Antimicrobial Resistance: A Call to Action!

Clinical Infectious Diseases, Dec 2016

Lillian Brown, Charles Langelier, Michael J. A. Reid, Rachel L. Rutishauser, Luke Strnad

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Antimicrobial Resistance: A Call to Action!

CID 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 CORRESPONDENCE - 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) [1]. 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 [2]. 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 for action. 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 antimicrobial prescribing. 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 [3] 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the reasons for this drop are complex, in its open letter to the US House of fectious Diseases Society of America cited unpublished data showing that low salary is the reason most often cited by internal medicine residents for not applying to the ID field [4]. 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 [5]). The case of plasmid-mediated colistin resistance recently reported for the first time in the United States [6] 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 elicit change. 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 been disclosed. 1. Laxminarayan R , Sridhar D , Blaser M , Wang M , Woolhouse M. Achieving global targets for antimicrobial resistance . Science 2016 ; 353 : 874 - 5 . 2. O'Neil J. Tackling drug-resistant infections globally: final report and recommendations . In: Ro A, ed. Resistance. London, United Kingdom : 2016 ; 1, 84 . 3. National Resident Matching Program and Association of American Medical Colleges . Charting outcomes in the match : Specialty Matching Service, appointment year 2011 , 2013 . Available at: wp-content/uploads/2013/08/chartingoutcomessms 2011.pdf. Accessed 2 September 2016 . 4. Bakken J . Letter to Congress. Infect Dis Soc Am 2016 ; 1 , 4. IDSA/Policy_and_Advocacy/Current_Topics_and_ Issues/Antimicrobial_Resistance/10x20/Letters/ To_Congress/IDSA% 20Letter%20to%20House% 20EC%20Subcommittee%20on%20Oversight% 20and%20Investigations%20RE%20AR%20Hearing% 20061316(1) .pdf. Accessed 2 September 2016 . 5. Infectious Diseases Society of America. Urge the United Nations to combat antimicrobial resistance . 2016 . Available at: http://www.change. org/p/united-nationsurge-the-united-nations-to-combat-antimicrobialresistance . Accessed 2 September 2016 . 6. McGann P , Snesrud E , Maybank R , et al. Escherichia coli harboring mcr-1 and blaCTX-M on a novel IncF plasmid: first report of mcr-1 in the United States . Antimicrob Agents Chemother 2016 ; 60 : 4420 - 1 . 7. Van Boeckel TP , Gandra S , Ashok A , et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data . Lancet Infect Dis 2014 ; 14 : 742 - 50 . 8. Infectious Diseases Society of America, Spellberg B, Blaser M , Guidos RJ , et al. Combating antimicrobial resistance: policy recommendations to save lives . Clin Infect Dis 2011 ; 52 (suppl 5): S397 - 428 . 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. For permissions, e-mail journals . . DOI: 10.1093/cid/ciw678

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Lillian Brown, Charles Langelier, Michael J. A. Reid, Rachel L. Rutishauser, Luke Strnad. Antimicrobial Resistance: A Call to Action!, Clinical Infectious Diseases, 2017, 106-107, DOI: 10.1093/cid/ciw678