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      The Antimicrobial Resistance Crisis: Causes, Consequences, and Management

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          Abstract

          The antimicrobial resistance (AMR) crisis is the increasing global incidence of infectious diseases affecting the human population, which are untreatable with any known antimicrobial agent. This crisis will have a devastating cost on human society as both debilitating and lethal diseases increase in frequency and scope. Three major factors determine this crisis: (1) the increasing frequency of AMR phenotypes among microbes is an evolutionary response to the widespread use of antimicrobials; (2) the large and globally connected human population allows pathogens in any environment access to all of humanity; and (3) the extensive and often unnecessary use of antimicrobials by humanity provides the strong selective pressure that is driving the evolutionary response in the microbial world. Of these factors, the size of the human population is least amenable to rapid change. In contrast, the remaining two factors may be affected, so offering a means of managing the crisis: the rate at which AMR, as well as virulence factors evolve in microbial world may be slowed by reducing the applied selective pressure. This may be accomplished by radically reducing the global use of current and prospective antimicrobials. Current management measures to legislate the use of antimicrobials and to educate the healthcare world in the issues, while useful, have not comprehensively addressed the problem of achieving an overall reduction in the human use of antimicrobials. We propose that in addition to current measures and increased research into new antimicrobials and diagnostics, a comprehensive education program will be required to change the public paradigm of antimicrobial usage from that of a first line treatment to that of a last resort when all other therapeutic options have failed.

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          Most cited references46

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          Global trends in emerging infectious diseases

          The next new disease Emerging infectious diseases are a major threat to health: AIDS, SARS, drug-resistant bacteria and Ebola virus are among the more recent examples. By identifying emerging disease 'hotspots', the thinking goes, it should be possible to spot health risks at an early stage and prepare containment strategies. An analysis of over 300 examples of disease emerging between 1940 and 2004 suggests that these hotspots can be accurately mapped based on socio-economic, environmental and ecological factors. The data show that the surveillance effort, and much current research spending, is concentrated in developed economies, yet the risk maps point to developing countries as the more likely source of new diseases. Supplementary information The online version of this article (doi:10.1038/nature06536) contains supplementary material, which is available to authorized users.
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            Antibiotics and antibiotic resistance in water environments.

            Antibiotic-resistant organisms enter into water environments from human and animal sources. These bacteria are able to spread their genes into water-indigenous microbes, which also contain resistance genes. On the contrary, many antibiotics from industrial origin circulate in water environments, potentially altering microbial ecosystems. Risk assessment protocols for antibiotics and resistant bacteria in water, based on better systems for antibiotics detection and antibiotic-resistance microbial source tracking, are starting to be discussed. Methods to reduce resistant bacterial load in wastewaters, and the amount of antimicrobial agents, in most cases originated in hospitals and farms, include optimization of disinfection procedures and management of wastewater and manure. A policy for preventing mixing human-originated and animal-originated bacteria with environmental organisms seems advisable.
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              Antibiotic resistance is ancient.

              The discovery of antibiotics more than 70 years ago initiated a period of drug innovation and implementation in human and animal health and agriculture. These discoveries were tempered in all cases by the emergence of resistant microbes. This history has been interpreted to mean that antibiotic resistance in pathogenic bacteria is a modern phenomenon; this view is reinforced by the fact that collections of microbes that predate the antibiotic era are highly susceptible to antibiotics. Here we report targeted metagenomic analyses of rigorously authenticated ancient DNA from 30,000-year-old Beringian permafrost sediments and the identification of a highly diverse collection of genes encoding resistance to β-lactam, tetracycline and glycopeptide antibiotics. Structure and function studies on the complete vancomycin resistance element VanA confirmed its similarity to modern variants. These results show conclusively that antibiotic resistance is a natural phenomenon that predates the modern selective pressure of clinical antibiotic use. © 2011 Macmillan Publishers Limited. All rights reserved
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                Author and article information

                Contributors
                URI : http://frontiersin.org/people/u/174273
                URI : http://frontiersin.org/people/u/176584
                URI : http://frontiersin.org/people/u/91747
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                16 September 2014
                2014
                : 2
                : 145
                Affiliations
                [1] 1School of Medical and Molecular Biosciences, University of Technology , Sydney, NSW, Australia
                [2] 2Asia – Pacific Natural Hazards Research Group, School of Geosciences, University of Sydney , Sydney, NSW, Australia
                [3] 3ithree Institute, University of Technology , Sydney, NSW, Australia
                Author notes

                Edited by: Christina Maria Joseph Elisabeth Vandenbroucke-Grauls, VU University Medical Center, Netherlands

                Reviewed by: Johann Pitout, University of Calgary, Canada; Fiona Walsh, National University of Ireland Maynooth, Ireland

                *Correspondence: Carolyn Anne Michael, School of Medical and Molecular Biosciences, University of Technology, Broadway, Sydney, NSW 2001, Australia e-mail: camcon@ 123456ozemail.com.au

                This article was submitted to Infectious Diseases, a section of the journal Frontiers in Public Health.

                Article
                10.3389/fpubh.2014.00145
                4165128
                25279369
                bdd479b3-57f6-4170-a877-b9eace4697fd
                Copyright © 2014 Michael, Dominey-Howes and Labbate.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 20 July 2014
                : 01 September 2014
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 50, Pages: 8, Words: 7876
                Categories
                Public Health
                Review Article

                antibiotic,antimicrobial resistance,global crisis,horizontal gene transfer,public perception

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