Antimicrobial Crisis: Decreasing Discovery, Increasing Resistance

Antimicrobial Crisis: Decreasing Discovery, Increasing Resistance

The discovery and subsequent success of antibiotics in the early 20^th century significantly reduced deaths and severe complications from bacterial infections. Yet, the effectiveness of antibiotics is eroding as resistant infections emerge, including methicillin-resistant Staphylococcus aureus (MRSA) and drug-resistant Mycobacterium tuberculosis. Antibiotic-resistant infections result in annual costs of $21 billion to $34 billion, in addition to 8 million more hospital days each year in the U.S.

In conjunction with the emergence of antimicrobial resistance, investment in antimicrobial research and discovery has been steadily declining, despite the obvious need for new antimicrobials. Factors contributing to the decline include a less-than-ideal market and an expensive and lengthy drug approval process. A decrease in the number of effective antimicrobial agents affects society in multiple and far-reaching ways; these include the inability to treat once curable diseases, an increased risk of complications from invasive medical procedures such as surgery or transplant medicine, and even a risk of bioterrorism with a drug-resistant microorganism.

Proposed methods of addressing this dual crisis of increasing resistance and decreasing drug development include: economic incentives such as novel reimbursement strategies and increased research funding. Changes to the approval process to create a streamlined, less expensive, and more feasible pathway to antimicrobial approval have also been proposed. In addition, stewardship programs to foster appropriate antimicrobial use and awareness of the antimicrobial crisis, combined with increased surveillance of antimicrobial use and resistance, are strongly encouraged.