Antimicrobial resistance is a public health crisis that is global in nature. In the United States, antimicrobial-resistant bacteria cause more than 2 million infections and are responsible for 23,000 deaths each year, resulting in approximately $20 billion in excess medical spending and $35 billion in lost productivity. The problem, however, is not limited to bacteria.

Antimicrobial resistance also threatens our ability to prevent and treat infections caused by viruses, fungi and parasites.

What’s proper stewardship?

Although microbes, particularly bacteria, even under the circumstances of correct antibiotic usage, may adapt over time to become resistant to these medications, certain practices — such as inappropriate prescribing of antibiotics and agricultural use of antibiotics to stimulate animal growth — can accelerate the problem.

Antibiotic stewardship, precautions against spread of bacteria particularly in the hospital setting, and public education can help limit the occurrence and spread of antibiotic resistance. In addition, scientifically proven public health initiatives, such as vaccination against certain bacterial infections and improved hygienic practices, are essential.

“Hospitalizations and cancer chemotherapy will become unsuitably high-risk endeavors for affected patients.”

The key research

In 2013, an ambitious, new clinical program was begun focusing on antimicrobial resistance. Since that time, over 25 studies been run to evaluate new diagnostics, treatments and approaches to thwart antimicrobial resistance. Research efforts are addressing three of the most urgent antimicrobial resistance threats: Neisseria gonorrhoeae, which causes the sexually transmitted disease gonorrhea; Clostridium difficile, which can cause life-threatening diarrhea and occurs most commonly in people who have been hospitalized and treated with antibiotics; and carbapenem-resistant Enterobacteriaceae, which is resistant to nearly all antibiotics available today, and a growing threat among hospitalized patients.

This effort is supporting pre-clinical studies in the test tube and in animals to develop novel antibiotics and create interventions that harness the body’s naturally occurring microorganisms, called the microbiome, to fight off invaders. In addition, this push has led to testing on multiple fronts: testing of multiple antibiotic drug candidates in human clinical trials; funding the development of highly sensitive, rapid diagnostics — including those that can distinguish between bacterial and viral infections; testing of approved antibiotic drugs for optimal use in order to limit or slow the emergence of resistance; and developing vaccines to prevent infections, so treatments are not necessary.

Researchers are concurrently endeavoring to develop a national database that will track genomic and clinical data for specific pathogens. In this particular effort, teamwork is crucial. Our organization is collaborating with the Biomedical Advanced Research and Development Authority in the Department of Health and Human Services to award up to $20 million for the development of rapid, point-of-care diagnostics.

In the looming presence of antibiotic resistance, surgeries, organ transplantation, hospitalizations and cancer chemotherapy will become unsuitably high-risk endeavors for affected patients. The scientific, medical and public health communities must act urgently to address this current and growing threat.