Antimicrobial Resistance and Human Use of Antibiotics
Antimicrobial resistance is a growing concern in the United States with a 2004 survey by the Infectious Diseases Society of America estimating that 70 percent of hospital-acquired infections are due to antibiotic-resistant bacteria. Organ transplant candidates and recipients have extensive exposure to the healthcare environment and have extensive antibiotic exposures. As a result of these risk factors, transplant candidates and recipients have a higher rate (up to 80%) of colonization and infection due to antibiotic-resistant bacteria. Antimicrobial resistance contributes to increased cost of care and poorer outcomes, including decreased patient and transplanted organ survival, and increased deaths on transplant waiting lists.
The American Society of Transplantation (AST) supports a multi-tiered approach to combating the challenge of antimicrobial resistance. Initiatives must be directed at drug development, measures to reduce the spread of these resistant organisms, and improved early detection and diagnostic systems.
Development of new antibiotics is increasingly difficult. Discovery of novel antibiotics has been rapid, but these discoveries have only rarely resulted in new agents becoming clinically available. Increasingly, large pharma is investing less in antibiotic research and development, leaving the complicated task to smaller companies with less resources. Many of the new drugs that have come to market provide alternative therapies for resistant gram positive agents, such as methicillin-resistant S. aureus and vancomycin-resistant Enterococcus. Few drugs have been developed that have activity against the growing array of multi-drug resistant gram negative organisms. The AST favors support for incentives to develop new antimicrobials, including efforts aligned with the Promise for Antibiotics and Therapeutics for Health (PATH) Act.
Further, the AST also favors approaches to reduce the spread of resistance. Potential approaches include hospital antimicrobial stewardship programs that promote the appropriate use of antimicrobials, discouraging the widespread use of broader spectrum drugs for inappropriate indications. While these programs have consistently been demonstrated to reduce the burden of resistant organisms in participating centers, they are costly and there are currently no mechanisms to allow for reimbursement of the costs associated with these programs. Further, these programs need to expand beyond the traditional hospital setting to including long term care and ambulatory facilities.
Lastly, efforts are needed to control the ever expanding incidence of resistant bacteria. Outbreaks of resistant bacteria have been seen in schools and athletic facilities, as well as outpatients being treated for commonplace infections, including those involving the throat, ears, skin, and urinary tract. This expansion of resistance is driven by extensive use of antibiotics for indications that may not be appropriate. The AST supports the implementation of a major educational campaign to help stem this public demand as well as elimination of non-judicious antibiotic use in animals, plants and marine environments.
Education alone, however, will not be sufficient. In order to most safely treat our patients, improved diagnostics will be necessary. Modern assays that rapidly and accurately identify resistance in clinical isolates are needed to optimize the selection of antibiotics for individual patients.
On behalf of our patients, who are at greatest risk from these pathogens, the AST supports initiatives for the development of new drugs and diagnostics, as well as those initiatives designed to educate and treat our patients judiciously for infections.
Revised and approved by the AST Board of Directors, September 6, 2011
Revised and approved by the AST Board of Directors, August 12, 2015