AMR and Health Care Workers: What IPC Professionals Need to Know About Occupational Exposure and Modern Medicine Threats

The Occupational Hazard Health Care Workers Face

Antimicrobial resistance (AMR) represents a serious occupational hazard for all health care providers, particularly those working in high-risk settings. Health care workers face greater exposure to drug-resistant bacteria that colonize hospitals, including common pathogens like Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococci. While these organisms are a general occupational risk for anyone in health care settings, the threat extends far beyond individual infection risks.

"Antimicrobial resistance is kind of underappreciated as a threat, especially from policymakers, because it's a slow-moving threat. It's not the same thing as an Ebola outbreak, and that doesn't mean that it's less important, but it does require a kind of sustained effort to combat," Infectious disease expert Amesh Adalja, MD, FIDSA, senior scholar at the Johns Hopkins Center for Health Security, told Infection Control Today^® (ICT^®) in an interview.

Labor And Delivery: A Vulnerable Health Care Setting

One particularly vulnerable area is labor and delivery units, where cesarean sections require prophylactic antibiotic coverage. As AMR prevalence rises across health care systems, the likelihood that first-line antibiotics will fail rises correspondingly. This threatens the entire landscape of modern surgical practice.

"The more prevalent antimicrobial resistance becomes in any setting, the less likely it is for first-line antibiotics to work," Adalja explains. Antibiotics serve purposes far beyond treating active infections. They are essential for preventing perioperative and postoperative infections, facilitating chemotherapy for cancer patients, enabling organ transplantations, and managing immunocompromised patients.

In labor and delivery settings, when patients are colonized with drug-resistant bacteria, creating effective prophylactic regimens becomes increasingly difficult. This directly impacts maternal safety during cesarean deliveries and other surgical interventions.

The Broader Threat to Modern Medicine

The implications of rising AMR extend throughout medicine. As resistance increases, health care providers must rely on second-line antibiotics for surgeries, chemotherapy facilitation, organ transplantations, and infection treatment. Each escalation to more powerful antibiotics increases treatment toxicity and cost while reducing efficacy options.

The situation parallels what the Infectious Diseases Society of America describes as "bad bugs and no drugs." While more antibiotics are available now than a decade ago, resistance continues accelerating. Drug-resistant gonorrhea and gram-negative organisms with difficult-to-treat resistance patterns pose particular challenges.

Additionally, injudicious antibiotic use drives Clostridioides difficile infections, which are increasing as a result of inappropriate prescribing practices. Many health care providers prescribe antibiotics to placate uncertain patients or because they believe patients expect them, even when antibiotics are not medically indicated.

An Arms Race Since Penicillin

This problem is not new. Alexander Fleming, who discovered penicillin, predicted this exact scenario in his Nobel Prize speech in the 1950s. He recognized that antibiotic resistance is a biological mechanism governed by Darwinian selection that will always exist once antibiotics are introduced.

"It's basically always been an arms race since the advent of penicillin in the 1950s, when penicillin was commercialized," the expert notes. "The fact is that when you have tools like antibiotics, you have to use them judiciously, or you end up in a situation where they become less useful over time."

The Pharmaceutical Dilemma

A critical barrier to developing new antibiotics is the pharmaceutical industry's lack of financial incentive. Antibiotics represent poor investments compared to cancer drugs or other therapies with larger profit potential. This is because the optimal use of antibiotics actually reduces their market value. Judicious use means lower volume, lower sales, and lower revenue.

This paradoxical market dynamic requires innovative policy solutions. The PASTEUR Act, introduced in Congress, proposes decoupling antibiotic sales from revenue by adopting a subscription model similar to Netflix. Under this model, health care facilities would subscribe to antibiotic access rather than paying per dose, ensuring pharmaceutical companies receive a return on investment without needing to increase usage volumes.

"This has already happened in the United Kingdom, and there's efforts underway in the United States to do this as well," the expert explains. "If you've got to entice companies to come [into antibiotic development], because they need an appropriate return on investment, or they would rather invest in cancer drugs or something where there is a return on the investment."

Infection Prevention Measures for Patients

For individuals preparing for hospitalization, particularly labor and delivery, several preventive measures remain effective:

First, ensure health care workers practice proper hand hygiene. Request that staff wash their hands and remain vigilant about this basic infection-control practice.

Second, if antibiotics are prescribed, verify that they are medically indicated and not simply prescribed to manage provider uncertainty or perceived patient expectations.

Third, understand that antibiotic stewardship is not just an individual health issue but a public health imperative that protects everyone's access to effective antibiotics.

The Vaccine Schedule Court Decision

When asked about the recent federal court decision blocking Robert F. Kennedy Jr.'s changes to the childhood vaccine schedule, Adalja and other experts expressed strong support for the ruling.

"I think that this was a good decision, and I think the judge really highlighted what many of us in the field have been saying, that RFK Jr.'s reign has been one of trying to ban expertise from the public health agencies that he controls," Adalja states.

The decision emphasized that vaccine schedule changes were made solely to serve antivaccine ideology and lacked any attention to actual scientific data. However, the expert cautioned that significant damage has already been done to the vaccine ecosystem, and this single court decision, while important, may prove difficult to fully reverse.

Moving Forward

AMR requires sustained, coordinated effort from policymakers, health care providers, pharmaceutical companies, and infection prevention professionals. Judicious antibiotic use must become standard practice. Policy innovations like the PASTEUR Act offer hope for maintaining a robust antibiotic pipeline.

For infection prevention professionals, understanding AMR as an occupational hazard and its threat to modern medicine underscores the importance of antimicrobial stewardship, infection prevention protocols, and advocacy for evidence-based public health policy.