Antimicrobial resistance: a global view from the 2013 World Healthcare-Associated Infections Forum

Abstract

Antimicrobial resistance (AMR) is now a global threat. Its emergence rests on antimicrobial overuse in humans and food-producing animals; globalization and suboptimal infection control facilitate its spread. While aggressive measures in some countries have led to the containment of some resistant gram-positive organisms, extensively resistant gram-negative organisms such as carbapenem-resistant enterobacteriaceae and pan-resistant Acinetobacter spp. continue their rapid spread. Antimicrobial conservation/stewardship programs have seen some measure of success in reducing antimicrobial overuse in humans, but their reach is limited to acute-care settings in high-income countries. Outside the European Union, there is scant or no oversight of antimicrobial administration to food-producing animals, while evidence mounts that this administration leads directly to resistant human infections. Both horizontal and vertical infection control measures can interrupt transmission among humans, but many of these are costly and essentially limited to high-income countries as well. Novel antimicrobials are urgently needed; in recent decades pharmaceutical companies have largely abandoned antimicrobial discovery and development given their high costs and low yield. Against this backdrop, international and cross-disciplinary collaboration appears to be taking root in earnest, although specific strategies still need defining. Educational programs targeting both antimicrobial prescribers and consumers must be further developed and supported. The general public must continue to be made aware of the current scale of AMR's threat, and must perceive antimicrobials as they are: a non-renewable and endangered resource.

Keywords: Animal medicine; Antibiotic stewardship; Antimicrobial conservation; Antimicrobial resistance; Care bundles; Environment; Global health; Hand hygiene; Human medicine; Infection control; Regulations; Surveillance networks; World Healthcare-Associated Infections Forum.

Figure 1

An advertisement by Schenley Laboratories Inc. By 1944, laboratories across the country were increasing penicillin production. Schenley’s advertisement stated, "When the thunderous battles of this war have subsided to pages of silent print in a history book, the greatest news event of World War II may well be the discovery and development of penicillin." Credit: Research and Development Division, Schenley Laboratories Inc., Lawrenceburg, Indiana, USA.

Figure 2

Community-associated, hospital-associated, and overall MRSA prevalences in the United States from 1999 through 2010. From the Center for Disease Dynamics, Economics and Policy (http://www.cddep.org).

Figure 3

A decline in human per capita outpatient antibiotic use in North America and France has been documented over the past decade. From the Center for Disease Dynamics, Economics and Policy (http://www.cddep.org).