Antimicrobial Resistance: An International Public Health Problem

Abstract

In recent years, the problem of antimicrobial resistance has been recognized and addressed by international, regional, and national public health agencies, authorities, and professional societies [1–4]. Antibiotics have saved millions of lives and have enabled many other medical advances since their discovery and introduction into clinical practice. The worsening problem of antimicrobial resistance now jeopardizes many of these advances. However, action plans to minimize this threat have been developed by many public health agencies around the globe [5–8]. This focus is likely to increase among public health agencies in the coming years. Several facets of the problem involve the relationship between human and animal use of antimicrobial agents [3, 9]. This chapter summarizes the components of the cost of resistance from a public health perspective and contrasts this perspective to other societal perspectives. It then reviews strategies at several different levels of responsibility, ranging from the patient care provider to international agencies. Finally, it considers appropriate public health responses according to the resources available for control. In an era of globalization, antimicrobial resistance represents an international concern that demands a concerted effort from multiple health and industry sectors. Public health must be at the forefront of these efforts. Antimicrobial resistance is widely recognized as a complex international problem. Antibiotics have saved millions of lives and have enabled many other medical advances since their discovery and introduction into clinical practice. The worsening problem of antimicrobial resistance now jeopardizes many of these advances [1, 2, 4, 7, 8, 10–13]. The number of pathogens resistant to multiple classes of antimicrobials has increased worldwide [14]. There have been reports of infections with Pseudomonas aeruginosa and Acinetobacter species which are resistant to all available antibiotics [15]. Other pathogens, such as Neisseria gonorrhoeae, that were previously relatively easy to treat, are now becoming much more difficult to treat due to antimicrobial resistance [16]. There is also evidence that resistant organisms that were previously confined to the acute care hospital setting are now sources of community-acquired infections [17]. Resistance is not only an issue for bacterial pathogens like staphylococci, enterococci, Escherichia coli, Klebsiella, Neisseria, and Mycobacterium tuberculosis but also the problem of resistance that is increasingly being recognized in nonbacterial pathogens like Candida, HIV, malaria, and influenza [14].