The global threat of antimicrobial resistance: science for intervention.

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Abstract

In the last decade we have witnessed a dramatic increase in the proportion and absolute number of bacterial pathogens resistant to multiple antibacterial agents. Multidrug-resistant bacteria are currently considered as an emergent global disease and a major public health problem. The B-Debate meeting brought together renowned experts representing the main stakeholders (i.e. policy makers, public health authorities, regulatory agencies, pharmaceutical companies and the scientific community at large) to review the global threat of antibiotic resistance and come up with a coordinated set of strategies to fight antimicrobial resistance in a multifaceted approach. We summarize the views of the B-Debate participants regarding the current situation of antimicrobial resistance in animals and the food chain, within the community and the healthcare setting as well as the role of the environment and the development of novel diagnostic and therapeutic strategies, providing expert recommendations to tackle the global threat of antimicrobial resistance.

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Most cited references 25

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The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America.

B Spellberg, R. Guidos, D. Gilbert … (2008)

The ongoing explosion of antibiotic-resistant infections continues to plague global and US health care. Meanwhile, an equally alarming decline has occurred in the research and development of new antibiotics to deal with the threat. In response to this microbial "perfect storm," in 2001, the federal Interagency Task Force on Antimicrobial Resistance released the "Action Plan to Combat Antimicrobial Resistance; Part 1: Domestic" to strengthen the response in the United States. The Infectious Diseases Society of America (IDSA) followed in 2004 with its own report, "Bad Bugs, No Drugs: As Antibiotic Discovery Stagnates, A Public Health Crisis Brews," which proposed incentives to reinvigorate pharmaceutical investment in antibiotic research and development. The IDSA's subsequent lobbying efforts led to the introduction of promising legislation in the 109 th US Congress (January 2005-December 2006). Unfortunately, the legislation was not enacted. During the 110 th Congress, the IDSA has continued to work with congressional leaders on promising legislation to address antibiotic-resistant infection. Nevertheless, despite intensive public relations and lobbying efforts, it remains unclear whether sufficiently robust legislation will be enacted. In the meantime, microbes continue to become more resistant, the antibiotic pipeline continues to diminish, and the majority of the public remains unaware of this critical situation. The result of insufficient federal funding; insufficient surveillance, prevention, and control; insufficient research and development activities; misguided regulation of antibiotics in agriculture and, in particular, for food animals; and insufficient overall coordination of US (and international) efforts could mean a literal return to the preantibiotic era for many types of infections. If we are to address the antimicrobial resistance crisis, a concerted, grassroots effort led by the medical community will be required.

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Combating antimicrobial resistance: policy recommendations to save lives.

Brad Spellberg, Martin B Blaser, Robert Guidos … (2011)

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EUCAST expert rules in antimicrobial susceptibility testing.

R Leclercq, R Canton, D.F.J. Brown … (2013)

EUCAST expert rules have been developed to assist clinical microbiologists and describe actions to be taken in response to specific antimicrobial susceptibility test results. They include recommendations on reporting, such as inferring susceptibility to other agents from results with one, suppression of results that may be inappropriate, and editing of results from susceptible to intermediate or resistant or from intermediate to resistant on the basis of an inferred resistance mechanism. They are based on current clinical and/or microbiological evidence. EUCAST expert rules also include intrinsic resistance phenotypes and exceptional resistance phenotypes, which have not yet been reported or are very rare. The applicability of EUCAST expert rules depends on the MIC breakpoints used to define the rules. Setting appropriate clinical breakpoints, based on treating patients and not on the detection of resistance mechanisms, may lead to modification of some expert rules in the future. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.

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Author and article information

Journal

Journal ID (iso-abbrev): New Microbes New Infect

Title: New microbes and new infections

Publisher: Elsevier BV

ISSN: 2052-2975

ISSN (Print): 2052-2975

Publication date (Electronic): Jul 2015

Volume: 6

Affiliations

[1 ] ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.

[2 ] Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey ; ESCMID Executive Committee, Basel, Switzerland.

[3 ] Department of Microbiology at the Ramón y Cajal University Hospital, Ramón y Cajal Institute for Health Research (IRYCIS), Division for Research in Microbial Biology and Evolution, CIBERESP, Madrid, Spain.

[4 ] Fondation Hôpital St, Joseph, Paris, France and World Alliance Against Antibiotic Resistance (WAAAR), Creteil, France.

[5 ] European Medicines Agency (EMA), London, UK.

[6 ] Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.

[7 ] Brighton and Sussex Medical School, Brighton, UK.

[8 ] Global Commercial Lead, GlaxoSmithKline (GSK), London, UK.

[9 ] Department of Medicine, Radboud University Medical Center and Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.

[10 ] European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.

[11 ] Clinical Microbiology, Central Hospital, Växjö, Sweden ; ESCMID Executive Committee, Basel, Switzerland ; EUCAST Steering Committee, Växjö, Sweden.

[12 ] WHO Regional Office for Europe, UN City, Marmorvej, Copenhagen, Denmark.

[13 ] Center for Disease Dynamics, Economics and Policy, Washington, DC, USA ; Princeton University, Princeton, NJ, USA.

[14 ] Scientific Unit on Biological Hazards, European Food Safety Authority (EFSA), Parma, Italy.

[15 ] Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.

[16 ] Department of Medical Microbiology, Southmead Hospital, Bristol, UK ; EUCAST Steering Committee, Växjö, Sweden.

[17 ] School of Public Health, Physiotherapy and Population Science, UCD Centre for Food and Safety, Molecular Innovation and Drug Discovery, University College Dublin, Dublin, Ireland.

[18 ] Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, and Departamento de Medicina, Universidad de Sevilla, Seville, Spain ; ESCMID Executive Committee, Basel, Switzerland.

[19 ] Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Inserm, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, and APHM, CHU Timone, Pôle Infectieux, Marseille, France.

[20 ] Instituto de Salud Carlos III, ISCIII, Madrid, Spain.

[21 ] Centro de Investigação em Saúde da Manhiça and Instituto Nacional de Saúde/Ministério de Saúde, Maputo, Mozambique.

[22 ] Division of Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany ; ESCMID Executive Committee, Basel, Switzerland.

[23 ] School of Life Sciences, University of Warwick, Coventry, UK.

[24 ] ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain ; ESCMID Executive Committee, Basel, Switzerland.

Article

Publisher Item ID: S2052-2975(15)00029-3

DOI: 10.1016/j.nmni.2015.02.007

PMC ID: 4446399

PubMed ID: 26029375

SO-VID: ed9f22dd-aa25-46d2-b277-6e38121be789

History

Keywords: Antibiotic consumption,antibiotic resistance,antibiotic stewardship,antibiotics as growth promoters,drug discovery,infection control measures,multidrug resistant bacteria,self-medication,surveillance,wastewater treatment plants

The global threat of antimicrobial resistance: science for intervention.

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Abstract

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Most cited references 25

The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America.

Combating antimicrobial resistance: policy recommendations to save lives.

EUCAST expert rules in antimicrobial susceptibility testing.

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