Antimicrobial resistance (AMR) is a chilling reality that my patients and I face every day. As an infectious diseases physician, I see increasing numbers of patients with serious or life-threatening infections, and I am running out of antibiotics to treat them. The emergence of MCR-1 and MCR-2—newly discovered genes that convey resistance to Colistin (an antibiotic of last resort) suggest that the post-antibiotic era may already be upon us.
This week offers some hope. The United Nations (UN) will hold a high level meeting on antimicrobial resistance—focusing an unprecedented level of international attention on this public health crisis and setting a foundation for coordinated global action. The Infectious Diseases Society of America (IDSA) stands ready to partner with governments, public health agencies, industry, and other stakeholders to carry forward the commitments made this week.
IDSA has been leading the charge against antimicrobial resistance for over a decade, with our 2004 Bad Bugs, No Drugs report, our 2011 Combating Antimicrobial Resistance: Policy Recommendations to Save Lives report, and our ongoing federal advocacy. Many of IDSA’s recommendations were adopted in the US National Action Plan for Combating Antibiotic Resistant Bacteria. IDSA’s advocacy secured significant new federal funding in 2016 to support AMR activities. IDSA is also advancing legislation to incentivize antibiotic R&D, such the Promise for Antibiotics and Therapeutics for Health (PATH) Act. Earlier this year, IDSA was honored to present to the UN to help shape its consideration of AMR.
IDSA recommended that UN action on AMR focus on the following areas: surveillance and data collection; stewardship and prevention; antibiotic and diagnostics R&D; and investment in the infectious diseases (ID) physician workforce. Further, IDSA recommended that the UN provide mechanisms for global coordination, reporting, and accountability.
Global data from both humans and animals on antimicrobial use and resistance patterns is critical to help us understand the problem and evaluate interventions. Resources will be needed to establish the infrastructure and mechanisms for collecting and reporting these data. Ideally, surveillance should include standardized monitoring of antibiotic use at institutional, regional, and country levels to allow comparative benchmarking. Such data should be updated preferably in real-time and at least every 12 months.
We already know that in healthcare facilities across the world, antibiotics are often administered inappropriately, driving the development of AMR. Antibiotic stewardship programs (ASP) have been shown to reduce inappropriate antibiotic use while improving patient outcomes. Following IDSA’s recommendation, the U.S. government has proposed a requirement for all hospitals and long term care facilities to establish ASPs.
Global efforts to promote appropriate antimicrobial drug use must recognize that antimicrobial drugs remain available over the counter in many parts of the world—a practice that is associated with misuse. In low income countries with few physicians, over the counter access may be the only current access to antimicrobial drugs for many individuals. The UN should work toward the goal of prescriber oversight for all antimicrobial drug use, recognizing that an investment in the health care workforce will be needed to ensure appropriate access to antimicrobial drugs. Preventing infections, including through vaccination, is also an important strategy to prevent antibiotic use.
Rapid diagnostic tests are crucial for antibiotic stewardship. Incentives are needed to stimulate the development of needed diagnostics. Additional policies (including physician education, appropriate reimbursement and access strategies) are also needed to ensure that diagnostics are optimally utilized.
It is also important to promote antimicrobial stewardship in animals. IDSA hopes the UN can lead global efforts to end the use of antibiotics for growth promotion and routine disease prevention in food animals, and implement veterinary oversight of all antibiotic use in animals.
Even with ideal measures to control AMR, bacteria will continue evolving. We need a robust pipeline of new antimicrobial drugs to treat patients today and to meet the emerging threats of tomorrow. Unfortunately, the market has failed to sufficiently stimulate antibiotic R&D for several reasons. Antibiotics are difficult and costly to develop. Antibiotics are typically priced low compared to other new drugs, used for a short duration, and held in reserve to protect their utility, making them far less economically viable investments for companies than other types of drugs. IDSA urges the UN to help pool global resources to provide incentives for antibiotic R&D.
Finally, ID physicians play a central role, caring for patients with serious infections, leading stewardship programs, conducting antibiotic and diagnostics R&D, and leading public health activities. The UK Review on Antimicrobial Resistance explicitly recommended an investment in the ID workforce, including appropriate payment for ID physicians, to help ensure the existence of a workforce that will be necessary to implement all facets of a plan to tackle antimicrobial resistance.
Antimicrobial resistance threatens to undo many of the medical advancements of the past century—from complex surgeries to chemotherapy and other interventions that rely upon antibiotics. One UN meeting cannot solve this problem, but it can catalyze the necessary global action to combat AMR. IDSA is proud to partner in this life-saving work.