COMMENTARY

Antimicrobial Resistance Hits Global Stage at UN Summit

Paul G. Auwaerter, MD

Disclosures

November 02, 2016

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Hello. This is Paul Auwaerter, speaking for Medscape Infectious Diseases and from the Johns Hopkins University School of Medicine, Division of Infectious Diseases.

Helen Boucher and I had the honor of representing the Infectious Diseases Society of America at the recent opening week of the United Nations General Assembly for an unprecedented universal affirmation of a resolution highlighting the importance of antimicrobial resistance. [See High-Level Meeting on Antimicrobial Resistance].

For any of us laboring in infectious diseases, this has been a slow-moving and persistent problem, ranging from [inpatient management of] resistant organisms to helping outpatients with resistant urinary tract infections. On many fronts, [such as] tuberculosis, malaria, or illnesses affecting animal populations, antimicrobial resistance has taken on great importance in the United States. The Joint Commission has recognized the need for antimicrobial stewardship, as have the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention. They hope to get antimicrobial surveillance, resistance, and stewardship programs in place at most hospitals by the year 2020.

Visiting the United Nations is an interesting experience, where delegates represent views of their state governments. I had the feeling that many were just learning about antimicrobial resistance. I think the [draft] resolution, represented one of the first times where some countries formally acknowledged that this might indeed be a problem.

It is only the fourth time the United Nations has sponsored such a health-related resolution—the others being HIV, Ebola, and noncommunicable infectious diseases. The goals were to try to follow a global action plan that has been articulated by the World Health Organization (WHO), which includes, foremost[1]:

  • Awareness and education, with the building of robust reporting structures for antibiotic resistance (the United States is behind Europe, for example);

  • Infection-controlled prevention practices (which, of course, fall to stewardship in other arenas);

  • Optimal use of antibiotics in people and also in animal populations—while many antibiotics are used in the treatment of animals, [the hope is] to completely avoid use of antibiotics for animal growth; and

  • Innovation, research, and development support for new antimicrobial products.

None of these are radically new ideas to infectious disease practitioners, but what I heard from government delegates is really acknowledgement and awareness, which I viewed as very helpful. [There was discussion about] increasing rates of resistance with the sexually transmitted disease gonorrhea; tuberculosis; and somewhat more obscure topics, such as NDM-1 [New Delhi metallo-beta-lactamase-1] and MCR-1, which are believed to be resistance elements coming out of such countries as China and India and are quickly spreading around the globe.

These are global issues, much like climate change, where many countries need to band together to really move the needle toward limiting the emergence of resistance, preserving our antibiotics, and making new antibiotics.

Some people were certainly a bit disappointed. A number of state and civil societies and organizations tried to get this resolution [approved] last year. Although no clear targets were set, which some had opined for, seeing actually how many countries try to follow the WHO global action plan[1] in the short term—perhaps in 2 years—will be important. Perhaps the next stage will be [setting] formal targets.

Lastly, the second annual World Antibiotic Awareness Week, in part sponsored by the WHO, will be held November 14-20, 2016. There is increasing acknowledgement that all countries, industrialized and lower-resourced, need to work together to try to combat what the United Nations views as a public health emergency—similar to prior acknowledgements of HIV and Ebola.

Thanks for listening.

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