Drug resistance

Public Health Importance of Antimicrobial Resistance

Infectious diseases were the primary cause of mortality in mankind prior to the discovery and use of antimicrobials. In much of the developing world without access to good quality medicines, infections continue to be the major killers, and in all countries healthcare-associated infections with resistant microorganisms are a major cause of death.

Antimicrobial resistance is an unusual public health threat

  • Antimicrobial resistance is not a "disease". Typically, there is no difference in the severity of disease caused by susceptible strains and resistant ones. Resistance is generally not a problem of disease pathology but one of limited therapy options.
  • The core issue is our dependence on antimicrobials for treating infections. If there were alternate methods of treating infections, antimicrobial resistance would persist in the world but would no longer be relevant as a public health concern.
  • Antimicrobial resistance is a public health threat driven by healthcare practices, most notably the overuse of antimicrobials in conditions for which they provide no benefit.
  • Resistance is a characteristic of many pathogens causing different diseases. Containment strategies thus must be adapted to the needs of specific disease control and treatment programs.

Some Leading Resistant Pathogens

Many types of microorganisms cause infection in humans and animals, so disease prevention and treatment strategies must be adapted to reflect infection risk factors and available treatment options. Over the past decades, most pathogenic species have developed resistance to one or more antimicrobials. Some of the species in which resistance is of greatest public health concern are listed below.

Bacteria - Community

  • Escherichica coli
  • Mybocaterium tuberculosis (cause of tuberculosis)
  • Neisseria gonorrhoeae (cause of gonorrhoea)
  • Salmonella Typhi
  • Staphylococcus aureus, including community-associated MRSA (Methicillin-Resistant S. aureus)
  • Streptococcus pneumoniae

Bacteria - Hospitals

  • Acinetobacter baumannii
  • Enterococcus faecium and Enterococcus faecalis, including VRE (Vancomycin-resistant enterococci)
  • Multidrug-resistant enteric pathogens, including Escherichia coli and Klebsiella pneumoniae producing ESBL and KPC enzymes
  • Pseudomonas aeruginosa
  • Staphylococcus aureus, including MRSA (Methicillin-Resistant S. aureus)
  • Stenotrophomonas maltophilia

Bacteria - Zoonotic disease

  • Campylobacter species
  • Salmonella species

Fungi

  • Candida albicans

Parasites

  • Leishmania species
  • Plasmodium species (cause of malaria)
  • Trypanosoma species

Viruses

  • Cytomyegalovirus
  • Herpes simplex virus
  • HIV
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