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Antimicrobial Resistance (AMR)

AMR occurs when microorganisms (e.g., bacteria, fungi, viruses, parasites) evolve and become resistant to the medications normally used to treat their infections. This is a serious problem worldwide as infections that were once curable with standard treatment — such as specific strains of pneumonia, gonorrhea, tuberculosis — are now presenting as resistant to one or more antimicrobials (e.g., antibiotics, antifungal agents).

The quick spread of AMR has been attributed to a number of factors, most notably the misuse and overuse of antimicrobials. According to this WHO report, AMR has a significant impact on human health and the health-care system, as infections by drug-resistant antimicrobials are associated with poor health outcomes, including increased length of stay in hospital, complications, and mortality. Worldwide, it is estimated that AMR will become a leading cause of death by 2030. Nationally, a report from the Canadian Council of Academies estimates that by 2050, close to 400,000 lives in Canada will be lost due to AMR, costing the health-care system $120 billion.

Role of the nurse

Nurses have a critical role to play in the fight against AMR and can support the judicious use of antimicrobials in many ways, including:

  • Assess and monitor for signs and symptoms of infections and side-effects of antimicrobial treatment. In particular, monitor for health-care-associated infections and adverse events due to antimicrobials.
  • Prescribe and de-prescribe judiciously. Authorized nurse prescribers and nurse practitioners can be stewards of antimicrobial prescribing and de-prescribing.
  • Act as stewards for microbiology and laboratory testing. Nurses can help ensure testing is done correctly to help drive the appropriate prescribing of antimicrobials.
  • Educate patients and the public. Discuss when it is appropriate to use antimicrobials and address patient concerns.
  • Implement infection prevention and control practices. This can limit the spread of drug-resistant infections and prevent infections to help avoid the use of antimicrobials altogether. This includes ensuring compliance with best practice and institutional guidelines and activities in the community through activities such as immunization programs.

AMR resources

CNA’s advocacy role

  • CNA is a member of a stewardship task group working on the creation of a federal Pan-Canadian Action Plan on Antimicrobial Resistance and Antimicrobial Use
  • CNA is the co-lead of the AMR sub-group of the chief public health officer’s health professions forum. CNA is co-leading the group with the Association of Medical Microbiology and Infectious Disease Canada to support health-care providers in addressing AMR.
  • June 2019: CNA president Claire Betker presented on nursing’s leadership role in AMS at the International Council of Nurses congress in Singapore.
  • 2018: CNA’s Choosing Wisely Canada lists identify recommendations that support AMS
  • August 2017: in its 2018 Pre-budget Consultation [PDF, 181.6 KB], CNA recommended strategies to support scaling up provincial/territorial AMS programs and invest in nursing leadership of AMS. CNA’s submission also supported the recommendations in Putting the Pieces Together: A National Action Plan on Antimicrobial Stewardship.
  • June 2017: Antimicrobial Resistance in Canada – Brief for the Standing Committee on Health [PDF, 194.7 KB]