Antibiotic resistance (AMR) in bacteria is the outcome of change in the drug target, inactivation of the drug in the bacterial cell, or ineffectiveness of the drug in reaching the drug target in a bacterial cell. AMR is becoming a threat to the world because it leads to approximately 35,000 deaths in the United States alone annually (IDSA). Additionally, in the WHO European Region, 4.6 million people are newly diagnosed with cancer annually, including 114,000 children (WHO). The low-and middle-income countries are worst effected by AMR. The superbugs called ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) are causal agents in causing resistance in cancer settings. Cancer patients are more susceptible to AMR due to the immunosuppressive nature of the cancer treatments, so they are prescribed with higher antimicrobial doses which leads to AMR in these patients. More importantly, resistance because of antibiotics in cancer patients leads to higher sepsis-related mortality. There is an urgent need for addressing AMR in cancer patients because the chances of cancer patients dying of fatal infection than normal patients are 3 times higher and this has a great impact on the efficacy of the cancer treatments and leads to adverse outcomes. The objective of this article is to drive the researchers' attention towards the need to curb this demon.
Cancer patients can develop susceptibility to infections due to many reasons. For instance, in patients with haematological cancers, resistance may be due to impaired bone marrow neutrophil production, deficient adaptive B-cell immunity, or compromised splenic functions. Patients with solid tumors are more prone to infections due to compromised anatomic barriers, cancer-related surgeries, and cancer treatments like chemotherapy and radiation. The use of medical devices also opens the entry points for bacteria. The AMR can also stem from excessive or misuse of antibiotics and ineffective infection control practices.
To control the number of deaths in the cancer population due to AMR in 2016, the Centre for Disease Control and Prevention (CDC) introduced an antibiotic resistance solutions initiative. Solutions also include promoting judicious antibiotic use through widespread education on the dangers of antimicrobial misuse, improving infection control by sustainable infrastructure for water, sanitation, and hygiene WASH and adhering to clinical guidelines mentioned in WHO AMR Implementation Handbook and the WHO AWaRe (Access, Watch, Reserve) antibiotic book. Additionally, investment in the development of new and effective rapid diagnostics, such as point-of-care tests, is crucial to enable timely and appropriate treatment decisions. Regulatory measures should be enforced to address over-the-counter sales of antimicrobials and ensure their appropriate use among healthcare professionals. Collaboration between stakeholders in healthcare, pharmaceuticals, and government bodies is essential to facilitate the development of innovative funding models, like subscription payment systems for antibiotics, and public-private partnerships such as the Global Antibiotic Research and Development Partnership (GARDP). Furthermore, integrating cancer registries with microbiology databases can enhance surveillance efforts like Global Antimicrobial Resistance Surveillance System (GLASS), and Cancer Moonshot and inform tailored interventions to combat antibiotic resistance effectively. However, this solution was a good step forward but lacked the system to track the resistant infections in cancer patients. Annual public awareness campaigns are also organized for antimicrobial awareness.
In conclusion, a multifaceted approach is required to control AMR in this vulnerable population. This comprises educating the healthcare professionals and patient populations on the proper use of antibiotics and introducing new treatment alternatives and databases to track all infections in cancer patients.
References
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