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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×

COMBATING ANTIMICROBIAL RESISTANCE

A One Health Approach to a Global Threat

PROCEEDINGS OF A WORKSHOP

Ceci Mundaca-Shah, V. Ayano Ogawa, and Anna Nicholson, Rapporteurs

Forum on Microbial Threats

Board on Global Health

Health and Medicine Division

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×

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This activity was supported by contracts between the National Academy of Sciences and the U.S. Agency for International Development; U.S. Army Medical Research and Materiel Command (#10001249); U.S. Centers for Disease Control and Prevention (#10002642); U.S. Department of Homeland Security (#10003591); U.S. Department of Justice: Federal Bureau of Investigation, National Institute of Allergy and Infectious Diseases/National Institutes of Health (#10003226), Uniformed Services University of the Health Sciences (#10003626), and U.S. Food and Drug Administration (#10002125); and U.S. Department of Veterans Affairs (#10003353); and by the American Society for Microbiology, Infectious Diseases Society of America, Johnson & Johnson (#10003710), Sanofi Pasteur, and Skoll Global Threats Fund (#1003664). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-46652-3
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Combating antimicrobial resistance: A One Health approach to a global threat: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24914.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×

PLANNING COMMITTEE ON COMBATING ANTIMICROBIAL RESISTANCE: A ONE HEALTH APPROACH TO A GLOBAL THREAT1

LONNIE J. KING (Chair), Professor and Dean Emeritus, College of Veterinary Medicine, The Ohio State University

FRANCK BERTHE, Senior Livestock Specialist, Agriculture Global Practice, World Bank

LAURA A. BOCZEK, Microbiologist, Office of Research and Development, National Risk Management Research Laboratory, U.S. Environmental Protection Agency

LUCIANA L. BORIO, Acting Chief Scientist for Science and Public Health, U.S. Food and Drug Administration

TIMOTHY BURGESS, Director, Infectious Diseases Clinical Research Program, Uniformed Services University of the Health Sciences

DENNIS CARROLL, Director, Global Health Security and Development Unit, U.S. Agency for International Development

JAMES M. HUGHES, Professor of Medicine and Public Health, Rollins School of Public Health, Emory University

KENT E. KESTER, Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur

RIMA F. KHABBAZ, Deputy Director for Infectious Diseases; Director of Office of Infectious Diseases, U.S. Centers for Disease Control and Prevention

JOHN H. REX, Chief Strategy Officer, CARB-X

JEFFREY SILVERSTEIN, Deputy Administrator, Animal Production and Protection, Office of National Programs, Agricultural Research Service, U.S. Department of Agriculture

PAIGE E. WATERMAN, Lieutenant Colonel, U.S. Army; Director, Translational Medicine Branch, Walter Reed Army Institute of Research

ED WHITING, Director of Policy and Chief of Staff, Wellcome Trust

MARY E. WILSON, Clinical Professor of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco

Health and Medicine Division Staff

CECI MUNDACA-SHAH, Director, Forum on Microbial Threats

V. AYANO OGAWA, Program Officer

T. ANH TRAN, Senior Program Assistant

JULIE PAVLIN, Director, Board on Global Health

Consultant

ANNA NICHOLSON, Consulting Writer

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×

FORUM ON MICROBIAL THREATS1

DAVID A. RELMAN (Chair), Thomas C. and Joan M. Merigan Professor, Departments of Medicine and of Microbiology and Immunology, Stanford University

JAMES M. HUGHES (Vice Chair), Professor of Medicine and Public Health, Rollins School of Public Health, Emory University

LONNIE J. KING (Vice Chair), Professor and Dean Emeritus, College of Veterinary Medicine, The Ohio State University

KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security

ENRIQUETA C. BOND, Burroughs Wellcome Fund (Emeritus); QE Philanthropic Advisors

LUCIANA L. BORIO, Acting Chief Scientist for Science and Public Health, U.S. Food and Drug Administration

TIMOTHY BURGESS, Director, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences

DENNIS CARROLL, Director, Global Health Security and Development Unit, U.S. Agency for International Development

ARTURO CASADEVALL, Professor and Chair, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health

PETER DASZAK, President, EcoHealth Alliance

JEFFREY S. DUCHIN, Health Officer and Chief, Communicable Disease Epidemiology and Immunization Section for Public Health, Seattle and King County, Washington

EMILY ERBELDING, Deputy Director, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health

MARCOS A. ESPINAL, Director, Communicable Diseases and Health Analysis, Pan American Health Organization

JENNIFER GARDY, Canada Research Chair in Public Health Genomics; Assistant Professor, University of British Columbia

JESSE L. GOODMAN, Professor of Medicine and Infectious Diseases; Director, Center on Medical Product Access, Safety, and Stewardship, Georgetown University

EDUARDO GOTUZZO, Director, Alexander von Humboldt Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Peru

EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology, University of California, Berkeley

CAROLINE S. HARWOOD, Gerald and Lyn Grinstein Professor of Microbiology, University of Washington

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×

STEPHEN A. JOHNSTON, Director, Center for Innovations in Medicine, The Biodesign Institute, Arizona State University

KENT E. KESTER, Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur

GERALD T. KEUSCH, Associate Director, National Emerging Infectious Diseases Laboratory, Boston University

RIMA F. KHABBAZ, Deputy Director for Infectious Diseases; Director of Office of Infectious Diseases, U.S. Centers for Disease Control and Prevention

STANLEY M. LEMON, Professor of Medicine and Microbiology and Immunology, University of North Carolina at Chapel Hill

JONNA MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis

SUERIE MOON, Director of Research, Global Health Centre, Graduate Institute of International and Development Studies, Geneva

JENNIFER OLSEN, Manager, Pandemics, Skoll Global Threats Fund

GEORGE POSTE, Chief Scientist, Complex Adaptive Systems Initiative, Arizona State University, SkySong

KUMANAN RASANATHAN, Chief, Implementation Research and Delivery Science Unit, United Nations Children’s Fund

DAVID RIZZO, Chair, Department of Plant Pathology, University of California, Davis

GARY A. ROSELLE, Chief of Medical Service, Veterans Affairs Medical Center; Director, National Infectious Disease Services, Veterans Health Administration

PETER A. SANDS, Senior Fellow, Mossavar-Rahmani Center for Business and Government, Harvard Kennedy School

THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis

JANET SHOEMAKER, Director, Office of Public Affairs, American Society for Microbiology

JAY P. SIEGEL, Chief Biotechnology Officer, Head of Scientific Strategy and Policy, Johnson & Johnson

PAIGE E. WATERMAN, Lieutenant Colonel, U.S. Army; Director, Translational Medicine Branch, Walter Reed Army Institute of Research

MARY E. WILSON, Clinical Professor of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco

EDWARD H. YOU, Supervisory Special Agent, Weapons of Mass Destruction Directorate, Federal Bureau of Investigation

National Academies of Sciences, Engineering, and Medicine Staff

CECI MUNDACA-SHAH, Director, Forum on Microbial Threats

V. AYANO OGAWA, Program Officer

T. ANH TRAN, Senior Program Assistant

JULIE PAVLIN, Director, Board on Global Health

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Keiji Fukuda, University of Hong Kong

Lonnie King, The Ohio State University

Kevin Outterson, CARB-X

Jeffrey Silverstein, U.S. Department of Agriculture

Kavita Trivedi, Trivedi Consults, LLC

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by Robert Lawrence, Johns Hopkins University. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×

Acknowledgments

The Forum on Microbial Threats staff and planning committee deeply appreciate the many valuable contributions from individuals who assisted us with this project. We offer our profound thanks to all the presenters and discussants at the workshop who gave so generously of their time and expertise. A full list of speakers and moderators and their biographical information may be found in Appendix C.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×
Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×

Acronyms and Abbreviations

AAVMC

Association of American Veterinary Medical Colleges

APHIS

Animal and Plant Health Inspection Service

APLU

Association of Public and Land-grant Universities

BEARI

Behavioral Economics to improve treatment of Acute Respiratory Infection

BMGF

Bill & Melinda Gates Foundation

BQA

Beef Quality Assurance

CARE

Collective Antimicrobial Resistance Ecosystem

CDC

U.S. Centers for Disease Control and Prevention

CMS

Centers for Medicare & Medicaid Services

COP

colonizing opportunistic pathogen

CRE

carbapenem-resistant Enterobacteriaceae

DRI

drug-resistant infection

EHR

electronic health record

ESBL

extended spectrum beta-lactamase

ESKAPE

Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter

FAO

Food and Agriculture Organization of the United Nations

FDA

U.S. Food and Drug Administration

Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
×
GARDP

Global Antibiotic Research & Development Partnership

GDF

Global Drug Facility

GFSI

Global Food Safety Initiative

GHSA

Global Health Security Agenda

GLASS

Global Antimicrobial Resistance Surveillance System

GP

general practitioner

HAI

health care–associated infection

IACG

Interagency Coordinating Group on Antimicrobial Resistance

ICU

intensive care unit

IDSA

Infectious Diseases Society of America

IHR

International Health Regulations

IMI

Innovative Medicines Initiative

IV

intravenous

MDR

multidrug resistant

MDR-TB

multidrug-resistant tuberculosis

MI

microbiome index

MRSA

methicillin-resistant Staphylococcus aureus

MSSA

methicillin-susceptible Staphylococcus aureus

MTB

Mycobacterium tuberculosis

NAE

no-antibiotics-ever

NARMS

National Antimicrobial Resistance Monitoring System

NIFA

National Institute of Food and Agriculture

OIE

World Organisation for Animal Health

PAVE

Priority Antimicrobial Value and Entry

PCV

pneumococcal conjugate vaccine

RIF

rifampin

SHEA

Society for Health Care Epidemiology of America

SSAFE

Safe Supply of Affordable Food Everywhere

TB

tuberculosis

UN

United Nations

USDA

U.S. Department of Agriculture

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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VFD

Veterinary Feed Directive

WHO

World Health Organization

XDR-TB

extensively drug-resistant tuberculosis

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24914.
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As of 2017, the emergence and spread of antimicrobial resistance continues unabated around the world, leaving devastating health and economic outcomes in its wake. Those consequences will multiply if collaborative global action is not taken to address the spread of resistance. Major drivers of antimicrobial resistance in humans have been accelerated by inappropriate antimicrobial prescribing in health care practices; the inappropriate use of antimicrobials in livestock; and the promulgation of antibiotic resistance genes in the environment.

To explore the issue of antimicrobial resistance, the Forum of Microbial Threats planned a public workshop. Participants explored issues of antimicrobial resistance through the lens of One Health, which is a collaborative approach of multiple disciplines - working locally, nationally, and globally - for strengthening systems to counter infectious diseases and related issues that threaten human, animal, and environmental health, with an end point of improving global health and achieving gains in development. They also discussed immediate and short-term actions and research needs that will have the greatest effect on reducing antimicrobial resistance, while taking into account the complexities of bridging different sectors and disciplines to address this global threat. This publication summarizes the presentations and discussions from the workshop.

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