The New Precision Stewards?

Abstract

The precision health era is likely to reduce and respond to antimicrobial resistance (AMR). Our stewardship and precision efforts share terminology, seeking to deliver the “right drug, at the right dose, at the right time.” Already, rapid diagnostic testing, phylogenetic surveillance, and real-time outbreak response provide just a few examples of molecular advances we dub “precision stewardship.” However, the AMR causal factors range from the molecular to that of global health policy. Mirroring the cross-sectoral nature of AMR science, the research addressing the ethical, legal and social implications (ELSI) of AMR ranges across academic scholarship. As the rise of AMR is accompanied by an escalating sense of its moral and social significance, what is needed is a parallel field of study. In this paper, we offer a gap analysis of this terrain, or an agenda for “the ELSI of precision stewardship.” In the first section, we discuss the accomplishments of a multi-decade U.S. national investment in ELSI research attending to the advances in human genetics. In the next section, we provide an overview of distinct ELSI topics pertinent to AMR. The distinctiveness of an ELSI agenda for precision stewardship suggests new opportunities for collaboration to build the stewardship teams of the future.

Can One Health Policy Help Us Expand an Ethics of Interconnection and Interdependence?

“…The complexity of antimicrobial resistance lends itself to multiple framings. 33,34 Rather than viewing frames as competing approaches, multidisciplinary teams might employ different frames to focus on an element of antimicrobial resistance. A One Health backdrop serves as a reminder to avoid oversimplification by keeping interconnection and interdependence front and center as new solutions are envisioned, designed, and implemented.…”

What Is Antimicrobial Stewardship?

“…In its simplest form, antimicrobial stewardship promotes the correct-that is, the empirically correct-use of antimicrobials via clinicians choosing an antimicrobial that is effective against the target microorganism and able to penetrate the affected body tissue; administering that drug at a dose appropriate to the patient's condition, size, and metabolism; and continuing the treatment for the duration needed to achieve the therapeutic goal. 4 Certainly, there are empirically wrong choices for a given therapeutic goal, and stewardship seeks to avoid them. But the sheer complexity of patient, disease, and drug characteristics may make it hard to identify a single "right" or "best" choice based only on empirical data.…”