Surveillance Systems to Confront Antibiotic Resistance
Surveillance Systems to Confront Antibiotic Resistance
Purpose of review It is widely accepted that infection control, advanced diagnostics, and novel therapeutics are crucial to mitigate the impact of antibiotic-resistant bacteria. The role of global, national, and regional surveillance systems as part of the response to the challenge posed by antibiotic resistance is not sufficiently highlighted. We provide an overview of contemporary surveillance programs, with emphasis on gram-negative bacteria.
Recent findings The WHO and public health agencies in Europe and the United States recently published comprehensive surveillance reports. These highlight the emergence and dissemination of carbapenem-resistant Enterobacteriaceae and other multidrug-resistant gram-negative bacteria. In Israel, public health action to control carbapenem-resistant Enterobacteriaceae, especially Klebsiella pneumoniae carbapenemase producing K. pneumoniae, has advanced together with a better understanding of its epidemiology. Surveillance models adapted to the requirements and capacities of each country are in development.
Summary Robust surveillance systems are essential to combat antibiotic resistance, and need to emphasize a 'one health' approach. Refinements in surveillance will come from advances in bioinformatics and genomics that permit the integration of global and local information about antibiotic consumption in humans and animals, molecular mechanisms of resistance, and bacterial genotyping.
The introduction of penicillin and sulfonamides into clinical practice in the middle of the twentieth century revolutionized the treatment of bacterial infections, offering remedy for diseases that were previously lethal. This power did not rest in the hands of a few skilled practitioners in wealthy societies, but became widely available. It is not an exaggeration to assert that antimicrobial chemotherapy, as well as improved sanitary conditions and vaccination, largely explains trends toward longer life expectancy around the world. Antibiotic treatment and prophylaxis of bacterial infections remain essential to sustain advances in neonatal care, surgery, organ transplantation, and cancer chemotherapy. The emergence of bacteria resistant to all or most existent antibiotics, especially in the realm of gram-negative bacteria, constitutes a crisis: a return to the preantimicrobial era is a real possibility in the twenty-first century.
In order to stem this crisis, a worldwide response is urgent to develop new agents that fill unmet therapeutic needs, to improve the use of currently available antibiotics, and to prevent and control the transmission of bacteria resistant to antibiotics. Such actions can only be guided by reliable epidemiological information about the prevalence and impact of resistant bacteria in different settings. Although antibiotic resistance is a universal public health concern, great gaps remain in our current understanding of the magnitude of the problem. Improved surveillance of antibiotic resistance in bacteria is necessary to fill those gaps. The ultimate goal of strengthening surveillance is to formulate strategies and interventions to address the challenge of antibiotic resistance and improve the outcome of individual patients.
Abstract and Introduction
Abstract
Purpose of review It is widely accepted that infection control, advanced diagnostics, and novel therapeutics are crucial to mitigate the impact of antibiotic-resistant bacteria. The role of global, national, and regional surveillance systems as part of the response to the challenge posed by antibiotic resistance is not sufficiently highlighted. We provide an overview of contemporary surveillance programs, with emphasis on gram-negative bacteria.
Recent findings The WHO and public health agencies in Europe and the United States recently published comprehensive surveillance reports. These highlight the emergence and dissemination of carbapenem-resistant Enterobacteriaceae and other multidrug-resistant gram-negative bacteria. In Israel, public health action to control carbapenem-resistant Enterobacteriaceae, especially Klebsiella pneumoniae carbapenemase producing K. pneumoniae, has advanced together with a better understanding of its epidemiology. Surveillance models adapted to the requirements and capacities of each country are in development.
Summary Robust surveillance systems are essential to combat antibiotic resistance, and need to emphasize a 'one health' approach. Refinements in surveillance will come from advances in bioinformatics and genomics that permit the integration of global and local information about antibiotic consumption in humans and animals, molecular mechanisms of resistance, and bacterial genotyping.
Introduction
The introduction of penicillin and sulfonamides into clinical practice in the middle of the twentieth century revolutionized the treatment of bacterial infections, offering remedy for diseases that were previously lethal. This power did not rest in the hands of a few skilled practitioners in wealthy societies, but became widely available. It is not an exaggeration to assert that antimicrobial chemotherapy, as well as improved sanitary conditions and vaccination, largely explains trends toward longer life expectancy around the world. Antibiotic treatment and prophylaxis of bacterial infections remain essential to sustain advances in neonatal care, surgery, organ transplantation, and cancer chemotherapy. The emergence of bacteria resistant to all or most existent antibiotics, especially in the realm of gram-negative bacteria, constitutes a crisis: a return to the preantimicrobial era is a real possibility in the twenty-first century.
In order to stem this crisis, a worldwide response is urgent to develop new agents that fill unmet therapeutic needs, to improve the use of currently available antibiotics, and to prevent and control the transmission of bacteria resistant to antibiotics. Such actions can only be guided by reliable epidemiological information about the prevalence and impact of resistant bacteria in different settings. Although antibiotic resistance is a universal public health concern, great gaps remain in our current understanding of the magnitude of the problem. Improved surveillance of antibiotic resistance in bacteria is necessary to fill those gaps. The ultimate goal of strengthening surveillance is to formulate strategies and interventions to address the challenge of antibiotic resistance and improve the outcome of individual patients.
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