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      The global threat of antimicrobial resistance: science for intervention

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      New Microbes and New Infections


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

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          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 35

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          Food animals and antimicrobials: impacts on human health.

          Antimicrobials are valuable therapeutics whose efficacy is seriously compromised by the emergence and spread of antimicrobial resistance. The provision of antibiotics to food animals encompasses a wide variety of nontherapeutic purposes that include growth promotion. The concern over resistance emergence and spread to people by nontherapeutic use of antimicrobials has led to conflicted practices and opinions. Considerable evidence supported the removal of nontherapeutic antimicrobials (NTAs) in Europe, based on the "precautionary principle." Still, concrete scientific evidence of the favorable versus unfavorable consequences of NTAs is not clear to all stakeholders. Substantial data show elevated antibiotic resistance in bacteria associated with animals fed NTAs and their food products. This resistance spreads to other animals and humans-directly by contact and indirectly via the food chain, water, air, and manured and sludge-fertilized soils. Modern genetic techniques are making advances in deciphering the ecological impact of NTAs, but modeling efforts are thwarted by deficits in key knowledge of microbial and antibiotic loads at each stage of the transmission chain. Still, the substantial and expanding volume of evidence reporting animal-to-human spread of resistant bacteria, including that arising from use of NTAs, supports eliminating NTA use in order to reduce the growing environmental load of resistance genes.
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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.

            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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              The role of the natural environment in the emergence of antibiotic resistance in gram-negative bacteria.

              During the past 10 years, multidrug-resistant Gram-negative Enterobacteriaceae have become a substantial challenge to infection control. It has been suggested by clinicians that the effectiveness of antibiotics is in such rapid decline that, depending on the pathogen concerned, their future utility can be measured in decades or even years. Unless the rise in antibiotic resistance can be reversed, we can expect to see a substantial rise in incurable infection and fatality in both developed and developing regions. Antibiotic resistance develops through complex interactions, with resistance arising by de-novo mutation under clinical antibiotic selection or frequently by acquisition of mobile genes that have evolved over time in bacteria in the environment. The reservoir of resistance genes in the environment is due to a mix of naturally occurring resistance and those present in animal and human waste and the selective effects of pollutants, which can co-select for mobile genetic elements carrying multiple resistant genes. Less attention has been given to how anthropogenic activity might be causing evolution of antibiotic resistance in the environment. Although the economics of the pharmaceutical industry continue to restrict investment in novel biomedical responses, action must be taken to avoid the conjunction of factors that promote evolution and spread of antibiotic resistance. Copyright © 2013 Elsevier Ltd. All rights reserved.

                Author and article information

                New Microbes New Infect
                New Microbes New Infect
                New Microbes and New Infections
                16 April 2015
                July 2015
                16 April 2015
                : 6
                : 22-29
                [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
                [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
                [12) ]WHO Regional Office for Europe, UN City, Marmorvej, Copenhagen, Denmark
                [13) ]Center for Disease Dynamics, Economics and Policy, Washington, DC, USA
                [14) ]Princeton University, Princeton, NJ, USA
                [15) ]Scientific Unit on Biological Hazards, European Food Safety Authority (EFSA), Parma, Italy
                [16) ]Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
                [17) ]Department of Medical Microbiology, Southmead Hospital, Bristol, UK
                [18) ]School of Public Health, Physiotherapy and Population Science, UCD Centre for Food and Safety, Molecular Innovation and Drug Discovery, University College Dublin, Dublin, Ireland
                [19) ]Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, and Departamento de Medicina, Universidad de Sevilla, Seville, Spain
                [20) ]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
                [21) ]Instituto de Salud Carlos III, ISCIII, Madrid, Spain
                [22) ]Centro de Investigação em Saúde da Manhiça and Instituto Nacional de Saúde/Ministério de Saúde, Maputo, Mozambique
                [23) ]Division of Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany
                [24) ]School of Life Sciences, University of Warwick, Coventry, UK
                [25) ]ESCMID Executive Committee, Basel, Switzerland
                [26) ]EUCAST Steering Committee, Växjö, Sweden
                Author notes
                [] Corresponding author: J. Vila, Department of Clinical Microbiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain jvila@
                © 2015 The Authors

                This is an open access article under the CC BY-NC-ND license (



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