What does not kill you makes you stronger. While not generally touted as absolute truth, the above idiom correctly sums up trends in antimicrobial resistance amongst pathogens. Like the dreaded final boss in a video game, if you do not correctly eliminate these pathogenic bacteria, they evolve into stronger, smarter versions of themselves and come right back with a vengeance. These versions, commonly known as “super bacteria,” have developed mechanisms that prove resistant against common antibiotics. Antimicrobial Resistance (AMR) is currently described by the WHO as one of the top global public health threats facing humanity. This problem is exceptionally prevalent in Pakistan, where misuse of antimicrobials has resulted in increasing AMR trends amongst common pathogens. However, through the combined efforts of Dr. Nida Javaid, Dr. Safee Ullah Chaudhary and Dr. Shaper Mirza from the Department of Biology, we can start our quest in fighting back against these pathogens and defeat them once and for all.

However, every heroic journey starts with an origin story. For this tale, our researchers described how they found their passion for Biology that began a decades-long journey that culminated in the publication of a ground-breaking research study. Dr. Nida Javaid, one of the researchers for this study, tells us how curious she found illnesses to be as a child. Inquisitive from the start, she wondered how something so microscopic that it is almost invisible could profoundly impact our lives. Thus, began her fascination with these invisible yet powerful agents leading her to choose microbiology and epidemiology as her field of interest. Equipped with a world-class education, a creative mind and a steadfast determination, our heroes understood the gravity of the threat AMR posed to Pakistan and quickly endeavored to find a solution to this problem.

 "Know your enemy." Arguably, the greatest military strategist in world history, Sun Tzu understands the importance of insight. To guarantee victory in any battle, one must have a thorough understanding of their opponent; otherwise, they will surely bite the dust. Therefore, the first step to combating rising AMR trends was to analyze the different types of soldiers in the bacterial army, their strengths, weaknesses, and attack strategies. From a scientific perspective, this means identifying the most common pathogens that cause deadly diseases, understanding their evolution to resist certain types of anti-biotics, their geographic distribution across Pakistan and what gender or age-group demographic are most susceptible to infection.

Along with their teams, the above-mentioned researchers have been working on a comprehensive analysis of long-term AMR trends in Pakistan and have published a paper identifying these trends from 2011 to 2015. Conducting a ground-breaking study on such a massive scale poses several formidable challenges, but our researchers have faced these difficulties head-on and dispatched them with ease. Dr. Nida describes how organizing such a vast dataset for this study, from so many sources, was a monumental task. They needed information on the site of isolation, demographics, and antimicrobial susceptibility profile of each isolate against over 15 antimicrobials. That’s more than 3000 separate profiles for each pathogen they have encountered. Even Sun Tzu himself would have blanched at such an onslaught of information. However, our researchers remained resolute and enjoyed the process of diligently visualizing this data. Dr. Nida fondly remembers how satisfying it was learning to utilize Circos plotting software and ultimately transforming the data into a single figure for each pathogen. After the data had been compiled, visualized and analyzed, the researchers began to draw conclusions from the results and buried under layers of increasing AMR trends for many a pathogen, they discovered something quite interesting.

The findings report a rise in antimicrobial resistance in several pathogens isolated from blood and cerebrospinal fluid cultures, such as the Acinetobacter species, which demonstrated the highest resistance rates to all antimicrobials. This, then, could be considered the Lieutenant General of the Bacterial Army, a potent threat that must be defeated, or we would suffer dire consequences. Almost all other pathogens also showcased increasing AMR trends following their leader and showcasing the might of their army. Interestingly, decreasing resistance trends were observed for Staphylococcus aureus against common antibiotics, unlike its other aggressive pathogen comrades. To that end, we would like to nominate ‘S. Aureus’ for Pathogen of the Month for being so well mannered. Truly a shining example for other microbes to follow. These findings were compiled into a research paper nearly half a decade in the making. Through this arduous journey, the researcher's preservation paid immense dividends, as Dr. Nida described her elation when this paper got accepted for publication. This data will be invaluable in planning a stellar counterattack against these pathogens. The paper highlights several actions we can take to stop the growing threat of AMR in its tracks. The public must be aware of the dangers of antibiotic misuse to resolve the problem at its source before it's too late.  

The battle lines have been drawn. As one researcher described it, AMR is a major public health challenge. The antibiotic production pipeline is drying out, and microbes are becoming increasingly resistant by the day. By 2050, every minute, a person would die due to antimicrobial-resistant infections. Considering how the COVID-19 pandemic crippled the world and its economies, it is paramount that policymakers should prioritize antimicrobial stewardship to counter the rising trends of AMR.

References:

Title: Trends In Antimicrobial Resistance Amongst Pathogens Isolated from Blood and Cerebrospinal Fluid Cultures in Pakistan (2011-2015): A Retrospective Cross-Sectional Study

Authors: Nida Javaid, Qamar Sultana, Karam Rasool, Sumanth Gandra, Fayyaz Ahmad, Safee Ullah Chaudhary, Shaper Mirza 

DOI: 10.1371/journal.pone.0250226