This ‘Slowly Evolving Crisis’ Needs Attention
Hello. I’m Paul Auwaerter with Medscape Infectious Diseases and the Johns Hopkins University School of Medicine.
The pandemic and coronavirus are top of mind not only among our infectious diseases profession but globally. However, some attention is being paid to collateral issues such as decreased immunization in children, which might lead to increased contagious diseases (eg, measles or chicken pox), elective surgeries that have been delayed, and people not seeking out healthcare.
Antimicrobial resistance, something that the World Health Organization has declared a serious global threat (and which worried me probably the most in 2009), has not gotten as much attention, but it is still worth thinking about because this is a slowly evolving crisis that really hasn’t captured the attention of our politicians.
There are some important aspects that I want to highlight.
Little Structure in Antimicrobial Stewardship
First, what do clinicians think about antimicrobial resistance and stewardship issues? Open Forum Infectious Diseases published the results of a survey of primary care doctors, and 94% — a healthy percentage — acknowledged antimicrobial resistance as problematic.
Yet, when asked if they think it’s a problem in their individual practice, more than half said no. And 60% mentioned that their prescribing habits are better than those of their peers, so perhaps they don’t feel that they’re contributing to any such problem.
Although antimicrobial resistance has been mostly focused in the hospital or in hospitalized patients, who often have the most resistant pathogens, it’s thought that the global or the total burden of antibiotics that are prescribed — the tonnage — probably correlates greatly. This probably reflects prescribing practices in general.
For example, northern European countries have some of the lowest rates, whereas southern European countries and southern parts of the United States tend to have higher rates of antimicrobial prescribing in general.
At least in hospital, there’s been much attention in recent years. The Centers for Medicare & Medicaid Services requires that participating hospitals have an antimicrobial stewardship program. Certain states, such as California, have passed state laws, but there’s still little structure in the outpatient and ambulatory care world. Indeed, most feel that they would need some help in trying to understand how to achieve best practices and preserve the antimicrobials we have.
Keeping Drug Development Alive
On the other hand, the federal government and others have done a lot in the past few years, much spurred by the Infectious Diseases Society of America’s 10 x ’20 Initiative — that is, 10 new antimicrobials by the year 2020. And here we are. We’ve actually exceeded that because the US Department of Health and Human Services and agencies such as BARDA, the Biomedical Advanced Research and Development Authority, have funded research and development.