Blog | Wednesday, December 4, 2013

Antibiotic resistance is a global problem

The Lancet Infectious Diseases Commission on Antibiotic Resistance led by Otto Cars from the Swedish Institute for Communicable Disease Control has published “Antibiotic resistance—the need for global solutions.” The stated goal of this 42-page tour-de-force is to “explore why antibiotic resistance has become such a problem worldwide, and, most importantly, propose solutions to avert the impending crisis.”

The Commission is broken down into nine parts, with each group of authors responsible for their individual sections. The document discusses antimicrobial use in humans and animals including stewardship, improved diagnostics, novel therapeutics and antibacterial drug discovery.

The Commission is accompanied by 7 commentaries from the global community, which are each worth a read. All articles are free to access once you set up a username and password.

These documents are largely focused on antibacterial use and development, which are incredibly important global problems that will require collaborative responses at the local, national and international level.

But much like the recent Frontline documentary that, as blogger Dan Diekema, MD, FACP, mentioned, did not have “enough discussion of the hard work of basic infection prevention,” infection control is only briefly mentioned in the main document. (Section 2, page 7) You can get the sense of the Commission’s approach with this quote: “From a resistance perspective, prevention reduces antibiotic use and the spread of resistant bacteria; however, prevention is not the main strategy to control resistance because antibiotic use also needs to be controlled.”

Of course, “benchmarking (open comparison of health-care facilities) of frequencies of health-care-associated infections is useful.” Yet public reporting is only useful as far as we have effective methods to prevent the reported infections.

Despite these minor quibbles, this is an incredibly timely and tremendously useful report. The authors and the journal should be congratulated. Let’s hope it moves the needle towards more recognition and funding for antimicrobial discovery, antibiotic stewardship, and perhaps, infection prevention?

Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands). This post originally appeared at the blog Controversies in Hospital Infection Prevention.