Antibiotic Resistance: Global Trends, Policies, and Novel Solutions

Antibacterial agents such as sulfonamides, penicillin, and streptomycin became available in the 1930s and 1940s and were quickly adopted into clinical practice. It was noted early on that bacteria, when exposed to antimicrobial agents, rapidly developed strategies to resist them. Penicillin resistance in Staphylococcus aureus was detected as early as in 1945. From the 1950s onwards, a large number of antimicrobial drugs became clinically available and had a major impact on the treatment of infections. Most recently, bacterial antibiotic resistance has grown exponentially along with the increasing use of antimicrobial agents, while at the same time the development of new antimicrobial agents has decreased dramatically. This has led to major global crises of infections with drug-resistant microbes, increased morbidity, and mortality, and increased health care costs.

Antibiotic resistance results from mutations or acquisition of new genes in bacteria that reduce or eliminate the effectiveness of antibiotics. According to the CDC, every year more than 2 million people in the US develop an illness due to antibiotic resistant bacteria and 23,000 of them die. There are multiple reasons for the development and spread of antibiotic-resistant bacteria. Overuse and inappropriate use of antibiotics are prevalent in clinical practice. The spread of resistant bacteria in hospitalized patients raises grave concerns for increased local antibiotic resistance. Non-human use of antibiotics for animal growth promotion is a major cause of development of global antibiotic resistance.

A multifaceted approach is needed to detect, prevent, and control antibiotic resistance at local, national, and global levels. The National Action Plan for Combating Antibioticresistant Bacteria was developed by the CDC, and it provides a roadmap to guide the US in rising to this challenge. Implementation of antimicrobial stewardship programs, diligent surveillance for resistant bacteria, rigorous implementation of infection control practices, restriction of antibiotics for non-human and non-infectious purposes are needed to combat the growing threat of antibiotic resistance. Another important strategy to counter the menace of antimicrobial resistance is to develop new antibiotics with novel mechanisms of action.

This chapter describes the global threat of antibiotic resistance, the mechanisms of development of antimicrobial resistance, the major causes of increased incidence of this problem, and the possible local, national, and global solutions to fight the scourge of antibiotic resistance.

Keywords: Antibiotics, antimicrobials, antibiotic resistance, infections, healthcare associated infection.