Antibiotic Resistance In ‘Eskape’ Pathogens Through Self Medication: A Biggest Public Health Concern Surging In Kashmir

Antibiotic Resistance In ‘Eskape’ Pathogens Through Self Medication: A Biggest Public Health Concern Surging In Kashmir

The ‘ESKAPE’ mnemonic stands for Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumonia, Acinetobacter baumanni, Pseudomonas aeruginosa and Enterobacter species. The mnemonic represents deadly bacterial pathogens with rapidly growing multidrug resistance properties which have led to various ‘difficult to treat infections’ like central line associated blood stream infections, cathater associated urinary tract infection, ventilator associated pneumonia and surgical site infections mostly prevalent in hospital settings and communities. This group of Gram positive and Gram-negative bacteria can evade commonly used antibiotics due to their increasing multidrug resistance (MDR). As a result, throughout the world they are major causes of life-threatening infection particularly in immunocompromised and critically ill patients. Because of natural and unnatural pressure, and other factors, antibiotic resistance in bacteria usually emerges through genetic mutation or acquired through horizontal gene transfer – a genetic process by which antibiotic resistance can spread via transfer of antibiotic resistant genes (ARGs).  The main cause of rising antibiotic resistance which have led to the emergence of the ‘ESKAPE’ pathogens is the excessive use of antibiotics not only in healthcare but also in animals and agriculture sectors. Although antibiotic resistance is the result of adaptation of pathogens to nature genetically but misuse and overuse of antimicrobials play a cardinal role in this process. Main factors related to this are inappropriate antibiotic choices, poor adherence to treatment guidelines and inadequate antibiotic dosing with acts of self-medication. This injudicious methodology of medicine intake is prevalent in people of Kashmir and is thus a big public health concern. Almost everywhere, Antibiotics and other medications are consumed by people either without taking in consideration, a professional over sight or accept pseudo-dosed prescriptions from medically uneducated local medicine storekeepers.  This is the main cause of escalation of antibiotic resistance, which renders typical antibiotics ineffective. Issues of antibiotic resistance are rising rapidly, affecting adversely the goals of sustainable development. In the last three decades pace of resistance has increased manifold and unfortunately the pace of adding new antimicrobials to the armory of existing drugs has slowed down. Emergence of new antimicrobial mechanisms have engulfed the globe thus posed a threat in treating even a common infectious disease that were once sensitive to small doses of typical antibiotics. This public health issue has such a gigantic face that WHO has dedicated awareness weak to address this concern. Combating this threat is a public health priority and needs a collaborative approach. Researchers and scientists around the world are putting their hands together to find new solutions to fix this grave public health issue. Thus, it is need of hour that people adhere to the proper treatment guidelines as prescribed by Doctors and not by local medicine storekeepers. Also, there is a need of incorporating only medical professionals possessing life-science related degrees in dealing with medicines like selling over the counter medicines for humans or animals. These strategies can greatly help in stopping the development of superbugs. This public health issue is evident today to only microbiologists but with the passage of time all people will face the deadly consequences, as this issue is going to open its gigantic face. It will not be considered wrong to say that we are in the last era of antibiotics. A step forward from this era can give a simple bacterium the status of sars-cov-2 (covid-19) whose antivirus we yearn for.

From the global perspective, injudicious and persistent use has provoked the emergence of multi-drug resistance (MDR) and extremely drug resistant (XDR) bacterial species leading to 16% of hospital acquired infection cases. This all has created unprecedented challenges for the human civilization. Specifically, the opportunistic nosocomial ‘ESKAPE’ pathogens, the majority of whose isolates are MDR, correspond with the highest risk of mortality. Two pathogens within the ‘ESKAPE’ group – carbapenem resistant Acinetobacter and carbapenem resistant Enterobacteriaceae are currently in top five antibiotic resistant bacteria on the CDC’s 2019 urgent threat list, whereas Vancomycin resistant Enterococcus faecium (VRE) and methicillin resistant staphylococcus aureus (MRSA) are in the list of high priority group.

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