Antimicrobial Resistance Is a Global Health Emergency

Leading experts have declared that the end of the age of antibiotics is imminent and that this development could undermine the foundation of much of modern medicine and public health.1,2 Since antibiotics were first introduced into clinical practice some 80 years ago, microbes have been evolving ways to resist these drugs, but in recent years this problem of antimicrobial resistance (AMR) has been rapidly getting worse.1 It is estimated that there are at least 2 million cases per year of AMR infection in the United States directly resulting in at least 23,000 deaths.2 In many nations around the world, the problem of AMR is worse than in the US. For example, rates of gram-negative resistance reach over 25% in parts of southern Europe, and all 6 regions of the World Health Organization (WHO) include countries that are reporting more than a 50% incidence of resistance of Klebsiella to third-generation cephalosporins.3,4 There are no reliable estimates of the number of cases globally, largely because surveillance is incomplete; however, fragmentary evidence suggests that the problem is much worse in many developing countries.1 These infections occur in nearly all medical settings. A substantial percentage of childhood ear infections, urinary tract infections, community-acquired pneumonias, sexually transmitted infections, and wound and skin infections are caused by pathogens that have evolved resistance to one or more antibiotics to which they were previously sensitive. For example, all WHO regions report countries with rates of resistance to penicillin exceeding 50% in community-acquired pneumococcal infections, and half of the WHO regions have countries wherein the rate of gonorrhea resistance to third-generation cephalosporins exceeds 50%.4