Antimicrobial Resistance: A Call to Action!
0 Antimicrobial Resistance: A Call to Action!
1 Division of HIV, ID and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center , California
2 Division of Infectious Diseases, Department of Medicine, University of California , San Francisco
TO THE EDITOR—On 21 September,
the United Nations (UN) General
Assembly brought together world leaders
to convene a high-level meeting focused
on the public health crisis of
antimicrobial resistance (AMR) . The meeting
outlined a plan to mitigate the more
than 200 000 deaths and $20 billion in
excess healthcare spending attributable
to drug-resistant pathogens each year
. As a cohort of recently graduated
infectious diseases (ID) fellows, we believe
that this meeting heralds a unique
moment in history for the ID community
to shape political discourse. We envision
2 distinct, but equally important, venues
First, we can leverage the momentum of
a renewed global spotlight on AMR to
make an impact at a local level. We can
build on the enthusiasm of the UN meeting
to bolster programs at our own institutions
that support the judicious use of
antimicrobials. We can take this opportunity to
educate our colleagues in other specialties not
only about antibiotic algorithms but also
about the global importance of wise local
A comprehensive approach to
reducing AMR cannot take place without a
full workforce of ID-trained physicians,
midlevel providers, nurses, and
pharmacists. However, it is widely known that
there has been a steep drop in applicants
to ID fellowships over recent years 
Although the reasons for this drop are
complex, in its open letter to the US House of
fectious Diseases Society of America cited
unpublished data showing that low salary
is the reason most often cited by internal
medicine residents for not applying to the
ID field . In this setting, we can
encourage our own institutions to increase
remuneration to ID providers and
leverage this important moment to inspire
the next generation of providers to join
us in making a difference.
The UN General Assembly meeting
highlights a second way in which we in
the ID community can take action on
this important issue beyond our local
practice settings. As experts in AMR,
our opinions are valued, and our voices
carry substantial weight in venues such
as newspaper editorials, community
town halls, government testimony, and
legislative petitions (eg, the Infectious
Diseases Society of America’s petition
to the UN ). The case of
plasmid-mediated colistin resistance recently
reported for the first time in the United States
 has made us keenly and humbly
aware of global interconnectedness and
the direct connection between
environmental antimicrobial use and the
development of AMR. To have a meaningful
advocate for policies that reduce the
indiscriminant and widespread use of
antibiotics in agriculture and livestock
[2, 7, 8].
ID clinicians are uniquely qualified to
leverage this moment of national and
international political interest and shape
the future in meaningful ways. We have
the power to change the tide and paradigm
of policies that are compromising the last
antimicrobials we have available, but
accomplishing this will require us to
step out of our typical roles and speak
together on this critical global issue to
Financial support. This work was supported
by the National Institutes of Health (T32 training
grant 5T32AI007641-12 to L. S.,
5T32MH19105-2 to L. B. and M. J. A. R., 5T32AI060530
to R. L. R., and T32AI007641-14 to C. L.).
Potential conflicts of interest. All authors:
No reported conflicts. All authors have submitted
the ICMJE Form for Disclosure of Potential
Conflicts of Interest. Conflicts that the editors
consider relevant to the content of the manuscript have
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Correspondence : M. J. A. Reid , University of California, San Francisco, 513 Parnassus Ave, Room S380 , San Francisco, CA 94110 ().
Clinical Infectious Diseases ® 2017 ; 64 ( 1 ): 106 - 7 © The Author 2016 . Published by Oxford University Press for the Infectious Diseases Society of America . All rights reserved.
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