Antibiotic resistance is a major global health threat. It arises when bacteria acquire mechanisms that enable them to survive antibiotic exposure, resulting in infections that become increasingly difficult, and occasionally impossible, to treat. As a result, illnesses can become more severe and prolonged, leading to disability and even death.
Antibiotic resistance is often accelerated by the overuse and misuse of antibiotics in humans, animals, and agriculture. When bacteria are repeatedly exposed to antibiotics, they can adapt and develop mechanisms that allow them to resist the effects of the drugs. These bacteria can then multiply and spread, sometimes by destroying the antibiotic or by changing their structure so that the drug can no longer affect them.
Antimicrobial resistance (AMR) is a global burden. It does not discriminate and has no country borders. It is more commonly found in places where there is limited access to clean water, sanitation and hygiene, poor infection prevention and control in healthcare facilities such as hospitals, lack of awareness, and limited access to quality diagnostics, treatments and vaccines.
It is projected that by 2050 antimicrobial resistance will cause nearly 2 million deaths annually that will be directly attributable to resistant infections, with an additional 8.22 million deaths associated with AMR, where infections are a contributing factor. This would bring the total to around 10 million deaths per year, surpassing cancer, and making AMR one of the leading causes of death worldwide if significant action is not taken.
People living with chronic conditions, including arthritis and many other diseases, are particularly vulnerable to the consequences of antimicrobial resistance. In these individuals, infections can become more difficult to treat and may lead to severe complications or even premature death.
When bacteria become resistant to antibiotics, the treatment of infectious arthritis becomes more complicated and may cause severe joint damage. This is particularly critical in cases of prosthetic joint infections following joint replacement surgery. In many cases, long-term and complex antibiotic treatments are required, and revision surgery may also become necessary.
Resistant pathogens such as bacteria, viruses, or fungi increase the risk of treatment failure. They can prolong illnesses and recovery, sometimes for months, placing an additional burden on healthcare systems and increasing healthcare costs.
The rise of drug-resistant infections in implant surgeries can have devastating consequences for patient outcomes and treatment success. With improvements in healthcare systems, particularly in the Western world, and with an ageing population, the number of hip and knee arthroplasties is rising sharply.
Despite the high overall success rates of these procedures, prosthetic joint infections occur in approximately 1% to 4% arthroplasties. Recurrent infections in open fractures, including hip and knee surgeries, range from 30% to 55%, often resulting in delayed healing, suboptimal recovery, reduced quality of life, and higher mortality rates.
The increased susceptibility to infections in arthritis patients may arise from the disease itself, which can alter the body's natural defence mechanisms, or from the medications used to manage the condition.
Antimicrobial resistance affects arthritis in two significant ways. Firstly, it complicates the treatment of infectious arthritis, such as septic joint infections. Secondly, some research suggests that infections may also play a role in triggering autoimmune responses that contribute to the development of rheumatoid arthritis.
Many patients with severe and chronic arthritis, such as rheumatoid arthritis or osteoarthritis, rely on joint replacement surgery to restore mobility and improve their quality of life. The success of these procedures depends heavily on the effectiveness of antibiotics to prevent surgical site infections.
However, resistant bacteria can form biofilms on implants. These biofilms protect the bacteria and make them extremely difficult to eradicate using standard antibiotics. In such cases, patients may require multiple revision surgeries and long-term treatment with stronger and often more toxic "last-resort" antibiotics.
Antibiotic-resistant "superbugs" continue to evolve and adapt. Over time, they become more resilient and capable of surviving medicines that were originally designed to eliminate them.
Addressing antimicrobial resistance requires a collective effort. Governments, healthcare professionals, pharmaceutical companies, researchers, and the public all have a role to play in preserving the effectiveness of antibiotics. Increasing awareness, promoting responsible antibiotic use, and strengthening infection prevention measures are essential steps to help slow the spread of antimicrobial resistance.
Protecting the effectiveness of antibiotics is essential to ensure that modern medical treatments, including joint replacement surgery, remain safe and effective for future generations.
Arthritis and Rheumatism Association of Malta are full members of Malta Health Network www.maltahealthnetwork.org