Review of Antimicrobial Resistance | Clinical Pharmacy and Pharmacology | JAMA | The JAMA Network

Review of Antimicrobial Resistance | Clinical Pharmacy and Pharmacology | JAMA | The JAMA Network

Antimicrobial Resistance
HD Marston et al, JAMA, September 20, 2016
(Time Posted: Sep-20-2016 7PM)

September 20, 2016

Antimicrobial Resistance

Hilary D. Marston, MD, MPH¹; Dennis M. Dixon, PhD²; Jane M. Knisely, PhD²; et alTara N. Palmore, MD³;Anthony S. Fauci, MD¹

Author Affiliations

JAMA. 2016;316(11):1193-1204. doi:10.1001/jama.2016.11764

 

FullText

Abstract

Importance  The development of antibiotics is considered among the most important advances of modern science. Antibiotics have saved millions of lives. However, antimicrobial resistance (AMR) threatens this progress and presents significant risks to human health.

Objective  To identify factors associated with AMR, the current epidemiology of important resistant organisms, and possible solutions to the AMR problem.

Data Sources, Study Selection, and Data Synthesis  PubMed (2000-2016), NIH REPORTER, and ClinicalTrials.gov databases were searched for articles and entries related to AMR, focusing on epidemiology, clinical effects of AMR, discovery of novel agents to treat AMR bacterial infections, and nonpharmacological strategies to eliminate or modify AMR bacteria. In addition to articles and entries found in these databases, selected health policy reports and public health guidance documents were reviewed. Of 217 articles, databases, and reports identified, 103 were selected for review.

Results  The increase in AMR has been driven by a diverse set of factors, including inappropriate antibiotic prescribing and sales, use of antibiotics outside of the health care sector, and genetic factors intrinsic to bacteria. The problem has been exacerbated by inadequate economic incentives for pharmaceutical development of new antimicrobial agents. A range of specific AMR concerns, including carbapenem- and colistin-resistant gram-negative organisms, pose a clinical challenge. Alternative approaches to address the AMR threat include new methods of antibacterial drug identification and strategies that neutralize virulence factors.

Conclusions and Relevance  Antimicrobial resistance poses significant challenges for current clinical care. Modified use of antimicrobial agents and public health interventions, coupled with novel antimicrobial strategies, may help mitigate the effect of multidrug-resistant organisms in the future.