Antibiotic Resistance: Implications for Global Health and by Institute of Medicine, Board on Global Health, Forum on

By Institute of Medicine, Board on Global Health, Forum on Microbial Threats, Alison Mack, David A. Relman, Eileen R. Choffnes

Years of utilizing, misusing, and overusing antibiotics and different antimicrobial medications has ended in the emergence of multidrug-resistant 'superbugs.' The IOM's discussion board on Microbial Threats held a public workshop April 6-7 to debate the character and resources of drug-resistant pathogens, the consequences for international future health, and the innovations to minimize the present and destiny influence of those superbugs.

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Chambers described how Staphylococcus aureus, which has no natural resistance to most standard therapeutic agents, acquired methicillin resistance and eventually emerged first as MRSA in hospitals, and then as community-acquired MRSA (CA-MRSA) outside the healthcare environment (Chambers and DeLeo, 2009). Following some false starts in the form of MRSA clones that failed to expand, successful resistant strains carried a readily transferable resistance element. CA-MRSA strains contain a smaller version of this element that is even easier to mobilize and transfer into a variety of genetic backgrounds, Chambers observed.

2008). “We have resistance in clinical [and commensal] organisms . . resistance in animals . . resistance in the soil, resistance in the water,” Wright observed. ” This observation raises important questions as to how resistance genes move from the environment into the clinic, and whether barriers to horizontal gene transfer exist or could be created to slow the development of resistance to antimicrobial drugs. , 2010). Anthropogenic Influences on AMR Microbial evolution has occurred in two distinct phases, punctuated by the Industrial Revolution, Davies observed.

Genes that code for traits that reduce an organism’s sensitivity to antibiotics, such as efflux pumps, but are not specifically resistance genes. 10 Copyright © National Academy of Sciences. All rights reserved. Antibiotic Resistance: Implications for Global Health and Novel Intervention Strategies: Workshop Summary 16 Antibiotic Resistance • the “natural” environment, where microbes encounter low concentrations of antimicrobial compounds produced by other microbes, and resistance is low; • the “non-clinical” environment, where the presence of man-made antimicrobials raises selective pressure for AMR; and • the clinical environment, where the relative concentration of antimicrobials is highest and, consequently, so is AMR.

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