Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine (2022) / Chapter Skim
Currently Skimming:
Summary
Summary
Pages 1-16
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 1... ...
Efforts to mitigate the emergence and spread of resistant pathogens are complicated by the fact that antimicrobial resistance is 1 References are not included in the Summary. For the full list of the works cited view the body of the report.
|
From page 2... ...
NIAID staff, in collaboration with their counterparts at other government agencies implementing the national action plans, developed a charge for this committee. This charge includes questions on managing effective surveillance for infections related to antimicrobial resistance, measuring the health and economic consequences of antimicrobial resistance, interventions in animal health, and the incentives for developing new medical products to prevent and treat resistant infections.
|
From page 3... ...
Antibiotic Resistant Threats in the United States 2019, which drew on population surveillance and research from electronic medical records to estimate that every year 2.8 million resistant infections in the United States cause 35,900 deaths, with Clostridioides difficile infection killing another 12,800 people. The CDC report also attempted to put some economic parameters on the problem, estimating the direct costs of treating six, common, multidrug-resistant pathogens at $4.6 billion a year, with C
|
From page 4... ...
Without effective alternatives and enhanced infection control, removal of antimicrobials from animal agriculture could increase animal disease burden and mortality, leading to compromised animal welfare and productivity losses, with potential downstream effects on food security and livelihoods. Better estimates of the burden of antimicrobial resistance in humans and animals depend on better microbiological data and more clarity on the appropriate design of epidemiological research.
|
From page 5... ...
Some insight into the source of the resistance genes, resistant pathogens, or antimicrobial residues in the environment could come from analyzing the places contaminants enter water. Wastewater treatment plants are one such place, equipped to contain and remove water contaminants but not to eliminate resistance traits or drug residues.
|
From page 6... ...
Tailored antimicrobial stewardship programs may need to make use of telemedicine when infectious disease consultations are needed. Some modernization of record keeping may also be helpful in settings that do not routinely use electronic medical records, which could be used for preauthorization for restricted antimicrobials and to discourage treatment of asymptomatic infections.
|
From page 7... ...
There are logistical barriers to testing animals, especially large animals, and a testing expense that the animal owner usually pays out of pocket. A lack of susceptibility test breakpoints specific to the species tested is another barrier.
|
From page 8... ...
Recommendation 5-5: The National Institutes of Health and the Centers for Disease Control and Prevention should provide supplemental research funding to track antimicrobial use and antimicrobial resistance in immunization trials and large cohort studies to measure the indirect benefits vaccines provide and to provide evidence to enhance vaccine deployment as a tool to mitigate antimicrobial resistance. Better quality evidence, ideally from randomized, controlled trials could clarify the relationship between vaccine use, antimicrobial consumption, and the emergence of resistance and the multiple, often complex relationships among them.
|
From page 9... ...
The 2012 Generating Antibiotic Incentives Now (GAIN) Act, for example, provides additional years of market exclusivity to new drugs designated as "qualified infectious disease products" and revisions to the amount CMS will reimburse hospitals for new antimicrobials.
|
From page 10... ...
Most of the antimicrobials approved recently offer little to no added clinical value over existing treatments. Market entry rewards between $500 million and $2 billion are often suggested as an incentive to develop an innovative antimicrobial that, for logistical and public health reasons, will not likely sell well.
|
From page 11... ...
Every investment in keeping automated testing devices up to date is an investment in keeping clinical practice more responsive to antimicrobial resistance and protecting public health. Recommendation 6-2: To reduce regulatory hurdles in bringing automated susceptibility tests to market, the Food and Drug Administration should coordinate the review of new antimi crobials with the review of their automated susceptibility tests and work with the Clinical Laboratories Standards Institute to issue and update breakpoints for microbe–drug combinations.
|
From page 12... ...
Department of Agriculture, the Environmental Protection Agency, and the Department of Defense and interested academic, industry, and nonprofit organizations. The partnership would have working groups on diagnostics, alternatives to antibiotics, and preven tion, with a goal of supporting a diversified and balanced port folio of tools to reduce antimicrobial resistance using a One Health approach.
|
From page 13... ...
A reliance on process outcomes makes it easier to claim successes, but such process milestones will not necessarily translate into meaningful improvements in antimicrobial use or the spread of resistant pathogens. Both the 2015 national action plan and its more recent iteration for 2020 to 2025 have open-ended targets for which the responsible agency is not always clear.
|
From page 14... ...
reducing need for antimicrobials by broadening agencies' work on infection prevention and antimicrobial stewardship in humans and animals; and (3) ensuring sustained leadership and critical evaluation by creating a Global Coordinator for Anti microbial Resistance similar to the Global AIDS Coordinator.
|
From page 15... ...
A designated national leader modeled on the Global AIDS Coordinator would be crucial to managing this coordination and efficient response. By supporting a truly systemic, One Health response, the recommended program may be able to drive progress on a range of health indicators, including, but not limited to, the burden of resistant infections.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.