working Group.
“We just had the Covid pandemic; But we call this the silent pandemic because if you look at the number of deaths associated with antimicrobial resistance on a global scale, it’s so much more than Covid was and is,” said Arshad. “It’s spread over years and geographical areas, and it sort of comes in ways people don’t recognize as a pandemic, where it really is.”
As global consumption of prescribed antibiotics has increased— 46 percent globally between 2000 and 2018, according to one study—so too have deaths from antibiotic-resistant infections. Antimicrobial resistance was associated with 4.95 million deaths worldwide in 2019 and roughly 1.7 million were directly attributable to antimicrobial-resistant infections, according to a study published in The Lancet.
The Antibiotic Resistance Working Group, established in 2020 with faculty from Feinberg and Weinberg and supported by the Buffett Institute, is an interdisciplinary, global effort to fully understand the issue of antimicrobial resistance and develop strategies to mitigate the impact.
While attending medical school in Pakistan, Arshad noticed a rise in antibiotic-resistant infections. It made sense, Arshad said, that a developing country with lax rules around prescribing antibiotics would see an increase in antibiotic resistance, but when she came to the U.S. for her residency and fellowship in pediatric medicine and saw cases climb, she realized it would take a global effort to address this complex global problem.
“We’re seeing more and more resistant organisms in our pediatric population and we’re finding it more difficult to treat them,” Arshad said. “Our patients are dying from resistant infections, whereas that was not ever something that we thought about before. This concept of a post-antibiotic era, where our anti-microbials don’t work anymore, is becoming a very real thing for us physicians, even in a country like the U.S.”
Currently, the working group has established research relationships at Aga Khan University and a partnership with the National Institutes of Health (NIH) in Pakistan. With these partnerships, the group aims to establish a pathogen surveillance program to understand the relationship between genomic, phenotypic and clinical characteristics associated with disease due to resistant organisms.
In the future, the groups will survey of providers on the reasons behind the overprescription of antibiotics and expand capacity for antimicrobial resistance surveillance in Pakistan.
In 2021, the group secured a $2.5 million grant from the Centers for Disease Control and Prevention to study antimicrobial resistance patterns and develop a roadmap for coordinating responses to antimicrobial resistance across academic, political, pharmaceutical and medical institutions.
Arshad and her collaborators are also conducting antimicrobial surveillance in Chicago and have revealed some alarming early findings.
“We’ve had some notable data we’ve collected; We’ve found that 15 percent of healthy pregnant mothers in the community in Chicago are carriers of these multi-drug resistant bacteria, which is pretty high if you think about it, because these are adults that have had no recent antibiotic use or hospital exposures which are typically thought of risk factors for carriage of drug-resistant bacteria. About half of those mothers also transmitted these bacteria to their infants at the time of delivery which is concerning because infants have low immunity and can become sick with these highly resistant and difficult-to-treat bacteria,” Arshad said. “I think that what we’re capturing is very much the tip of the iceberg. This community prevalence of resistant bacteria is very underappreciated. Resistant bacteria have been reported in developing countries, but we sort of never thought this would happen in the U.S., and in Chicago, too.”
In March, the Centers for Disease Control released an alert for a circulating multi-drug-resistant fungus, Candida auris, as it has spread quickly through hospitals in New York, New Jersey and Chicago.
“Most people don’t think they have to worry about resistant infections, because unless you get a severe infection in the hospital, you’re not going to get infected with these antimicrobial-resistant bacteria or fungi. But that’s changing,” said Egon Ozer, MD, PhD, ‘08 GME, assistant professor of Medicine in the Division of Infectious Diseases and director of the Center for Pathogen Genomics and Microbial Evolution and member of the working group. “We are all very worried about the potential for a post-antibiotic era, where we go back to the way it was before we had even penicillin.”
While the issue of antimicrobial resistance is mounting, there’s still hope that the issue can be addressed before it spreads any further, said Erica Hartmann, PhD, associate professor of Civil and Environmental Engineering and co-leader of the working group.
“One of the things we’re working on right now is understanding how widespread antimicrobial resistance is in the community,” Hartmann said. “In hospitals, especially in the developed world, there’s a lot of monitoring for antimicrobial resistance, and we’re relatively good at tracking and preventing outbreaks within a facility. But many people probably carry antimicrobial-resistant organisms without even knowing about it. We want to know where this resistance comes from and whether it can become a medical issue. This feeds into the bigger picture of understanding the full scope of the problem so we can make better decisions about when and how to use the drugs that we have.”
Understanding antimicrobial resistance is just the first step to solving this complicated issue, Hartmann said, which will require interdisciplinary cooperation across the globe.
“Antimicrobial resistance is a huge issue that will require coordinated action across many disciplines and across the world. The reassuring thing is that a lot of people are thinking about it from a lot of different perspectives. I think the situation is often framed as an arms race between us and the microbes, but really, it’s more like we accidentally created a system with feedback and now we need to rearrange the speakers and mics, and maybe get some noise-canceling headphones.”
