Sunday, September 21, 2014

Movement on antibiotic resistance

http://upload.wikimedia.org/wikipedia/commons/0/01/1860s_White_House.jpgIn a flurry of activity last week, the Obama administration announced a new national strategy on combating antibiotic resistant bacteria, published a report on combating antibiotic resistance, and issued an Executive Order (EO) committing the federal government to
work domestically and internationally to detect, prevent, and control illness and death related to antibiotic-resistant infections by implementing measures that reduce the emergence and spread of antibiotic-resistant bacteria and help ensure the continued availability of effective therapeutics for the treatment of bacterial infections.
These moves are important because they place an immensely important public health problem into the national political discourse, take concrete steps toward better understanding the problem, and attempt to identify and implement solutions to parts of the problem. All are positive and to be applauded.

It would have been nice to have seen two additional topics included. For one, the policies focus exclusively on resistance in bacteria, although antimicrobial resistance is an important issue for a variety of medically important pathogens beyond bacteria, both globally and domestically. It's unclear how the national strategy will support advances in the larger problem.

For another, the reports and policies are silent on the practice of hospital infection prevention and control. Why is this important? The addition of new antibiotics to our arsenal makes it virtually inevitable that resistance to those drugs will emerge. The development of better tests and surveillance called for in the national strategy should alert us when this occurs, making it less likely that new resistance will spread within hospitals and the community, but no test or surveillance system is perfect. While new effective drugs are badly needed, better insights into how to prevent the contagion of newly resistant bacteria are also important.

I hope that federal initiatives surrounding the EO will spur new research to devise evidence- based, scientifically grounded, and validated approaches to prevent the spread of hospital acquired infections. The need for such research has been noted before and will benefit patients by preventing infection with both antibiotic susceptible and resistant organisms.

(image source: Wikipedia)

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