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AMR poses significant health risks, challenges to clinical care
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Avoiding major threats to human health posed by antimicrobial resistance requires an innovative and multifaceted response, according to a review of literature on the subject since 2000.
“The importance of [antimicrobial resistance (AMR)] to human health is clear,” Anthony S. Fauci, MD, director of National Institute of Allergy and Infectious Diseases, and colleagues wrote. “In this Special Communication, we review the factors associated with AMR (and efforts to mitigate them), mechanisms of AMR and their influence on clinical practice, and the biomedical research response to the challenge.”
Fauci and colleagues searched the PubMed database from January 2000 to June 2016 for articles related to AMR, focusing on epidemiology, clinical effects and approaches to addressing the problem. In addition, selected media reports, public health documents, health policy reports, and NIH REPORTER and ClinicalTrials.gov databases were searched. Of 217 sources identified, 103 were selected for inclusion.
Anthony S. Fauci
The review summarized several factors driving AMR. Some antibiotic resistance is inevitable based on rapid bacterial replication cycles, which offer the opportunity for mutation. According to the researchers, however, the recent evolution of AMR was found to be heavily influenced by human activity.
Factors related to human activity include overuse of antibiotics in agriculture, inappropriate use of antibiotic use within hospitals, outpatient prescribing practices and direct-to-consumer sale of antibiotics, which are more likely to be inappropriately selected or taken at doses below standard of care. Furthermore, the pace at which new antibiotics have been introduced has slowed greatly, partly because of poor economic incentives for innovation.
The organisms and resistance mechanisms identified as causing the greatest concern and challenge for clinical care include carbapenem- and colistin-resistant gram–negative organisms, Clostridium difficile, Neisseria gonorrhoeae and Staphylococcus aureus.
Fauci and colleagues outlined promising approaches to addressing AMR, such as developing new technologies to aid in antibiotic discovery, the use of vaccines and monoclonal antibodies, manipulating microbial communities to counteract resistant infections, targeting virulence factors and improving diagnostics.
“Since bacterial resistance to antibiotics is inevitable,” they wrote, “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.”
Similarly, they noted that medical professionals and facilities play an important role by implementing antimicrobial stewardship programs, reducing inappropriate prescribing, immunizing against bacterial and viral pathogens and practicing robust infection control measures.
“Without a coordinated response,” they concluded, “the post-antibiotic age presaged by so many is a distinct and unwelcome possibility.” – by Sarah Kennedy
Disclosure: The researchers report no relevant financial disclosures.
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