Professor Holger Rohde
Professor of Molecular Microbiology, University Medical Center, Hamburg-Eppendorf
Professor Chantal Morel
University of Bern, ESCMID AMR Action Subcommittee
Antimicrobial resistance is rising despite greater global attention. Progress remains slow, threatening health worldwide and demanding urgent action.
With such slow progress, we may want to question whether we are focusing on (or at least communicating) the wrong thing. AMR isn’t a disease; it’s a biological phenomenon where microbes evolve to survive antimicrobial treatment. Currently, we communicate about AMR in terms of genotypic or phenotypic patterns, but this tells us little about whether patients can get effective treatment when they have an infection.
Limits of resistance data alone
Knowing that microbes (eg. bacteria, fungi) are resistant to certain medicines doesn’t reveal the full picture. A patient might have a ‘susceptible’ infection (sensitive to specified antimicrobials) but still face an untreatable condition if those medicines aren’t available or accessible.
Conversely, even microbes deemed to be genetically ‘resistant’ may still be treatable if the specific gene is not expressed within a specific patient or population. This can limit the usefulness of gene-based resistance data trends in the context of prescribing.
Resistance can emerge unpredictably, spread in non-linear ways and respond to multiple environmental factors
Biological complexity of resistance
The biological complexity surrounding resistance also makes it difficult to understand when interventions are working or not. Resistance can emerge unpredictably, spread in non-linear ways and respond to multiple environmental factors, making it nearly impossible to demonstrate clear cause-and-effect relationships between prevention or control efforts and outcomes. Unfortunately, this disconnect undermines the prioritisation of AMR and the implementation of National Action Plans on AMR globally.
A clinically rooted metric is needed
In trying to find solutions to this problem, we might shift focus (at least when communicating about AMR) from resistance patterns to ‘treatability’ — a comprehensive metric that captures whether infections can actually be treated effectively in real-world settings. This would consider multiple factors, including:
- Healthcare infrastructure and access to medical facilities
- Diagnostic capabilities and speed
- Availability of appropriate antimicrobials
- Infection prevention and control measures
- Local sanitation and hygiene systems
A treatability framework would provide clearer guidance for policymakers, enable better economic assessments of interventions and help track progress toward global AMR targets more meaningfully. Crucially, it would show how investments in basic healthcare infrastructure, sanitation and diagnostic capacity contribute to fighting AMR.
Ensuring people get effective treatment
Rather than communicating through abstraction, we should focus on the ultimate goal: ensuring people can get effective treatment when they have an infection. This reframing may help garner the badly needed political will and resources needed to make tangible progress against one of our most pressing global health challenges.
