THE SCIENCE BEHIND THE GAME
WHAT IS AMR?
Antimicrobial resistance (AMR) occurs when microorganisms such as bacteria, viruses, fungi and parasites do not respond to antimicrobials. Infections caused by resistant organisms can be harder to treat, last longer, require more expensive care and increase the risk of severe illness and death. The World Health Organization (WHO) has identified AMR as one of the greatest global public health threats facing humanity.
The misuse and overuse of antimicrobials are major drivers of AMR. They increase selective pressure that favours the survival and spread of resistant microorganisms. Check out the video for a summary of AMR.
GAMEPLAY SCENARIOS
1. GETTING TESTED
In the game, the player first enters the testing box and receives a blue, green or yellow result, which tells them which antimicrobial to collect. This represents laboratory diagnosis and antimicrobial susceptibility testing, which can help identify the pathogen causing an infection and determine which antimicrobial is likely to be effective against it. This information can support more targeted treatment and help avoid those that are unlikely to work.
In real life, the testing process can be more complex. A specimen may need to be collected, transported and analysed, and the pathogen may need to be identified before susceptibility testing can be performed. Results may take hours or days, although some rapid diagnostic tests can provide information much sooner. Clinicians may therefore need to begin empiric treatment before results are available, particularly when delaying treatment could be harmful.
2. CHOOSING THE CORRECT ANTIMICROBIAL
In the game, the player collects the antimicrobial that matches the test result. A coloured ring around the player shows that the antimicrobial is active for 10 seconds. This reflects the principle that antimicrobials are not equally effective against every pathogen and that the most appropriate treatment should be selected whenever possible. The limited period of activity is also a reminder that antimicrobials need to be used correctly.
In real life, antimicrobials should be taken exactly as prescribed, including the correct dose, timing and recommended duration. They should also not be shared. Treatment decisions are much more complex than simply matching a test result: clinicians also consider factors such as the type and site of infection, severity of illness, allergies, kidney and liver function, possible drug interactions and the patient's overall clinical condition.
3. DESTROYING PATHOGEN
In the game, the correct antimicrobial allows the player to destroy susceptible pathogens and earn points. This represents antimicrobial susceptibility: a pathogen described as susceptible is expected to respond to a particular antimicrobial when it is used appropriately.
In real life, the antimicrobial effect is not immediate. Different antimicrobials work in different ways such as killing microorganisms or inhibiting their growth/replication. Whether treatment is successful also depends on factors such as the concentration of the antimicrobial at the site of infection, the person's immune response, the location and severity of the infection and other characteristics of both the patient and pathogen.
4. CHOOSING THE WRONG ANTIMICROBIAL
In the game, choosing an antimicrobial that does not match the test result cannot destroy the microorganism. This is indicated by a dashed circle. On contact with a microorganism, the player may lose a life, and a new resistant pathogen appears. This represents an important AMR principle: inappropriate or unnecessary antimicrobial use can favour the survival and spread of resistant organisms.
In real life, a pathogen does not instantly become resistant because the wrong antimicrobial is used. Resistance can arise through a range of mechanisms such genetic changes or the acquisition of resistance genes. Antimicrobial exposure can create selective pressure that favours resistant organisms, allowing them to survive, multiply and spread. The appearance of a new resistant pathogen in the game is therefore a simplified visual representation of this process.
In the game, a resistant pathogen cannot be destroyed by the antimicrobial the player is currently using, so the player must avoid it. This demonstrates the basic principle of antimicrobial resistance: a pathogen is able to survive or continue multiplying despite exposure to an antimicrobial that would normally be expected to act against it.
In real life, resistance can lead to fewer effective treatment options and make infections more difficult or impossible to treat. This is why AMR is such an important public-health concern. lifesaving procedures and treatments such as surgery, organ transplantation and cancer chemotherapy is considerably riskier because infections may become harder to prevent or treat.
6. POWER-UP 1 - PERSONAL PROTECTIVE EQUIPMENT (PPE)
In the game, collecting the Personal Protective Equipment (PPE) power-up gives the player temporary protection from contact with pathogens. This represents the role of PPE as part of infection prevention and control. Appropriate PPE creates a barrier that can reduce exposure to infectious material and help reduce transmission.
In real life, PPE requirements depend on the type of pathogen, exposure and mode of transmission. It may include gloves, gowns, masks, respirators or eye protection. It must also be put on, removed and used correctly. The temporary protection in the game reflects the fact that PPE does not provide permanent protection: it is used when there is a particular risk of exposure and may need to be removed or replaced between patients, procedures or tasks.
7. POWER-UP 2 - HAND HYGIENE
In the game, collecting the hand-hygiene power-up temporarily slows the pathogens, making them easier to avoid. This represents the important role of hand hygiene in interrupting the transmission of infectious microorganisms.
Appropriate handwashing with soap and water or the use of an alcohol-based hand rub removes or kills microorganisms on the hands, reducing the opportunity for them to be transmitted to patients, other people, equipment or the environment. Because hands can become contaminated again after contact with people, body fluids, surfaces or equipment, hand hygiene needs to be performed repeatedly at the appropriate moments. The slowing effect in the game is therefore a visual representation of interrupting transmission.
NOTE
The game deliberately simplifies complex biological and clinical processes to make the key principles of AMR easier to understand. In real life, whether an infection develops, how it is treated, whether treatment succeeds and whether resistance emerges or spreads depend on many interacting factors.
The game is therefore not a simulation of clinical care. Its purpose is to introduce important concepts, raise awareness of antimicrobial resistance and encourage further discussion about how appropriate antimicrobial use, diagnostic testing and infection prevention can help address AMR.
For educational purposes only. Use is subject to the Public Health Academy Terms of Use.
REFERENCES AND RESOURCES
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World Health Organization: Antimicrobial Resistance [fact sheet]: https://www.who.int/news-room/fact-sheets/detail/antimicrobial- resistance
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Centers for Disease Control: Antimicrobial resistance: https://www.cdc.gov/antimicrobial-resistance/index.html
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World Health Organization: Global Action Plan on Antimicrobial Resistance. WHO Geneva, 2015
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World Health Organization. Antimicrobial Stewardship Interventions: A Practical Guide. Copenhagen, Denmark: WHO Regional Office for Europe; 2021.
