The antimicrobial resistance (AMR) scenario in Malaysia: A review of current trends, perspectives and strategic action

Main Article Content

Deebadarishani Sathasivan
Mazlin Mohideen
Mohd Hafiidz Jaafar
Ana Masara Ahmad Mokhtar
Nur Azzalia Kamaruzaman

Abstract

Fast becoming a global health crisis, antimicrobial resistance (AMR) is causing numerous deaths and having economic implications worldwide. This review paper highlights the AMR scenario in Malaysia, primarily in regard to the clinical implications of common bacterial pathogens. Other highlights of the study include the perspectives of public and private healthcare professionals, as well as consumers, on the knowledge, attitudes, and practices (KAP) associated with AMR and antibiotics usage, the aim being to identify gaps in the way AMR is addressed in Malaysia. In addition to the human factor, the agriculture and aquaculture sectors also contribute to AMR. The crucial role of the antimicrobial stewardship program (ASP) in Malaysia is also discussed here, with its implementation outlined chronologically. Furthermore, Malaysia’s AMR strategic action is assessed against the policies of other Southeast Asian countries to obtain a more comprehensive understanding of various international efforts to mitigate AMR issues. Alongside government measures, many non-governmental organisations (NGOs) are also actively involved in various AMR initiatives through international workshops and meetings, the creation of task forces, and heightening AMR awareness through publications, social media, and toolkit development. These efforts and more are necessary to raise awareness of AMR and address the related issues effectively.

Article Details

How to Cite
Sathasivan, D., Mohideen, M., Jaafar, M. H., Mokhtar, A. M. A., & Kamaruzaman, N. A. (2024). The antimicrobial resistance (AMR) scenario in Malaysia: A review of current trends, perspectives and strategic action. Asia-Pacific Journal of Science and Technology, 29(06), APST–29. https://doi.org/10.14456/apst.2024.101
Section
Review Articles

References

Uddin TM, Chakraborty AJ, Khusro A, Zidan BMRM, Mitra S, Emran T bin, et al. Antibiotic resistance in microbes: History, mechanisms, therapeutic strategies and future prospects. J Infect Public Health 2021;14:1750-1766.

Aminov RI. A brief history of the antibiotic era: lessons learned and challenges for the future. Front Microbiol. 2010;1:134.

Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629–655.

Manyi-Loh C, Mamphweli S, Meyer E, Okoh A. Antibiotic use in agriculture and its consequential resistance in environmental sources: Potential public health implications. Molecules. 2018;23(4):795.

Chereau F, Opatowski L, Tourdjman M, Vong S. Risk assessment for antibiotic resistance in South East Asia. BMJ. 2017;358:j3393.

Dewi DAPR, Thomas T, Ahmad Mokhtar AM, Mat Nanyan NS, Zulfigar SB, Salikin NH. Carbapenem resistance among marine bacteria-an emerging threat to the global health sector. Microorganisms. 2021;9(10):2147.

Zellweger RM, Carrique-Mas J, Limmathurotsakul D, Day NPJ, Thwaites GE, Baker S, et al. A current perspective on antimicrobial resistance in Southeast Asia. J Antimicrob Chemother 2017;72(11):2963–2972.

Ab Rahman N, Teng CL, Sivasampu S. Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia. BMC Infect Dis 2016;16(1):1-8.

Chua AQ, Verma M, Hsu LY, Legido-Quigley H. An analysis of national action plans on antimicrobial resistance in Southeast Asia using a governance framework approach. Lancet Reg Health West Pac. 2021;7:100084.

Jamaluddin NAH, Periyasamy P, Lau CL, Ponnampalavanar S, Lai PSM, Ramli R, et al. Point prevalence survey of antimicrobial use in a Malaysian tertiary care university hospital. Antibiotics. 2021;10(5):531.

Ismail ARA, Lisa G, Diana K, Vasso N, Kylie A. Unveiling antimicrobial resistance trends in Malaysia: A comparative study with global pattern. International Journal of Clinical Inventions and Medical Sciences. 2024;6(2):101–109.

Laxminarayan R. The overlooked pandemic of antimicrobial resistance. Lancet. 2022;399(10325):606–607.

Kariyawasam RM, Julien DA, Jelinski DC, et al. Antimicrobial resistance (AMR) in COVID-19 patients: a systematic review and meta-analysis (November 2019-June 2021). Antimicrob Resist Infect Control. 2022;11(1):45.

Filza Nur Athirah T, Aina Amanina AJ, Nor Safwan Hadi NA. Knowledge, attitude and prevalence of ivermectin use as coronavirus disease treatment: A crosssectional study among a Malaysian population. Malays Fam Physician. 2024;19:2.

Bokhary H, Pangesti KNA, Rashid H, Abd El Ghany M, Hill-Cawthorne GA. Travel-related antimicrobial resistance: A systematic review. Trop Med Infect Dis. 2021;6(1):11(1-27).

Lim C, Takahashi E, Hongsuwan M, Wuthiekanun V, Thamlikitkul V, Hinjoy S, et al. Epidemiology and burden of multidrug-resistant bacterial infection in a developing country. Elife 2016;5:1-18.

Che Hamzah AM, Yeo CC, Puah SM, Chua KH, Chew CH. Staphylococcus aureus infections in Malaysia: A review of antimicrobial resistance and characteristics of the clinical isolates, 1990–2017. Antibiotics. 2019;8(3):128.

Sahreena L, Kunyan Z. Methicillin-resistant staphylococcus aureus: Molecular characterization, evolution, and epidemiology. Clin Microbiol Rev. 2018;31(4):e00020-18.

El-Sayed Ahmed MAE-G, Zhong L-L, Shen C, Yang Y, Doi Y, Tian G-B. Colistin and its role in the Era of antibiotic resistance: an extended review (2000–2019). Emerg Microbes Infect. 2020;9(1):868–885.

Alvarez-Uria G, Gandra S, Mandal S, Laxminarayan R. Global forecast of antimicrobial resistance in invasive isolates of Escherichia coli and Klebsiella pneumoniae. Int J Infect Dis. 2018;68:50–53.

World Health Organization. Global action plan on antimicrobial resistance [Internet]. 2016 [cited 2022 Jan 31]. Available from: https://www.who.int/publications-detail-redirect/9789241509763.

Mariappan V, Vellasamy KM, Mohamad NA, Subramaniam S, Vadivelu J. OneHealth approaches contribute towards antimicrobial resistance: Malaysian perspective. Front Microbiol. 2021;12:718774.

Ahmad Mokhtar AM, Ngee CS, Mohammed Alias MZA, Salikin NH, Mohd Fadzil FNI, Kamaruzaman NA. Antimicrobial-resistant microorganisms and the possibility of using microbial fuel cell technology to reduce their transmission in the environment. In: Green Energy and Technology. Singapore: Springer Nature Singapore; 2023. p. 179–197.

Jia X, Yin Z, Zhang W, Du S. The Efficacy and Influencing Factors of Polymyxin B in High-level carbapenem-resistant Klebsiella pneumoniae infections. Infect Drug Resist. 2023;16:4177-4187.

Seung K, Keshavjee S, Rich M. Multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis. Cold Spring Harb Perspect Med. 2015;5(9):a017863.

Kazanjian P. UNAIDS 90‐90‐90 campaign to end the AIDS epidemic in historic perspective. Milbank Q. 2017;95(2):408-439.

Ross J, Jiamsakul A, Kumarasamy N, Azwa I, Merati TP, Do CD, Lee MP, Ly PS, Yunihastuti E, Nguyen KV, Ditangco R. Virological failure and HIV drug resistance among adults living with HIV on second‐line antiretroviral therapy in the Asia‐Pacific. HIV Med. 2021;22(3):201–211.

Lai C-C, Shih T-P, Ko W-C, Tang H-J, Hsueh P-R. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924.

Knight GM, Glover RE, McQuaid CF, Olaru ID, Gallandat K, Leclerc QJ, et al. Antimicrobial resistance and COVID-19: Intersections and implications. Elife. 2021;10:e64139.

Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014;5(6):229–241.

Alabid A, Mohamed Ibrahim MI, Hassali M. Dispensing practices of general practitioners and community pharmacists in Malaysia–A pilot study. J Pharm Pr Res. 2013;43(3):187-189.

Hassali M, Kamil T, Aryani MY, Alrasheedy A, Yusoff Z, Saleem F, et al. General practitioners’ knowledge, attitude and prescribing of antibiotics for upper respiratory tract infections in Selangor, Malaysia: findings and implications. Expert Rev Anti Infect Ther. 2015;13:1-10.

Sivanandy P, Loh HS. Knowledge, attitude, perception and practice of antibiotics usage among the medical students. Authorea, Inc. 2020.

Jaiprakash D, Patil A, Kale S, Shidhaye P. Knowledge, attitude and practices on antimicrobial resistance and usage among medical students in A Malaysian medical university. Int J Onl Eng. 2020;16(01):115-122.

Ahmad A, Khan MU, Patel I, Maharaj S, Pandey S, Dhingra S. Knowledge, attitude and practice of B.Sc. Pharmacy students about antibiotics in Trinidad and Tobago. J Res Pharm Pract. 2015;4(1):37-41.

Shakeel S, Hayat F, Mehsud S, Khan A, Iqbal M, Khan J. Students’ knowledge and attitude towards the rational use of antibiotics. Med Sci. 2020;24(106):4499-4509

Jamshed S, Elkalmi R, Rajiah K, Alshami AK, Shamsudin S, Siddiqui MJ, et al. Understanding of antibiotic use and resistance among final-year pharmacy and medical students: A pilot study. J Infect Dev Ctries. 2014;8(06):780-785.

Hassali M, Mohammad A, Saleem F, Khan M, Ahmad A, Mariam W, et al. Assessment of attitudes and practices of young Malaysian adults about antibiotics use: A cross-sectional study. Pharm Pract (Granada). 2017;15(2):929.

Oh AL, Hassali MA, Al-Haddad MS, Sulaiman SAS, Shafie AA, Awaisu A. Public knowledge and attitudes towards antibiotic usage: a cross-sectional study among the general public in the state of Penang, Malaysia. J Infect Dev Ctries. 2010;5(05):338-347.

Kong LS, Islahudin F, Muthupalaniappen L, Chong WW. Knowledge and expectations on antibiotic use among older adults in Malaysia: A cross-sectional survey. Geriatrics (Basel). 2019;4(4):61.

Qamar M, Abdullah N, Khan J, Mahmud A, Ahmad A. Knowledge and attitude towards antibiotic usage among general public in Shah Alam, Malaysia. Pharm Biosci J. 2014;2(6):60-66.

Tan G, Low Q-W, Lim H, Seah H, Chan H-K. Inappropriate antibiotic utilization: Outpatient prescription review of a regional secondary hospital in Kedah, Malaysia. J Pharm Pract Community Med. 2017;3(4):215–219.

Landers TF, Cohen B, Wittum TE, Larson EL. A review of antibiotic use in food animals: perspective, policy, and potential. Public Health Rep 2012;127(1):4-22.

Ibrahim S, Wei Hoong L, Lai Siong Y, Mustapha Z, C W Zalati CWS, Aklilu E, et al. Prevalence of antimicrobial resistance (AMR) Salmonella spp. and Escherichia coli Isolated from broilers in the east coast of Peninsular Malaysia. Antibiotics (Basel). 2021;10(5):579(1-11).

Othman S. Antimicrobial resistance in veterinary clinical isolates of escherichia coli from northern region of Peninsular Malaysia. Malays J Vet Res (Putrajaya). 2017;8(2):1-7.

Mithuna R, Tharanyalakshmi R, Jain I, Singhal S, Sikarwar D, Das S, et al. Emergence of antibiotic resistance due to the excessive use of antibiotics in medicines and feed additives: A global scenario with emphasis on the Indian perspective. Emerg Contam. 2024;10(4):100389.

Majumder MA, Rahman S, Cohall D, Bharatha A, Singh K, Haque M, et al. Antimicrobial stewardship: Fighting antimicrobial resistance and protecting global public health. Infect Drug Resist. 2020;13:4713-4738.

Iwu CD, Patrick SM. An insight into the implementation of the global action plan on antimicrobial resistance in the WHO African region: A roadmap for action. Int J Antimicrob Agents. 2021;58(4):106411.

Yam ELY, Hsu LY, Yap EP-H, Yeo TW, Lee V, Schlundt J, et al. Antimicrobial Resistance in the Asia Pacific region: a meeting report. Antimicrob Resist Infect Control. 2019;8(1):202.

Rubin O, Baekkeskov E. Policy entrepreneurship and problem brokering in the global governance of AMR. Steering Against Superbugs. Oxford University PressOxford; 2023. p. 191–204.

Maki G, Smith I, Paulin S, Kaljee L, Kasambara W, Mlotha J, et al. Feasibility study of the World Health Organization health care facility-based antimicrobial stewardship toolkit for low- and middle-income countries. Antibiotics. 2020;9(9):556.

Khor M. The global threat of antimicrobial resistance and the challenges and needs of developing countries. 2019 [cited 2022 Jun 23]. Available from: https://martinkhor.org/wp-content/uploads/2019/10/AMR-series-1-full-version.pdf.

Sha'aban A, Khan AH, Gazzali AM, Tangiisuran B, Yee CS, Chean DC, et al. Proceedings of MPS-national pharmacists convention 2023. Mal J Pharm. 2021;7(1):49-77.

Coque TM, Cantón R, Pérez-Cobas AE, Fernández-de-Bobadilla MD, Baquero F. Antimicrobial resistance in the Global Health network: Known unknowns and challenges for efficient responses in the 21st century. Microorganisms. 2023;11(4):1050.

National Poison Centre. Antimicrobial resistance [Internet]. 2022 [cited 2022 Dec 4]. Available from: https://prn.usm.my/index.php/research/antimicrobial-resistance#research.

Overton K, Fortané N, Broom A, Raymond S, Gradmann C, Orubu ES, Podolsky SH, Van Katwyk SR, Zaman MH, Kirchhelle C. Waves of attention: patterns and themes of international antimicrobial resistance reports, 1945-2020. BMJ Glob Health. 2021;6(11):e006909.

Dhaliwal JS, Yusra MA, Muharram SH, Akkawi ME, Hussain Z, Rahman H, Kok YY, Dhaliwal SK, Ming LC. Protocol for a three-phase prospective study to develop educational resource of antimicrobial resistance and stewardship for medical programme. BMJ Open. 2022;12(2):e049867.

Mao S, Soputhy C, Lay S, Jacobs J, Ku GM, Chau D, et al. The barriers and facilitators of implementing a national laboratory-based AMR surveillance system in Cambodia: key informants’ perspectives and assessments of microbiology laboratories. Front Public Health. 2023;11:1332423.

Dahesihdewi, Andaru, Adhi Kristianto Sugianli, and Ida Parwati. The surveillance of antibiotics resistance in Indonesia: a current reports. Bali Med J. 2019;8(2):565-570.

Coyne L, Arief R, Benigno C, Giang VN, Huong LQ, Jeamsripong S, et al. Characterizing antimicrobial use in the livestock sector in three south east Asian countries (Indonesia, Thailand, and Vietnam). Antibiotics (Basel). 2019;8(1):33.

Inthavong P, Chanthavong S, Nammanininh P, Phommachanh P, Theppangna W, Agunos A, Wagenaar JA, Douangngeun B, Loth L. Antimicrobial resistance surveillance of pigs and chickens in the Lao people’s democratic republic, 2018-2021. Antibiotics (Basel). 2022;11(2):177.

Chansamouth V, Inlorkham P, Keohavong B, Bellingham K, van Doorn HR, Mayxay M, et al. Implementing the WHO AWaRe antibiotic book guidance in lower-resource settings: the case of the Lao PDR. JAC Antimicrob Resist. 2023;6(1):1-6.

Sihombing B, Bhatia R, Srivastava R, Aditama TY, Laxminarayan R, Rijal S. Response to antimicrobial resistance in South-East Asia Region. Lancet Reg Health Southeast Asia. 2023;18:100306.

Lota MM, Chua AQ, Azupardo K, Lumangaya C, Reyes KA, Villanueva SY, Legido-Quigley H, Roxas EA. A qualitative study on the design and implementation of the national action plan on antimicrobial resistance in the Philippines. Antibiotics (Basel). 2022;11(6):820.

Lim KE, Chee DI, Ting SH, Choo E, Tan WL, Lin YN. Singapore’s national action plan on antimicrobial resistance. Asian Fish Sci. 2020;33:107-11.

Tangcharoensathien V, Sattayawutthipong W, Kanjanapimai S, Kanpravidth W, Brown R, Sommanustweechai A. Antimicrobial resistance: from global agenda to national strategic plan, Thailand. Bull World Health Organ. 2017;95(8):599-603.

Wernli D, Harbarth S, Levrat N, Pittet D. A ‘whole of United Nations approach’to tackle antimicrobial resistance? A mapping of the mandate and activities of international organisations. BMJ global health. 2022;7(5):e008181.

Bordier M, Binot A, Pauchard Q, Nguyen DT, Trung TN, Fortané N, Goutard FL. Antibiotic resistance in Vietnam: moving towards a one health surveillance system. BMC Public Health. 2018;18(1):1-4.