Antibiotic resistance

Dr Wardak Abdul Qayoum assists the expat microbiologist in supervising the team and carrying out isolation, identification and sensitivity testing of the 3000 bacterial strains expected. He uses a plastic loop to take a colony of bacteria from the culture plate. MSF has launched for the first time an Antibiotic Resistance Study in Lashkar Gah, Helmand, Afghanistan. A laboratory has been set up in the Boost Hospital where MSF works to carry out the study. The study started in January 2013.
AFGHANISTAN 2013 © Vivian Lee
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From the war-wounded in Jordan, to newborns in Pakistan, to burn patients in Haiti, to people with multi-drug resistant tuberculosis in South Africa and Eastern Europe, we see drug-resistant infections across the globe—including those that can only be treated with the very last lines of antibiotics.

Bacteria cause a wide range of infections like tuberculosis, bloodstream infections, meningitis and pneumonia. While resistance to antibiotics occurs naturally, changing health policies, behaviors and practices is key in curbing antimicrobial resistance (AMR) worldwide.

One of the challenges with AMR is the lack of new antibiotics. Despite the fact resistance is widely recognized as a global public health problem, pharmaceutical corporations have failed to invest in new antibiotics over the last several decades so there are few new options in the pipeline. Research and development of new, affordable and accessible diagnostic tools, vaccines and antibiotics should be prioritized while ensuring their appropriate distribution, use and affordability for all who need them.

While we wait for new antibiotics to treat infections, there are steps that need to be taken now to improve access to existing tools, especially in the resource-limited settings where MSF works. Specifically, there is an overall need to improve laboratory and diagnostic capacity to so doctors know what exactly they’re treating, as well as prevent infections by increasing access to vaccines and promoting infection prevention and control measures like mandatory handwashing for doctors and other medical staff.

Health professionals like doctors, pharmacists and microbiologists play a critical role in slowing resistance. In addition to only giving antibiotics when needed, it’s key that patients are given the right antibiotic for their specific infection at the right time, with the right dose and for the right duration. But medical professionals can only do this if they know exactly which bacteria they’re trying to tackle.

In many parts of the world there are few, if any, microbiology labs where clinical samples from patients, such as blood, bone, tissue or cerebrospinal fluid, can be tested to find out which antibiotic should be prescribed and whether their infection is resistant to treatment. Additionally, many regions lack the tools needed to routinely monitor and surveil local, national and regional bacteria and rates of resistance in and out of hospitals. Once data is collected, it should be shared with other members of the public health community so everyone has the information they need to best address this growing problem.

MSF uses MSF labs or MSF-validated labs in-country, is working on portable “mini labs,” and is calling for regional labs to improve access to microbiology.

The over-prescription of antibiotics and their over-the-counter availability is another issue fueling resistance as it makes it difficult to limit use. Not targeting the right bacteria, but instead taking antibiotics that target many different types, gives these germs an unnecessary opportunity to become resistant. 

To prevent infections in the first place, MSF is looking at field strategies to reduce infection and transmission of multi-drug resistant bacterial pathogens, which are frequently associated with hospital-acquired infections.

MSF research on antimicrobial resistance