What is antimicrobial resistance?
Antimicrobial resistance (AMR) is the tendency for microorganisms like bacteria, viruses, and fungi to resist the effects of medications prescribed to treat those specific pathogens. This resistance means that infections caused by these microorganisms are harder to treat, which leads to prolonged illnesses, raised medical costs, and a higher mortality rate.
AMR occurs through genetic changes in the microorganisms that reduce the effectiveness of specific drugs designed to prevent the spread of such microorganisms. These changes typically occur naturally through genetic mutations or the acquisition of resistance genes. For example, “the rate of resistance for ciprofloxacin, an antibiotic used to treat urinary tract infections, varied from 8.4% to a staggering 92.9% across 33 countries” (AMA Journal of Ethics).
In the United States, about 2.8 million infections are found to be antimicrobial-resistant related. “Antimicrobial resistance is an urgent global public health threat, killing at least 1.27 million people worldwide and associated with nearly 5 million deaths in 2019” (CDC).
What are the ethical implications of antimicrobial resistance?
To preface, Jasper Littmann, a researcher at the University of Kiel, provides an exceptional introduction to the ethical concerns regarding AMR: “AMR is more than a problem that arises as a result of the complications of treating infectious diseases; it is a complex, multifaceted global challenge that affects the environment, human and animal health, agriculture and the economy…AMR is putting current and future populations at substantial risk of injury, loss, and death. It is going to require a redistribution of resources and a balancing of benefits and burdens, which in turn forces us to make a number of individual and collective sacrifices—often for people thousands of kilometres away and for future persons who have not come into existence yet”.
Racial inequities
Currently, certain racial groups are disproportionately affected by AMR. For example, black patients experience higher rates of hospital-onset and community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections compared to white patients. These disparities may stem from black patients having less access to affordable medical care, as well as a higher likelihood of living in poverty and crowded conditions. These both contribute to longer hospital stays.
Furthermore, workplace racial inequities may also affect workers’ exposure to AMR. Workers in the healthcare industry who do not hold advanced medical degrees, like nursing staff and transport aides, often engage in prolonged patient contact. This could lead to occupational exposure to AMR pathogens. A 2011 study conducted in Europe demonstrated that medical personnel who fed patients had an increased risk of colonization with extended-spectrum beta-lactamase-producing Enterobacterales, in comparison to other medical workers. Therefore, it follows that medical personnel who handle bathing, toileting, and transporting patients also have an increased risk of AMR.
Educational inequities
One of the ways to combat antimicrobial resistance is to educate healthcare workers without advanced medical degrees. In the United States, nursing home workers have consistently cited a lack of training and medical education opportunities to effectively implement infection control measures. A study in the French healthcare system evaluated the knowledge of healthcare workers regarding multidrug-resistant organisms (MDROs). They found that those without advanced medical degrees scored significantly lower on comprehension of AMR and infection control protocols than those with advanced medical degrees, like physicians.
Fortunately, educational interventions targeted toward specific medical personnel have been effective in improving the general comprehension of pathogen transmission risks and imperative cleaning practices, which prevent the transmission of MDROs. Further education could “reduce the trend of low-income and Latinx communities to report self-medication with nonprescription antibiotics, using ‘left-over’ antibiotics, and purchasing foreign-made products, all of which could increase the risk of AMR” (AMA Journal of Ethics).
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