Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine (2022) / Chapter Skim
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1 Introduction
1 Introduction
Pages 17-28
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From page 17... ...
. While selective pressure from modern antimicrobial medicines has undoubtedly encouraged the survival of resistant organisms (simplified in Figure 1-1)
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From page 18... ...
. Horizontal transmission processes, shown in Figure 1-2, can rapidly spread beneficial genes across microbial communities, ultimately accounting for much of the baseline genetic variability then acted upon by selection pressure (Hall et al., 2020)
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Potential routes of transmission of antibiotic-resistant bacteria Figure 1-2 FIGURE 1-3 Microbes and resistomes travel across habitats. Figure Adapted SOURCE: 1-3 from Biomerieux, 2020.
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found the prevalence 1200 1000 800 Frequency 600 400 200 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 IMP VIM KPC OXA-48 NDM IMI KPC + VIM NDM + OXA-48 FIGURE 1-4 Carbapenemase-producing Enterobacteriaceae confirmed by Public Health England's Antimicrobial Resistance and Healthcare Associated Infections unit, from UK laboratories. NOTES: Resistance and Healthcare Associated Infections unit, from UK laborato ries.
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From page 21... ...
. CHARGE TO THE COMMITTEE The first national action plan for antimicrobial resistance was released in 2015, the result of President Obama's Executive Order Combating Antibiotic-Resistant Bacteria, which created both an interagency task force to implement the National Strategy for Combating Antibiotic-Resistant Bacteria (released at the same time)
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From page 22... ...
2013 2015 2020 Federal task force for CARB First funding established to agencies to implement National Strategy CARB CDC releases first 1st National 2nd National Antibiotic Action Plan Action Plan Resistance Threats Report 2014 2016 FIGURE 1-5 The timeline of key U.S. government publications on antimicrobial resistance.
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From page 23... ...
Opportunities to add to the current body of knowledge include: • Advising on an effective strategy to scale up global detection of resistant infections and infection prevention and control efforts -- especially outside of the United States and Europe; • Helping to assess and quantify the risk to human health from environmen tal sources and reservoirs of antibiotic-resistant pathogens and genes; • Assessing any methodologies for evaluating how interventions in agricul ture affect public health and how to improve them; • Assessing any methodologies for evaluating the effects of interventions in agricultural settings on animal health and welfare and how to improve them; • Assessing the effect of new incentives for antibiotic development (BARDA's project Bioshield, 2019 CMS IPPS) on the health of the antibiotic pipeline; • Exploring methodological innovations to improve projections of the burden of AMR and its economic impacts, with an eye toward informing the devel opment of incentives for antimicrobial products; • Exploring ways to develop, benchmark, and track rigorous quantitative measures of the effect of various strategies to mitigate AMR, with a focus on relevant, timely, and actionable measures; • Assessing the need for and advise on key diseases and antibiotics for which animal-specific antimicrobial susceptibility testing breakpoints are needed; and • Assessing the need for and explore how to incentivize and promote cooper ative relationships between industry and professional societies to prioritize test development of new diagnostics for use in veterinary settings, espe cially animal-side diagnostics that allow precise selection of antibiotics.
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From page 24... ...
The scope of public health programming and funding for HIV, tuberculosis, and malaria vastly outweighs the national and international resources directed to other resistant infections, however. Though the underlying mechanisms causing resistance are the same, the response to these diseases is not comparable to that for bacterial and fungal pathogens more broadly.
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From page 25... ...
For this reason, the committee avoided a reactive emphasis on the pathogens driving the burden of resistant infections today in favor of a broader, more adaptive strategy applicable to a range of bacteria and fungi. This is not to say that this report avoids drawing upon and citing the CDC Urgent Threats and the World Health Organization Priority Pathogens lists (CDC, 2019; WHO, 2017)
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Chapter 7 looks at the national action plan and the U.S. government's response from 2015 to 2020, and the last chapter suggests a role for the United States in the global response to antimicrobial resistance.
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From page 27... ...
Washington, DC: Federal Task Force on Combating Antibiotic-Resistant Bacteria, White House.
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From page 28... ...
2014. National strategy for combating antibiotic resistant bacteria.
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