The Slow-Motion Catastrophe of Antimicrobial Resistance and Practical Interventions for All Prescribers

Abstract

All medical and surgical specialties depend on the pool of effective antibiotics that continues to evaporate because of the increasing prevalence of drug-resistant bacteria. Antimicrobial-resistant infections kill 700,000 patients every year. By 2050, they are projected to cause 10 million deaths per year at a cumulative global cost of $100 trillion. Professional societies and international health agencies, including the United Nations, have declared escalating antimicrobial resistance as one of the gravest and most urgent threats to global public health and issued calls for action. The propensity of bacteria to mobilize and share genetic resistance determinants across species and genera, record levels of conflict-driven human population displacement, and the dearth of new antibiotics and rapid diagnostic tests, along with climate change and the epidemic of opioid addiction, exacerbate the antimicrobial resistance crisis. The predominant cause of antibiotic resistance is exposure to antibiotics through appropriate and inappropriate use. Mindfulness, nudging by peers, and adjuncts and alternatives to antibiotics, such as phage therapies, microbiome-based therapies, and novel medical informatics applications, could help reduce antibiotic use. This article describes the antimicrobial resistance crisis and highlights points in the continuum of care in which clinicians can readily implement practical, no-cost changes to minimize antibiotic exposure.

Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections

“…Adult patients admitted from the community with a suspicion of meningitis and encephalitis are routinely placed on three to four antimicrobials, per national guidelines [11,12]. Diagnostic delays can subject patients to the unintentional harm of excessive antimicrobial exposure, such as antimicrobial resistance and CDI [4,5]. Antimicrobial exposure can also lead to adverse drug events such as acute kidney injury.…”

“…Indeed, most LPs performed for suspected CNS infections subsequently reveal no evidence of infection [3]. Thus, the vast majority of patients that undergo an LP for a suspected CNS infection are exposed to excess antimicrobials that can lead to unintended consequences such as antimicrobial drug resistance and Clostridioides difficile infection (CDI) [4,5]. Similarly, each additional day spent in a hospital increases the risk of developing a hospital-acquired infection and represents extra cost to the healthcare system [6].…”

Progress and Challenges in the Management of Nursing Home Infections

“…The world is facing a crisis of antibiotic resistance, with dire predictions that in the absence of major change by 2050, we will be facing a near pandemic of multidrug-resistant infections and deaths. 61 So important is the role of post-acute and long-term care that it may well be time to examine how more strict infection control practices can be promoted, while continuing to support person-centered management practices. 62 It is now timedand in fact, past timedto more fully change the culture of infection control in post-acute and long-term care.…”

Antimicrobial use in wean to market pigs in the United States assessed via voluntary sharing of proprietary data

“…The spectre of antimicrobial‐resistant infections has loomed over human and veterinary medicine since antimicrobials became widely available in the 1940s, and clinically problematic resistance has reached crisis status in human medicine over the last 20 years (Anderson et al., 2019; Aslam et al., 2018). This has rightly brought scrutiny of how antimicrobials are used across all prescribing professions, along with efforts to define ‘best practices’ for antimicrobial use and how these practices should be disseminated and implemented (Lesho & Laguio‐Vila, 2019; Lloyd & Page, 2018). It is both generally accepted, and perhaps self‐evident, that negative consequences of antimicrobial use in animals may relate to both animal health (reduced therapeutic efficacy due to resistance in animal pathogens) and human health due to transmission of resistant organisms from animals to people (Morley et al., 2005).…”