Animal production and antimicrobial resistance in the clinic

Abstract

One of the major public health challenges this century is the development of antimicrobial resistance in many important and common pathogens, such as Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. 1 O'Neill J Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Review on antimicrobial resistance to the Government of the United Kingdom. HM Government, London2014http://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf Google Scholar The Lancet Series on antimicrobials tackles the issue head-on by presenting evidence on universal access to antibiotics, sustainability, and effectiveness. 2 Laxminarayan R Matsoso P Pant S et al. Access to effective antimicrobials: a worldwide challenge. Lancet. 2015; (published online Nov 18.)http://dx.doi.org/10.1016/S0140-6736(15)00474-2 Google Scholar , 3 Holmes AH Moore LSP Sundsfjord A et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2015; (published online Nov 18.)http://dx.doi.org/10.1016/S0140-6736(15)00473-0 Google Scholar , 4 Mendelson M Røttingen J-A Gopinathan U et al. Maximising access to achieve appropriate human antimicrobial use in low-income and middle-income countries. Lancet. 2015; (published online Nov 18.)http://dx.doi.org/10.1016/S0140-6736(15)00547-4 Google Scholar , 5 Dar OA Hasan R Schlundt J et al. Exploring the evidence base for national and regional policy interventions to combat resistance. Lancet. 2015; (published online Nov 18.)http://dx.doi.org/10.1016/S0140-6736(15)00520-6 Google Scholar , 6 Årdal C Outterson K Hoffman SJ et al. International cooperation to improve access to and sustain effectiveness of antimicrobials. Lancet. 2015; (published online Nov 18.)http://dx.doi.org/10.1016/S0140-6736(15)00470-5 PubMed Google Scholar The Series focuses on the use and misuse of antimicrobials in human medicine but does not ignore other sources of antimicrobial resistance development: waste and contamination from the pharmaceutical industry, animal agriculture, and the natural arms race that has been fought among microbes in the environment since the dawn of evolution. Access to effective antimicrobials: a worldwide challengeRecent years have seen substantial improvements in life expectancy and access to antimicrobials, especially in low-income and lower-middle-income countries, but increasing pathogen resistance to antimicrobials threatens to roll back this progress. Resistant organisms in health-care and community settings pose a threat to survival rates from serious infections, including neonatal sepsis and health-care-associated infections, and limit the potential health benefits from surgeries, transplants, and cancer treatment. Full-Text PDF Understanding the mechanisms and drivers of antimicrobial resistanceTo combat the threat to human health and biosecurity from antimicrobial resistance, an understanding of its mechanisms and drivers is needed. Emergence of antimicrobial resistance in microorganisms is a natural phenomenon, yet antimicrobial resistance selection has been driven by antimicrobial exposure in health care, agriculture, and the environment. Onward transmission is affected by standards of infection control, sanitation, access to clean water, access to assured quality antimicrobials and diagnostics, travel, and migration. Full-Text PDF Maximising access to achieve appropriate human antimicrobial use in low-income and middle-income countriesAccess to quality-assured antimicrobials is regarded as part of the human right to health, yet universal access is often undermined in low-income and middle-income countries. Lack of access to the instruments necessary to make the correct diagnosis and prescribe antimicrobials appropriately, in addition to weak health systems, heightens the challenge faced by prescribers. Evidence-based interventions in community and health-care settings can increase access to appropriately prescribed antimicrobials. Full-Text PDF Exploring the evidence base for national and regional policy interventions to combat resistanceThe effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains—responsible use, surveillance, and infection prevention and control—and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Full-Text PDF International cooperation to improve access to and sustain effectiveness of antimicrobialsSecuring access to effective antimicrobials is one of the greatest challenges today. Until now, efforts to address this issue have been isolated and uncoordinated, with little focus on sustainable and international solutions. Global collective action is necessary to improve access to life-saving antimicrobials, conserving them, and ensuring continued innovation. Access, conservation, and innovation are beneficial when achieved independently, but much more effective and sustainable if implemented in concert within and across countries. Full-Text PDF