Antimicrobial resistance post-COVID-19 pandemic

Antimicrobial resistance is a major challenge facing healthcare globally, with both the WHO (2019) and the National Institute for Health and Care Excellence (NICE) (2023) having issued a quality standard. The WHO has declared antimicrobial resistance as a global public health threat and it is listed on the UK Government's Risk Register. The most commonly resisted antibiotics are: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), multi-drug-resistant Mycobacterium tuberculosis (MDR-TB), and carbapenem-resistant Enterobacteriaceae (CRE) gut bacteria (Mancuso et al, 2021).

Prior to the era of antibiotics, the only treatments were arsenicals and sulphonamides, strict hygiene with disinfectants, which included metal ions, a wholesome diet and good nursing care. Indeed, many soldiers in World War I died of battle wound infections rather than a catastrophic injury, although there were plenty of those. In the 1930s, chemists searched for biocidal compounds to combat infections and developed sulphonamides. Landecker (2019) has argued that the development of resistant bacteria has its origins in the early 20th century when arsenicals and sulphonamides were treatments, and ammonium compounds formed the base of disinfectants and were produced and used on a large scale. Their widespread use helped drive resistance because they caused environmental selection and triggered genetic change in the existing bacteria, thereby conferring a resistance phenotype. Landecker (2019) tested her hypothesis using two case studies from the US, namely, World War II troop mobilisation and the change to intensive poultry farming between 1940–1950, during which there was widespread use of disinfectants and sub-therapeutic levels of sulphonamides for prophylaxis. The existence of sulphonamides and disinfectants in the environment provided the background for the bacterial landscape prior to the introduction of the first antibiotics, including penicillin during World War II. Therefore, penicillin did not supplant previous chemical therapies but rather, it joined the increasingly complex chemical environment in which microbes existed. Landecker's (2019) thesis challenges the assumption that microbial resistance is solely a clinical phenomenon by highlighting the early role of other chemical agents and their use in agriculture and the food chain, military health and general hygiene practices.