An Online Presentation at Ladoke Akintola University of Technology Alumni Forum, 2023

1. Health Care workers; taking the lead and
helping to fight antimicrobial resistance;TB
drug resistance as a case study
P.D. Adewole
1

2. Outline
Introduction
Mechanisms of Antimicrobial Resistance
Factors Contributing to the Spread of AMR
Overview of TB and Its Treatment
Types of TB drug resistance
Factors contributing to TB drug resistance
Implications of AMR for health care and public health
Role of health care workers in fighting AMR
Conclusion
Selected References
2

3. Introduction
Antimicrobial resistance (AMR) is the ability of microorganisms to
resist the effects of antimicrobial drugs that were previously effective
in treating infections.
AMR occurs when microorganisms evolve or acquire genetic
mutations that make them less susceptible to the drugs that were
previously used to treat them.
AMR is a growing global threat to public health and patient safety,
and it has the potential to reverse many of the gains that have been
made in controlling infectious diseases over the past century.
AMR could cause up to 10 million deaths annually by 2050 if no
action is taken.
(WHO, 2020).
3

4. A summary of events in the antibiotic-resistance timeline.
WHO, World Health Organization; WWI/II, World War I/II
Browne et al., 2020
4

5. Mechanisms of Antimicrobial Resistance
Mutations
 Modifications of the antimicrobial target
 A decrease in the drug uptake
 Activation of efflux mechanisms (MFS, SMR,RND,ABC MATE)
 Global changes in important metabolic pathways via modulation
of regulatory networks
Horizontal Gene Transfer
 Transformation (incorporation of naked DNA),
 Transduction (phage mediated)
 Conjugation (bacterial “sex”).
5

6. Mechanism of Antimicrobial
Resistance
6

7. Causes and transmission paths of antibiotic-
resistant bacteria
7

8. TB Drug Resistance as A case Study
• TB is a major global health problem, with an estimated 10 million
falling ill.
• Top 10 causes of death worldwide and the leading cause of death
from a single infectious agent.
• DR-TB is caused by bacteria that have developed resistance to
standard first-line drugs, often due to incomplete or incorrect
treatment.
• There were an estimated 465,000 cases of DR-TB worldwide in
2019, with about 78% of these cases being multidrug-resistant TB
(MDR-TB) (WHO, 2020).
8

9. TB Drug Resistance as A case Study
• In Nigeria, tuberculosis (TB) remains a major public health
challenge, with an estimated incidence of 219 cases per 100,000
population in 2019.
• Nigeria is one of the high-burden countries for TB, with the country
accounting for about 3% of the global TB burden.
• Estimated 157,000 deaths from TB in 2019 (WHO, 2020).
9

10. Global percentage of TB cases with
MDR/RR-TB, 2015–2021
WHO,2022
10

11. Regional trends in the estimated number of incident
cases of MDR/RR-TB, 2015–2021
WHO,2022 11

12. Trends in the estimated number of incident and
mortality cases of MDR/RR-TB, 2015–2021 in
NIgeria
WHO,2022
12

13. Types of TB drug resistance
((WHO, 2023
13

14. DR-TB SUSPECTS
• Previously treated
patients
• Default
• Relapses
• Failure of first-line
treatment
(FMoH, 2009).
HIV epidemic
Poor socio-economic
Poor nutrition
Limited access to
health services (GOK,
2009).
14

15. Implications of AMR for Health Care and Public Health
 The potential for increased morbidity and mortality rates, especially
among vulnerable populations (WHO, 2018).
 Increased healthcare costs and decreased quality of life for patients
(Laxminarayan et al., 2016).
 A significant burden on healthcare systems, especially in low- and
middle-income countries, where resources are often limited
(Laxminarayan et al., 2016).
 Its potential to spread rapidly across borders, creating a global
health security concern (CDC, 2019).
 AMR can also impact the effectiveness of other medical treatments,
such as chemotherapy and surgery, which rely on effective
antibiotics to prevent and treat infections that can occur as a result
of these procedures (WHO, 2018) 15

16. Implications of AMR for Health Care and
Public Health
 Healthcare systems will be consumed with the spread of
uncontrollable diseases.
16

17. Roles of health care workers in fighting AMR
Promoting appropriate use of antibiotics by following guidelines for
prescribing and administering antimicrobial drugs, using standard
diagnostic method, monitoring patients for adverse events and
treatment outcomes, and educating patients about the risks of AMR.
The use of alternative treatment options, such as vaccines, to
reduce the need for antimicrobial drugs .
Implementing effective infection prevention and control measures,
such as hand hygiene, appropriate use of personal protective
equipment, and isolation of patients with resistant infections.
Promoting vaccination and other public health interventions to
prevent the spread of infectious diseases and reduce the need for
antimicrobial drugs (WHO. 2020).
17

18. Roles of health care workers in fighting AMR
Education and training that ensured health care workers have the
knowledge and skills they need to effectively fight AMR and TB
drug resistance .
Health care workers should receive training on infection prevention
and control, appropriate use of antibiotics, and the risks and
implications of AMR (WHO, 2020).
18

19. Conclusion
• The fight against antimicrobial resistance (AMR) and tuberculosis
(TB) drug resistance requires a multi-pronged approach, with health
care workers playing a critical role.
• Through appropriate use of antibiotics, standard diagnostic
method, proper implementation and strict adherent to IPC protocols,
promoting vaccination and other public health interventions, we can
address the growing threat of AMR and TB drug resistance.
• As health care workers, it is up to us to take the lead in this fight
and help preserve the effectiveness of antibiotics and other
antimicrobial drugs for generations to come.
19

20. Selected References
1. WHO. 2023. Global Tuberculosis Programme. https://www.who.int/teams/global-
tuberculosis-programme/diagnosis-treatment/treatment-of-drug-resistant-tb/types-
of-tb-drug-resistance
2. World Health Organization. Global tuberculosis report 2020. Available at:
https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-
tuberculosis-report-2020. Accessed on February 16, 2023.
3. Tanimowo MO, Iroezindu MO, Eronini SA, et al. Multidrug-resistant tuberculosis in
Nigeria: a systematic review and meta-analysis. Infect Dis Poverty. 2020;9(1):146.
doi:10.1186/s40249-020-00762-9.
4. Federal Ministry of Health Nigeria. National tuberculosis and leprosy control
program. Available at: https://ntblcp.org.ng/. Accessed on February 16, 2023.
5. Centers for Disease Control and Prevention. Tuberculosis (TB). Available at:
https://www.cdc.gov/tb/default.htm
6. World Health Organization. Drug-resistant tuberculosis. Available at:
https://www.who.int/health-topics/drug-resistant-tuberculosis#tab=tab_1
7. Centers for Disease Control and Prevention. (2019). Antibiotic/Antimicrobial
resistance (AR/AMR). https://www.cdc.gov/drugresistance/about.html
8. Laxminarayan, R., Matsoso, P., Pant, S., Brower, C., Røttingen, J. A., Klugman,
K., ... & Tomson, G. (2016). Access to effective antimicrobials: a worldwide
challenge. The Lancet, 387(10014), 168-175. https://doi.org/10.1016/S0140-
6736(15)00474-2
9. O'Neill, J. (2016). Tackling drug-resistant infections globally: Final report and
recommendations. Review on Antimicrobial Resistance. https://amr-
review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf
20