<unk>  is mainly caused by the overuse of<unk> s. This leads to microbes either evolving a defense against drugs used to treat them, or certain strains of microbes that have a natural resistance to<unk> s becoming much more prevalent than the ones that are easily defeated with medication. While<unk>  does occur naturally over time, the use of<unk>  agents in a variety of settings both within the healthcare industry and outside of has led to<unk>  becoming increasingly more prevalent. Natural occurrence A CDC infographic on how antibiotic resistance (a major type of<unk>  happens and spreads.<unk>  can evolve naturally due to continued exposure to<unk> s. Natural selection means that organisms that are able to adapt to their environment, survive, and continue to produce offspring. As a result, the types of microorganisms that are able to survive over time with continued attack by certain<unk>  agents will naturally become more prevalent in the environment, and those without this resistance will become obsolete. Some contemporary antibiotic resistances have also evolved naturally before the use of antibiotics or human clinical use of respective<unk> s. For instance, methicillin-resistance evolved in a pathogen of hedgehogs, possibly as a co-evolutionary adaptation of the pathogen to hedgehogs that are infected by a dermatophyte that naturally produces antibiotics. Over time, most of the strains of bacteria and infections present will be the type resistant to the<unk>  agent being used to treat them, making this agent now ineffective to defeat most microbes. With the increased use of<unk>  agents, there is a speeding up of this natural process. Self-medication Self-medication by consumers is defined as "the taking of medicines on one's own initiative or on another person's suggestion, who is not a certified medical professional", and it has been identified as one of the primary reasons for the evolution of<unk> . In an effort to manage their own illness, patients take the advice of false media sources, friends, and family causing them to take<unk> s unnecessarily or in excess. Many people resort to this out of necessity, when they have a limited amount of money to see a doctor, or in many developing countries a poorly developed economy and lack of doctors are the cause of self-medication. In these developing countries, governments resort to allowing the sale of<unk> s as over the counter medications so people could have access to them without having to find or pay to see a medical professional. This increased access makes it extremely easy to obtain<unk> s without the advice of a physician, and as a result many<unk> s are taken incorrectly leading to resistant microbial strains. One major example of a place that faces these challenges is India, where in the state of Punjab 73% of the population resorted to treating their minor health issues and chronic illnesses through self-medication. The major issue with self-medication is the lack of knowledge of the public on the dangerous effects of<unk> , and how they can contribute to it through mistreating or misdiagnosing themselves. In order to determine the public's knowledge and preconceived notions on antibiotic resistance, a major type of<unk> , a screening of 3537 articles published in Europe, Asia, and North America was done. Of the 55,225 total people surveyed, 70% had heard of antibiotic resistance previously, but 88% of those people thought it referred to some type of physical change in the body. With so many people around the world with the ability to self-medicate using antibiotics, and a vast majority unaware of what<unk>  is, it makes the increase of<unk>  much more likely. Clinical misuse Clinical misuse by healthcare professionals is another cause leading to increased<unk> . Studies done by the CDC show that the indication for treatment of antibiotics, choice of the agent used, and the duration of therapy was incorrect in up to 50% of the cases studied. In another study done in an intensive care unit in a major hospital in France, it was shown that 30% to 60% of prescribed antibiotics were unnecessary. These inappropriate uses of<unk>  agents promote the evolution of<unk>  by supporting the bacteria in developing genetic alterations that lead to resistance. In a study done by the American Journal of Infection Control aimed to evaluate physicians’ attitudes and knowledge on<unk>  in ambulatory settings, only 63% of those surveyed reported antibiotic resistance as a problem in their local practices, while 23% reported the aggressive prescription of antibiotics as necessary to avoid failing to provide adequate care. This demonstrates how a majority of doctors underestimate the impact that their own prescribing habits have on<unk>  as a whole. It also confirms that some physicians may be overly cautious when it comes to prescribing antibiotics for both medical or legal reasons, even when indication for use for these medications is not always confirmed. This can lead to unnecessary<unk>  use. Studies have shown that common misconceptions about the effectiveness and necessity of antibiotics to treat common mild illnesses contribute to their overuse. Pandemics, disinfectants and healthcare systems Increased antibiotic use during the COVID-19 pandemic may exacerbate this global health challenge. Moreover, pandemic burdens on some healthcare systems may contribute to antibiotic-resistant infections. On the other hand, a study suggests that "increased hand hygiene, decreased international travel, and decreased elective hospital procedures may reduce<unk>  pathogen selection and spread in the short term". Disinfectants such as in various forms of use of alcohol-based hand sanitizers, and antiseptic hand wash may also have the potential to increase<unk> . According to a study, "Extensive disinfectant use leads to mutations that induce<unk> ". Environmental pollution Untreated effluents from pharmaceutical manufacturing industries, hospitals and clinics, and inappropriate disposal of unused or expired medication can expose microbes in the environment to antibiotics and trigger the evolution of resistance. Food production Livestock A CDC infographic on how antibiotic resistance spreads through farm animals. The<unk>  crisis also extends to the food industry, specifically with food producing animals. Antibiotics are fed to livestock to act as growth supplements, and a preventative measure to decrease the likelihood of infections. This results in the transfer of resistant bacterial strains into the food that humans eat, causing potentially fatal transfer of disease. While this practice does result in better yields and meat products, it is a major issue in terms of preventing<unk> . Though the evidence linking<unk>  usage in livestock to<unk>  is limited, the World Health Organization Advisory Group on Integrated Surveillance of<unk>  strongly recommended the reduction of use of medically important<unk> s in livestock. Additionally, the Advisory Group stated that such<unk> s should be expressly prohibited for both growth promotion and disease prevention. In a study published by the National Academy of Sciences mapping<unk>  consumption in livestock globally, it was predicted that in the 228 countries studied, there would be a total 67% increase in consumption of antibiotics by livestock by 2030. In some countries such as Brazil, Russia, India, China, and South Africa it is predicted that a 99% increase will occur. Several countries have restricted the use of antibiotics in livestock, including Canada, China, Japan, and the US. These restrictions are sometimes associated with a reduction of the prevalence of<unk>  in humans. Pesticides Most pesticides protect crops against insects and plants, but in some cases<unk>  pesticides are used to protect against various microorganisms such as bacteria, viruses, fungi, algae, and protozoa. The overuse of many pesticides in an effort to have a higher yield of crops has resulted in many of these microbes evolving a tolerance against these<unk>  agents. Currently there are over 4000<unk>  pesticides registered with the EPA and sold to market, showing the widespread use of these agents. It is estimated that for every single meal a person consumes, 0.3 g of pesticides is used, as 90% of all pesticide use is used on agriculture. A majority of these products are used to help defend against the spread of infectious diseases, and hopefully protect public health. But out of the large amount of pesticides used, it is also estimated that less than 0.1% of those<unk>  agents, actually reach their targets. That leaves over 99% of all pesticides used available to contaminate other resources. In soil, air, and water these<unk>  agents are able to spread, coming in contact with more microorganisms and leading to these microbes evolving mechanisms to tolerate and further resist pesticides.
Antimicrobial resistance
Drug resistance
Antibiotic synergy
Multiple drug resistance
Opportunistic infection
Vaccine resistance
Immunocompetence
Tolerogenic therapy