Title : Global clinical impact of the burden of antibiotic resistance
Abstract:
Antibiotics are the foundation of modern medicine. Antibiotic resistance (ABR) leads to unintended consequences including suboptimal therapeutic outcomes, increased morbidity and mortality, longer hospital stays, and higher healthcare costs. ABR is a global public health challenge that can also make treatment of infections more challenging, or in some cases, impossible to treat. ABR is a major issue that can potentially compromise the success of medical procedures such as chemotherapy, organ transplants, and surgeries. Although ABR affects countries across all income levels, its impact is disproportionality severe in low- and middle-income countries where public health infrastructure are weaker. In the US, nearly 3 million antimicrobial-resistant infections occur each year, resulting in more than 35,000 mortalities. Physicians have very few other options available to treat MDR and XDR infections. The World Health Organization (WHO) acknowledges ABR is one of the top global public health and development threats. Numerous bacterial pathogens and 18 antibiotic regimens (targeted and empirical) currently contribute to the global ABR. There are countries that face nosocomial MDR K. pneumoniae isolates. ESBL-producing K. pneumoniae is a threat to S.E. Asia and certain regions of Africa and the Middle east. A. baumannii has a higher carbapenem resistance rate than P. aeruginosa and Enterobacter spp. with a proportion of more than 50% among Chinese isolates. Although an uptick of new broad-spectrum antibiotics approved by the FDA within the last ten years geared toward MDR pathogens such as Ceftolozane/Tazobactam, Ceftazidime/Avibactam, Meropenem/Vaborbactam, Delafloxacin, Omadacycline, Eravacycline, Imipenem/Relebactam and Cefiderocol, these new agents, too, may acquire resistance if the principle of antibiotic stewardship is not rationally practiced. Given the rapid worldwide dissemination of resistant bacteria, a global perspective is essential in addressing this issue. Addressing this urgency will require innovative models for antibiotic research and development, improved global coordination and collaboration (One Health), and equitable access to new treatments across all regions. Additionally, efforts must be focused on educating healthcare professionals for making appropriate therapeutic decisions, improving surveillance, leadership, action plan, tracking and reporting. Particularly, laboratory infrastructure including molecular epidemiological methods and genetic analysis of resistant pathogens take urgent priority to contain the escalation of AR.
