Researchers must address the growing problem of antimicrobial resistance and stay ahead of the inevitable future emergencies of resistant bacteria, according to physicians and scientists at the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health. Writing in JAMA, the authors stress the urgent need for new strategies to identify and develop new antibiotic drug candidates and vaccines and other interventions to prevent bacterial infections.
In the United States, antimicrobial-resistant bacteria cause more than 2 million infections and 23,000 deaths each year, resulting in an estimated $20 billion in excess medical spending. Inappropriate antibiotic prescribing practices in human medicine, agricultural use of antibiotics to promote animal growth, and challenging bacterial genetic characteristics have contributed to the antimicrobial resistance problem, the authors write.
The authors emphasize that certain of these issues are already being addressed through public education campaigns. However, they should be augmented by proven public health initiatives, such as vaccination against bacterial infections and expanded access to clean water and sanitation. Additionally, policy and incentive efforts are helping to spur the development of new antibiotics, which has slowed in recent years.
Even with strategies for curbing antibiotic demand, an expanding array of drug-resistant microbes and mechanisms of resistance pose immediate concerns for human health, including organisms resistant to carbapenems and colistin, Clostridium difficile, Neisseria gonorrhoeae, and Staphylococcus aureus. To meet these challenges, researchers must develop new tools for facilitating drug discovery and development, say the authors who highlight as an example the novel iChip platform, which helps to screen naturally occurring antibiotics from soil organisms that previously could not be cultured. Further, scientists must harness the immune system to prevent and treat antibacterial infections through the use of vaccines or monoclonal antibodies.
Additionally, researchers should pursue research aimed at combating infections by manipulating the microbes that naturally inhabit the human body. The authors note that the gut microbiome is the furthest along as a target for prevention and treatment; however, the microbiota of the skin and respiratory tract could also be explored. Finally, according to the authors, targeted, novel therapeutics that limit the virulence of specific bacteria and highly sensitive, rapid diagnostics should also be pursued.
H.D. Marston et al. Antimicrobial Resistance. Journal of the American Medical Association DOI: 10.1001/jama.2016.11764.
NIAID Director Anthony S. Fauci, M.D. is available for interviews.