Beyond Antimicrobial Use: A Framework for Prioritizing Antimicrobial Resistance Interventions

Abstract

Antimicrobial resistance (AMR) is a threat to animal and human health. Antimicrobial use has been identified as a major driver of AMR, and reductions in use are a focal point of interventions to reduce resistance. Accordingly, stakeholders in human health and livestock production have implemented antimicrobial stewardship programs aimed at reducing use. Thus far, these efforts have yielded variable impacts on AMR. Furthermore, scientific advances are prompting an expansion and more nuanced appreciation of the many nonantibiotic factors that drive AMR, as well as how these factors vary across systems, geographies, and contexts. Given these trends, we propose a framework to prioritize AMR interventions. We use this framework to evaluate the impact of interventions that focus on antimicrobial use. We conclude by suggesting that priorities be expanded to include greater consideration of host–microbial interactions that dictate AMR, as well as anthropogenic and environmental systems that promote dissemination of AMR.

Evaluation of the Impact of Antimicrobial Use Protocols in Porcine Reproductive and Respiratory Syndrome Virus-Infected Swine on Phenotypic Antimicrobial Resistance Patterns

“…It is increasingly recognized that multiple factors other than AMU can have dramatic effects on AMR in populations ( 40 ). In food animal production, one potential factor that could influence AMR outcomes is timing of antimicrobial exposure in relation to harvest.…”

A multivariable analysis of the contribution of socioeconomic and environmental factors to blood culture Escherichia coli resistant to fluoroquinolones in high- and middle-income countries

“…These studies highlight the importance of considering systems level factors in combination with data on antibiotic use, sanitation, water treatment, and other environmental factors, in investigating determinants of AMR. Indeed, Noyes et.al., published a paper that emphasised the need to move away from solely focusing on antibiotic use and AMR, and to consider anthropogenic and environmental drivers of AMR [ 11 ].…”

The Pandemic beyond the Pandemic: A Scoping Review on the Social Relationships between COVID-19 and Antimicrobial Resistance

“…We searched for more recent studies regarding AMR and social sciences to adapt the framework to recent developments within the field. Two recent frameworks were found which address the social dimensions of AMR [5,6]; they, however, did not identify any additional social dimensions or elements that could be added to our current framework.…”