ReviewThe Lancet Infectious Diseases Commission on antimicrobial resistance: 6 years later
Introduction
Following the 2013 Lancet Infectious Diseases Commission1 on the implications of the global rise of antimicrobial resistance, discussions on antimicrobial resistance have risen to the top of the international agenda. In May, 2015, the 68th World Health Assembly adopted the Global Action Plan on Antimicrobial Resistance, which represented recognition among member states of the profound threat posed to human health by antimicrobial resistance and proposed specific actions to tackle the problem. Subsequently, a resolution passed unanimously by the UN General Assembly2 during a high-level meeting called for globally coordinated action and a One Health approach.3 Progress has been made in surveillance, adoption of national action plans, and recognition of the One Health framework for tackling the issue. Efforts are underway to rejuvenate the antibiotic pipeline and develop novel antibiotics for priority pathogens. However, progress has been uneven on national action plans, hospital infection control, and other methods to reduce the need for antibiotics, regulatory policies that govern the use of antibiotics in community and hospital settings, and public understanding of the need to conserve antibiotics.4 In this Review, we report on progress in science and policy to reduce antimicrobial resistance in humans, animals, and the environment since 2013, and we highlight the remaining challenges.
Section snippets
Resistance in humans, animals, and the environment
Antimicrobial resistance continues to rise in many low-income and middle-income countries (LMICs) but has leveled off in some high-income countries (HICs; figure 1). Weighted average resistance levels are generally higher in LMICs than in HICs.5 Resistance and consumption rates are variable across countries, although rates of resistant Acinetobacter baumannii tend to be higher than those of other bacteria.5 Enterococcus faecium resistance to broad-spectrum penicillins was as high as 87% in one
National action plans
The WHO Global Plan26 calls for national action plans and collaborative partnerships to build momentum on antimicrobial resistance. To date, 93 of the 194 WHO member states have national action plans (figure 2).62 Strategies to improve the use of existing antibiotics focus on five objectives: public and provider awareness, education, surveillance, stewardship, and infection prevention. Global awareness has been led by high-level political activity at the UN,63 a tripartite alliance (between
Replenishing the antibiotic pipeline
The pipeline of new antibiotics under development has improved since 2013 (figure 3). The US FDA has approved 14 new drugs to treat bacterial infections in the past decade. However, four of these companies fell into bankruptcy in 2019, and gaps remain concerning drugs for Gram-negative organisms and for novel classes of antibiotics. Despite the initiatives launched to refill the antibiotic pipeline107 and the announcements of renewed development by drug companies,108 bringing new antibiotics
The challenges ahead
More work has been done on antimicrobial resistance in the past 6 years—in surveillance, awareness building, reducing antibiotic consumption, and incentivising the development of new antibiotics—than in the preceding 30 years. A high point was the 2016 UN General Assembly's commitment to tackling antimicrobial resistance. The resulting national action plans, however, have not yet generated the concrete actions that are needed to ensure that antibiotics remain available in the future. Within the
References (116)
- et al.
Antibiotic resistance—the need for global solutions
Lancet Infect Dis
(2013) - et al.
A governance framework for development and assessment of national action plans on antimicrobial resistance
Lancet Infect Dis
(2019) - et al.
Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis
Lancet Infect Dis
(2018) - et al.
Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study
Lancet Infect Dis
(2016) - et al.
Extended-spectrum β-lactamase-producing and AmpC-producing Escherichia coli from livestock and companion animals, and their putative impact on public health: a global perspective
Clin Microbiol Infect
(2012) - et al.
The emergence of mecC methicillin-resistant Staphylococcus aureus
Trends Microbiol
(2014) - et al.
Restricting the use of antibiotics in food-producing animals and its associations with antibiotic resistance in food-producing animals and human beings: a systematic review and meta-analysis
Lancet Planet Health
(2017) - et al.
Extended-spectrum β-lactamase-producing Escherichia coli in human-derived and foodchain-derived samples from England, Wales, and Scotland: an epidemiological surveillance and typing study
Lancet Infect Dis
(2019) - et al.
Critical knowledge gaps and research needs related to the environmental dimensions of antibiotic resistance
Environ Int
(2018) - et al.
Concentrations of antibiotics predicted to select for resistant bacteria: proposed limits for environmental regulation
Environ Int
(2016)
Can branding and price of pharmaceuticals guide informed choices towards improved pollution control during manufacturing?
J Clean Prod
Access to effective antimicrobials: a worldwide challenge
Lancet
China bans colistin as a feed additive for animals
Lancet Infect Dis
Anthropological and socioeconomic factors contributing to global antimicrobial resistance: a univariate and multivariable analysis
Lancet Planet Health
Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial
Lancet
WHO Global Antimicrobial Resistance Surveillance System early implementation 2016–17
Lancet Infect Dis
Antimicrobial stewardship to optimize the use of antimicrobials for surgical prophylaxis in Egypt: a multicenter pilot intervention study
Am J Infect Control
Antimicrobial stewardship across 47 South African hospitals: an implementation study
Lancet Infect Dis
Point-of-care C-reactive protein testing to reduce inappropriate use of antibiotics for non-severe acute respiratory infections in Vietnamese primary health care: a randomised controlled trial
Lancet Glob Health
Draft political declaration of the high-level meeting of the General Assembly on antimicrobial resistance
Antibiotic resistance is the quintessential One Health issue
Trans R Soc Trop Med Hyg
Tracking trends in antibiotic effectiveness using the Drug Resistance Index
BMJ Glob Health
Characterization of a new metallo-beta-lactamase gene, bla(NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India
Antimicrob Agents Chemother
Emergent polymyxin resistance: end of an era?
Open Forum Infect Dis
The global distribution and spread of the mobilized colistin resistance gene mcr-1
Nat Commun
UK case of Neisseria gonorrhoeae with high-level resistance to azithromycin and resistance to ceftriaxone acquired abroad
Multi-drug resistant gonorrhoea detected in Australia
Time-scaled evolutionary analysis of the transmission and antibiotic resistance dynamics of Staphylococcus aureus clonal complex 398
Appl Environ Microbiol
Intermingled Klebsiella pneumoniae populations between retail meats and human urinary tract infections
Clin Infect Dis
Meticillin-resistant Staphylococcus aureus CC398 is an increasing cause of disease in people with no livestock contact in Denmark, 1999 to 2011
Euro Surveill
The livestock reservoir for antimicrobial resistance: a personal view on changing patterns of risks, effects of interventions and the way forward
Philos Trans R Soc Lond B Biol Sci
Are food animals responsible for transfer of antimicrobial-resistant Escherichia coli or their resistance determinants to human populations? A systematic review
Foodborne Pathog Dis
Global trends in antimicrobial resistance in animals in low- and middle-income Countries
Science
WHO guidelines on use of medically important antimicrobials in food-producing animals
Initiatives for addressing antimicrobial resistance in the environment: current situation and challenges
Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage
Nat Commun
Global action plan on antimicrobial resistance
A European One Health Action Plan against Antimicrobial Resistance
Frontiers 2017: emerging issues of environmental concern
Background document on the implementation of outcomes of the third session of the United Nations Environment Assembly
Progress on drinking water, sanitation and hygiene: 2000–17
Antimicrobial resistance benchmark 2020
Industry roadmap for progress on combating antimicrobial resistance
Review on AMR: tackling drug-resistant infections globally: final report and recommendations
National action plan on antimicrobial resistance (NAP-AMR) 2017–2021
Global increase and geographic convergence in antibiotic consumption between 2000 and 2015
Proc Natl Acad Sci USA
Access to antibiotics: a safety and equity challenge for the next decade
Antimicrob Resist Infect Control
WHO updates Essential Medicines List with new advice on use of antibiotics, and adds medicines for hepatitis C, HIV, tuberculosis and cancer
World Health Organization Model List of essential medicines: 21st list, 2019
AWaRe Policy Brief
Cited by (163)
Role of infrastructure and operation in disease prevalence in dairy farms: groundwork for disease prevention-based antibiotic stewardship
2024, Preventive Veterinary MedicineGlobal-PPS targets for antimicrobial stewardship in paediatric patients at hospitals in Sanandaj, Western Iran, compared with Southeast Asian and European hospitals
2024, Journal of Global Antimicrobial ResistanceDetection of antimicrobial resistance (AMR) and antimicrobial susceptibility testing (AST) using advanced spectroscopic techniques: A review
2024, TrAC - Trends in Analytical ChemistryAn extensively drug-resistant Pseudomonas aeruginosa isolate from Myanmar
2024, Journal of Global Antimicrobial ResistanceWastewater treatment plants: The missing link in global One-Health surveillance and management of antibiotic resistance
2023, Journal of Infection and Public Health