Understanding the scale and cost of antimicrobial resistance (AMR) is the critical first step to finding a solution – but, in Australia, the data has gaps. What we do know, is that it is a crisis putting our health system – and our communities – under huge economic strain.
Despite not attracting the same attention as other diseases, such as type 2 diabetes and obesity, recent systematic analyses predict that AMR will cause 10 million deaths worldwide by the year 2050. A UK Government review on AMR predicts it will be the leading cause of death within a generation – more than cancer or heart disease.
Big picture budgeting for AMR
Thousands of people die each year as the result of AMR in Australia. In hospitals, antimicrobial use – key in the development of AMR – is high, substantially so when compared with European countries and Canada.
Healthcare equity plays a part in estimating the scale of AMR. Access to healthcare services varies substantially based on geography, and impacts both the individual patient experience and national accounting.
Bacterial infections contracted in a poorly resourced area – without adequate facilities or medical staff to diagnose problems or run vaccination programs – can lead to an over-prescription of antibiotics, escalating AMR.
Estimates of AMR must also consider antibiotic use by the animal agriculture industry, where antimicrobial agents are used in livestock production and care. This can contribute to the proliferation of drug-resistant organisms that may come into contact with humans, either by their direct exposure to infected animals and their waste, or through poor handling or preparation of food products derived from these animals.
Hospitals and community feel the pain
AMR also places a huge financial burden on our hospital system. It leads to: greater demands on staff; the need of specialised infection training; expensive treatments; and, the added responsibility of collecting data and conducting surveillance.
It negatively impacts on the patient experience, too – AMR leads to longer stays, often in isolation units to stop the spread of drug-resistant bacteria.
Kylie Woolcock, Chief Executive Officer of the Australian Healthcare and Hospitals Association, stresses that the threat of AMR on the sustainability of the public health system means it’s critical it is addressed.
“Research estimates that a resistant infection can add $10,000 to the cost of treatment, and that Australian hospitals spend an additional $11.3 million per year treating just two common resistant hospital-associated infections, ceftriaxone-resistant in E.coli bloodstream infections and MRSA infections,” she says.
The human cost of AMR flows through to the community – a patient with a drug-resistant infection might have a prolonged absence from work, need a caregiver or sustain long-term disability.
At the same time, productivity is affected, private health insurance premiums surge, and out-of-pocket expenses soar. Importantly, these unforeseen, incidental costs need to be reflected in the accounts.
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If we can understand how AMR is acquired and interfere with that process, then we can effectively wind back the clock.
Professor Jon Iredell
Innovations to ease the financial costs
Antibiotic pipelines have been shrinking since the 1980s; declining profits have pushed pharmaceutical companies to explore more lucrative avenues and focus their efforts on chronic health conditions and metabolic diseases, rather than develop new antimicrobial drugs.
However, as Professor Jon Iredell, Director of the Centre for Infectious Disease and Microbiology at Westmead Hospital, points out, just making stronger, more aggressive antibiotics won’t solve the AMR problem.
“Any existential threat to an ecosystem with proven adaptive capacity, will force an evolutionary reaction,” he explains. “But if we can understand how AMR is acquired and interfere with that process, then we can effectively wind back the clock.”
Prof Iredell and his team are working on precision-therapy techniques to identify and remove harmful pathogens without causing damage to the remaining trillions of beneficial bacteria living in our gut.
“We are still scratching the surface of what can be achieved,” he says. “In the future, I envision that my younger colleagues will analyse the microflora of their patients and employ a multimodal approach combining precision techniques like bacteriophages, gene-package management and microbial transplantation to protect, repair and reset gut health.”
Other key strategies to fight AMR include innovation, collective action, prioritising AMR-prevention strategies over treatment and reducing our global reliance on antibiotics to safeguard their efficacy for the future, according to Prof Iredell.
Effective AMR management saves money – which can be invested into the research and development of innovative therapies – while also encouraging collective action through targeted campaigns.
Prof Iredell recognises that when governments are faced with the extreme pressure of a global epidemic, such as COVID-19, financial resources are promptly mobilised to develop novel solutions to stop its spread. But he hopes the march of AMR can be halted before we get to that point.
“We must shift our mindset in the way we approach AMR and antibiotic use,” he says. “The recipe is simple: more investments in antimicrobial R&D and greater capacity to deliver precision-based treatments.”
Dr Federica Conti is a Postdoctoral Research Associate at the University of Sydney. She is also a keen science communicator and author.
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