The Impact of Antimicrobial Resistance on Cancer Patients

Cancer patients are more likely to contract infections due to a compromised immune system. Antimicrobial resistance (AMR) can harm cancer patients by lowering anticancer therapy efficacy, causing persistent infection, and raising the chance of death.

What is antimicrobial resistance?

Antimicrobial resistance (AMR) arises when microorganisms such as bacteria, viruses, fungi, and parasites acquire genetic alterations over time and develop resistance to treatment interventions designed to eradicate them. This makes microbial illnesses difficult to treat and disrupts the chain of microbial transmission.

AMR has been named one of the top ten global public health hazards by the World Health Organization (WHO). AMR is mostly caused by the inappropriate or excessive use of antimicrobial medications. Drug-resistant bacteria render present antimicrobial therapies ineffective, increasing the danger of life-threatening infections during numerous medical operations such as surgery, organ transplantation, and cancer chemotherapy.

Impact of AMRs on Cancer Management

AMR has the potential to harm cancer treatment results and increase cancer-related death. Cancer is characterized by a decrease in the number and functionality of white blood cells, which results in an immune-compromised condition in cancer patients. Various cancer therapies, including surgery, bone marrow transplantation, radiotherapy, and chemotherapy, further depress cancer patients’ immune systems. All of these variables contribute to their vulnerability to infections.

Infection is the leading cause of hospitalization for one in every five cancer patients. Bacterial pneumonia and sepsis are the most prevalent illnesses among cancer patients in the hospital. According to current estimates, the mortality rate among cancer patients due to severe sepsis is 8.5%.

Antibiotics are the first-line treatment for bacterial infections in cancer patients. The rapid growth of drug-resistant bacteria complicates cancer care in this setting, resulting in a poor prognosis and increased mortality.

Impact of AMR on cancer immunotherapy

Antibodies that target immunological checkpoints, such as cytotoxic T-lymphocyte antigen 4 and programmed death receptor 1, have recently received a lot of interest due to their effectiveness in treating many forms of cancer.

Immunotherapies utilizing these check-point inhibitors have been linked to a variety of immune-related side effects, such as skin rash, colitis, pancreatitis, hepatitis, and pneumonitis. These challenges are produced by drug-induced immune system overexpression.

Immunosuppressants, such as steroids and tumor necrosis factor (TNF) inhibitors, are used to treat resistant or severe adversity. These medications make cancer patients more susceptible to infections. Furthermore, immune checkpoint inhibitors can raise the risk of some infections, such as TB and listeriosis, in cancer patients.

Evidence suggests that cytotoxic T-lymphocyte antigen 4 inhibitor (ipilimumab) therapy makes melanoma patients more susceptible to opportunistic infections such as invasive aspergillosis, cytomegalovirus-induced hepatitis, and pneumocystis pneumonia.

According to studies, the risk of infection is much higher in cancer patients who get immunosuppressive medicines such as corticosteroids and infliximab. Existing evidence suggests that individuals who get combination therapy with nivolumab and ipilimumab have a greater risk of serious infection than those who receive pembrolizumab. This discrepancy is most likely attributable to the intensity of drug-induced adversity.

Cancer patients with microbial infections are primarily treated with long-term antibiotics. Long-term usage of broad-spectrum antibiotics, on the other hand, can dramatically raise the risk of AMR onset. This complicates the management of cancer-related morbidity and mortality even more.

Furthermore, cancer patients are more vulnerable to hospital-acquired infection, which is another important source of AMR. Infections acquired in the hospital are also a key reason for cancer patient’s admission to the intensive care unit (ICU).

Impact of AMR on cancer care outcomes

Because cancer patients rely heavily on antibiotics to prevent and treat infections, AMR has a severe negative impact on cancer management. Although advances in medical care facilities have significantly extended cancer patient survival, current medicines continue to raise the danger of infection and the development of AMR.

According to the current data, around 26% of infections that occur in cancer patients following chemotherapy acquire resistance to typical preventive antibiotics. A drop in antibiotic efficacy of 30 – 70% in hematological cancer patients is expected to result in 4,000 – 10,000 extra infections and 500 – 1,000 additional deaths in the United States per year.

Pre-existing health issues, past antibiotic therapy, urinary catheters, or other sources associated with urinary infections are the most common causes of antibiotic-resistant infections. Antibiotic-resistant infections increase the risk of persistent bacteremia, metastatic infection, ICU admission, and mortality in cancer patients. These unfavorable outcomes are seen in both adult and pediatric patients suffering from hematological or solid tumors.

The most common causes of infection in individuals with solid tumors include chemotherapy- or radiation therapy-related neutropenia, anatomic barrier disruption caused by medical equipment or surgical operations, and blockage caused by primary or metastatic tumors.

AMR has been observed to have a greater impact on cancer patients of several ethnicities, including African Americans, Latinos, and Indigenous peoples. This could be attributed to increased use of prescribed antibiotics, lack of access to healthcare services, increased travel to countries with high AMR burdens, and increased employment in food animal production.

The decline in antibiotic effectiveness caused by AMR dramatically raises worldwide healthcare expenses. AMR is predicted to cost over 20 billion USD in healthcare and 35 billion USD in lost productivity in the United States each year. Cancer patients with methicillin-resistant S. aureus infection had a threefold higher chance of a prolonged hospital stay than those without this infection, which raises healthcare expenses.

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