Antimicrobial resistance poses significant challenges for current clinical care, and the modified use of antimicrobial agents and public health interventions, coupled with new antimicrobial strategies, may help reduce the effect of multidrug-resistant organisms in the future, according to a study appearing in JAMA.
Antibiotics have revolutionized the practice of medicine by enabling breakthroughs across the spectrum of clinical medicine, including safer childbirth, surgical procedures and organ transplantation. However, antimicrobial resistance (AMR) threatens to impede and even reverse some of this progress. In the United States, AMR organisms cause more than 2 million infections and are associated with approximately 23,000 deaths each year. In Europe, AMR is associated with approximately 25,000 deaths annually.
Anthony S. Fauci, M.D., Hilary D. Marston, M.D., M.P.H., of the National Institutes of Health, Bethesda, Md., and colleagues conducted a study to identify factors associated with AMR, the current epidemiology of important resistant organisms, and possible solutions to the AMR problem. Databases were searched for articles and entries related to AMR, focusing on epidemiology, clinical effects of AMR, discovery of novel agents to treat AMR bacterial infections, and nonpharmacological strategies to eliminate or modify AMR bacteria. In addition, selected health policy reports and public health guidance documents were reviewed. Of 217 articles, databases, and reports identified, 103 were selected for review.
The authors summarize that the increase in AMR has been driven by a diverse set of factors, including inappropriate antibiotic prescribing and sales, use of antibiotics outside of the health care sector, and genetic factors intrinsic to bacteria. The problem has been exacerbated by inadequate economic incentives for pharmaceutical development of new antimicrobial agents. A range of specific AMR concerns, including carbapenem- and colistin-resistant gram-negative organisms, pose a clinical challenge. Alternative approaches to address the AMR threat include new methods of antibacterial drug identification and strategies that neutralize virulence factors.
"Since bacterial resistance to antibiotics is inevitable, researchers must respond with innovative strategies to identify and develop new drug candidates, vaccines, and other prophylactic immune interventions and create novel treatment methods that are less likely than typical antibiotics to result in resistance," the researchers write.
"Although advances in biomedical research hold promise for efforts to prevent and treat AMR, many of these technologies are in the earliest stages of discovery. Meanwhile, effective action can slow the spread and mitigate the negative effects of resistant bacteria today. Medical professionals and facilities have an important role to play, through implementation of antimicrobial stewardship programs, reduction in inappropriate prescribing, immunization against bacterial and viral pathogens, and robust infection control measures including enhanced surveillance for resistant organisms."
"National plans, such as the President's National Strategy for Combating Antibiotic Resistant Bacteria, lay out more comprehensive approaches, drawing on contributions from health care practitioners, biomedical researchers, and the pharmaceutical and agricultural sectors (among others). Analogous international efforts, overseen by the World Health Organization, are also under way. These programs require committed and concerted implementation to realize their promise. Without a coordinated response, the postantibiotic age presaged by so many is a distinct and unwelcome possibility," the authors conclude.
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