Antimicrobial Resistance: The Big Picture

Global Problem, Global Solutions

Medscape: In the report, you emphasize how quickly these infections travel around the globe, and you emphasize that an international approach is necessary. How much cooperation is there among different countries to solve the problem of antimicrobial resistance?

Dr. Solomon: Antimicrobial resistance is a problem not just on a local level but regionally, nationally, and internationally. This is a world-wide problem. New forms of antibiotic resistance can cross international borders and spread between continents quickly and easily.

Right now, there is a great deal of international activity and international cooperation. CDC is working with many different countries, and we have relationships with both individual countries and international organizations. We work very closely with the World Health Organization (WHO) and the European Centre for Disease Prevention and Control. We have spoken with governments of Canada and Mexico about issues affecting North America. We work with individual countries to learn about problems in their populations that could conceivably become threats to the United States, as well as providing technical assistance to them in providing help to deal with problems in their own countries. Antibiotic stewardship is a high priority for WHO and many European countries. Throughout the world, people are gaining awareness about using antibiotics appropriately.

Medscape: What are you hoping to achieve with the report on antimicrobial resistance?

Dr. Solomon: We have high expectations for his report. People around the world -- health leaders and consumers -- are very concerned. We have recently heard health leaders talking about what a nightmare antimicrobial resistance is and that we are facing a potential health catastrophe. We want to get everyone in our society engaged in understanding the big picture of antimicrobial resistance, and that this is a very complex, holistic problem that we all need to be working together to solve. We are very worried about CRE, gonorrhea, MRSA, and all other bacteria on the list. But let's not approach them one at a time. Let's turn our attention to the big picture and begin to solve that in a societal way. We are hoping that this report is the first step in that direction.

Public Information from the CDC and Medscape

Cite this: Antimicrobial Resistance: The Big Picture - Medscape - Sep 16, 2013.

Table. Level of Concern Prioritization of Resistant Bacteria.
Urgent Threats	Serious Threats	Concerning Threats
Clostridium difficile^a Carbapenem-resistant Enterobacteriaceae (CRE) Drug-resistant Neisseria gonorrhoeae	Drug-resistant Acinetobacter Drug-resistant Campylobacter Fluconazole-resistant Candida Extended-spectrum, cephalosporin-resistant Enterobacteriaceae Vancomycin-resistant Enterococcus (VRE) Drug-resistant Pseudomonas aeruginosa Drug-resistant nontyphoidal Salmonella Drug-resistant Salmonella Typhi Drug-resistant Shigella Methicillin-resistant Staphylococcus aureus (MRSA) Drug-resistant Streptococcus pneumoniae Drug-resistanttuberculosis (MDR^b and XDR^c)	Vancomycin-resistant Staphylococcus aureus (VRSA) Erythromycin-resistant Streptococcus Group A Clindamycin-resistant Streptococcus Group B

^a Although C difficile is not significantly resistant to the drugs used to treat it, it is directly related to antibiotic use and resistance.
^b Multiple drug resistant
^c Extensively drug resistant

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