Treating infection is a key part of the work of most clinicians [...]

Lipman, J

Lonsdale, DO

English

St George's Online Research Archive

antibioticsEditorialAntimicrobial Resistance: We Must Pursue aCollaborative, Global Approach and Use a “OneHealth” ApproachDagan O Lonsdale 1,2 and Jeffrey Lipman 3,4,*1 Department of Intensive Care Medicine, St George’s University Hospitals NHS Foundation Trust, LondonSW17 0QT, UK; daganlonsdale@googlemail.com2 Department of Clinical Pharmacology and Therapeutics, St George’s, University of London,London SW17 0RE, UK3 Royal Brisbane and Womens’ Hospital, University of Queensland, Brisbane 4029, Australia4 Nimes University Hospital, University of Montpellier, 30029 Nimes, France* Correspondence: j.lipman@uq.edu.au; Tel.: +61-7-3636-8897; Fax: +61-7-3636-3542Received: 14 November 2019; Accepted: 25 November 2019; Published: 27 November 2019 Treating infection is a key part of the work of most clinicians. Whilst new drug technologieslike biologics have begun a revolution in the treatment of cancer and autoimmune disease, there hasbeen a conspicuous absence of new classes of antibiotic over the last 30 years. This, coupled with themass use of antibiotics in farming and the continued emergence of resistant pathogens has created aperfect storm, and antimicrobial resistance is now viewed as a global public health emergency [1,2].Combating the threat posed by the failure of current antibiotics presents a unique need to co-ordinateresearch and intervention policy across the spectrum of primary and secondary care, the private andpublic sector, and public health alongside working with colleagues in agriculture and farming aimingtowards a “one health” approach. In this issue of Antibiotics, a variety of articles are presented thatcover the breadth of human research in this field from in vitro work on novel therapies to commentaryon public health strategies.The emerging crisis of antibiotic resistance and paucity of novel therapies, has led to a resurrectionof historic drug development pipelines. Robertson and Musiol-Kroll [3] provide a comprehensiveaccount of the part actinomycetes have played in the history of antimicrobial therapy. The origins ofß-lactams, macrolides, and tetracyclines (among others) lie in the exploration of these organisms inthe mid twentieth century and the article details their discovery and utility, as well as outlining thepotential discovery pipeline for future development of naturally occurring antimicrobials. Previouslydiscarded treatment options are also undergoing a resurgence. In their articles, Romero-Calle andcolleagues [4] and Fernandez et al. [5] discuss the potential of bacteriophages (bactericidal viruses) incomprehensive summaries that discuss the history, mechanism of action, and current state of earlyphase research of these therapies. Mgbeahurulike et al. [6] utilize another strategy for developing newantimicrobial treatments by combining a novel synergistic compound with an established antibiotic.They provide evidence in their in vitro work of the synergistic effect of the alkaloids piperine andpiplartin with rifampicin against Staphylococcus aureus. Infection caused by carbapenem-resistantEnterobacteriaceae (CRE) provide a particular challenge to clinicians worldwide. Suay-Garcia andPérez-Gracia [7] provide a concise summary of the history, epidemiology and resistance mechanismsof these pathogens, and outline the treatment strategies that may be employed to treat them. Old(fosfomycin), newer (‘double carbapenem’), and novel (ceftazidime/avibactam) treatment strategiesare described, with a clear message that global cooperation is paramount to combating CRE.Antimicrobial stewardship, including the prevention of inappropriate antibiotic prescribing is keyto preventing the continued rise and spread of resistant pathogens. However, there is currently noAntibiotics 2019, 8, 237; doi:10.3390/antibiotics8040237 www.mdpi.com/journal/antibioticsAntibiotics 2019, 8, 237 2 of 3international consensus on the definition or accurate quantification of the global burden of inappropriateprescribing. Hood and colleagues [8] provide commentary on some of the audit tools available inAustralia [9] and the USA [10] and present a novel approach, developed through an expert Delphiprocess, that they aim to use in UK secondary care. Al-Hasan et al. [11] in their review, argue for a morestraightforward metric for antimicrobial stewardship performance–institutional antimicrobial use. Inprimary care, Colliers et al. [12] present an analysis of the burden of infection and antibiotic prescribingin out of hours contact between practitioners and patients in Belgium. They found that more than one infive out of hours appointments resulted in an antibiotic prescription. They also found that out of hoursprescribing was often not in keeping with local guidelines. Sunde, Nygaard, and Høye [13] presentsome of the challenges faced by General Practitioners when deciding whether to give antimicrobialprescriptions, highlighting in their qualitative and quantitative study that patient expectations remaina significant driver of prescribing for practitioners. Grigoryan and colleagues [14] present a qualitativeanalysis of antimicrobial prescribing for perhaps one of the more common indications in primary care,urinary tract infections. They include a report on a wide variety of resources used by practitionerswhen making prescribing decisions, pointing out that stewardship interventions must consider whereand how practitioners seek information. Borek et al. [15] further describe some of the barriers to successof antimicrobial stewardship interventions. They suggest some strategies, sourced from a stakeholderengagement exercise, to improve the success rates.For many clinicians, the threat or challenge of managing infection due to antimicrobial resistantorganisms is often focused on a single patient, ward or practice. In this issue, Holmes and Hughesdiscuss the wider health economic implications of failing to act to combat resistant pathogens [16]. Theheadline healthcare cost of no action, $100 trillion by 2050 [2], should prompt action from even the mostskeptical of policymakers. However, the authors provide insightful commentary on the challengesin economic evaluation of interventions that may provide benefit to only individual patients or topopulations over a long time period. They argue succinctly that economic assessment must be pairedalongside evaluation of clinical efficacy of healthcare interventions to combat antimicrobial resistance, iffunds are to be targeted efficiently and effectively. More broadly, it is clear that antimicrobial resistanceis not an issue that is related to, or originates solely from humans. Although common sense dictatesthat policy and interventions to combat antimicrobial resistance must be multi-faceted and includestakeholders from public health, hospitals, and the community alongside colleagues from agriculture,farming and veterinary medicine. Singh et al. [17] provide a commentary of the situation in Singapore,pointing out that even in an economy with significant resource, combating antimicrobial resistance iscomplex and challenging to coordinate. Their work, based on a qualitative analysis from stakeholderinterviews, highlights the need to understand and address cultural, social, and behavioral expectationsof antibiotic use, alongside implementing public health policy.Articles on in vitro work by Vianna et al. [18] on antimicrobial eﬄux pumps and Costa et al. [19]outlining the antimicrobial activity of silver camphro-imine complexes alongside work from Gavilánet al. [20] on a novel and sensitive assay for detecting low levels of antibiotic in animal feed, completethis innovative and exciting multi-disciplinary issue of Antibiotics.Conflicts of Interest: The authors declare no conflict of interest.References1. WHO. Antibiotic resistance. 2018. Available online: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance (accessed on 11 November 2019).2. Tackling Antimicrobial Resistance 2019–2024. The UK’s Five-Year National Action Plan. HM Government.2019. Available online: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/784894/UK_AMR_5_year_national_action_plan.pdf (accessed on 11 November 2019).3. Robertsen, H.L.; Musiol-Kroll, E.M. Actinomycete-Derived Polyketides as a Source of Antibiotics and LeadStructures for the Development of New Antimicrobial Drugs. Antibiotics 2019, 8, 157. [CrossRef] [PubMed]Antibiotics 2019, 8, 237 3 of 34. Romero-Calle, D.; Guimarães Benevides, R.; Góes-Neto, A.; Billington, C. Bacteriophages as Alternatives toAntibiotics in Clinical Care. Antibiotics 2019, 8, 138. [CrossRef] [PubMed]5. Fernández, L.; Gutiérrez, D.; García, P.; Rodríguez, A. The Perfect Bacteriophage for TherapeuticApplications—A Quick Guide. Antibiotics 2019, 8, 126. [CrossRef] [PubMed]6. Mgbeahuruike, E.E.; Stålnacke, M.; Vuorela, H.; Holm, Y. Antimicrobial and Synergistic Effects of CommercialPiperine and Piperlongumine in Combination with Conventional Antimicrobials. Antibiotics 2019, 8, 55.[CrossRef] [PubMed]7. Suay-García, B.; Pérez-Gracia, M.T. Present and Future of Carbapenem-resistant Enterobacteriaceae (CRE)Infections. Antibiotics 2019, 8, 122. [CrossRef] [PubMed]8. Hood, G.; Hand, K.S.; Cramp, E.; Howard, P.; Hopkins, S.; Ashiru-Oredope, D. Measuring AppropriateAntibiotic Prescribing in Acute Hospitals: Development of a National Audit Tool Through a DelphiConsensus. Antibiotics 2019, 8, 49. [CrossRef] [PubMed]9. James, R.; Upjohn, L.; Cotta, M.; Luu, S.; Marshall, C.; Buising, K.; Thursky, K. Measuring antimicrobialprescribing quality in Australian hospitals: Development and evaluation of a national antimicrobialprescribing survey tool. J. Antimicrob. Chemother. 2015, 70, 1912–1918. [PubMed]10. Spivak, E.S.; Cosgrove, S.E.; Srinivasan, A. Measuring Appropriate Antimicrobial Use: Attempts at Openingthe Black Box. Clin. Infect. Dis. 2016, 63, 1639–1644. [PubMed]11. Al-Hasan, M.N.; Winders, H.R.; Bookstaver, P.B.; Justo, J.A. Direct Measurement of Performance: A New Erain Antimicrobial Stewardship. Antibiotics 2019, 8, 127. [CrossRef] [PubMed]12. Colliers, A.; Adriaenssens, N.; Anthierens, S.; Bartholomeeusen, S.; Philips, H.; Remmen, R.; Coenen, S.Antibiotic Prescribing Quality in Out-of-Hours Primary Care and Critical Appraisal of Disease-SpecificQuality Indicators. Antibiotics 2019, 8, 79. [CrossRef] [PubMed]13. Sunde, M.; Nygaard, M.M.; Høye, S. General Practitioners’ Attitudes toward Municipal Initiatives to ImproveAntibiotic Prescribing—A Mixed-Methods Study. Antibiotics 2019, 8, 120. [CrossRef] [PubMed]14. Grigoryan, L.; Nash, S.; Zoorob, R.; Germanos, G.J.; Horsfield, M.S.; Khan, F.M.; Martin, L.; Trautner, B.W.Qualitative Analysis of Primary Care Provider Prescribing Decisions for Urinary Tract Infections. Antibiotics2019, 8, 84. [CrossRef] [PubMed]15. Borek, A.J.; Wanat, M.; Sallis, A.; Ashiru-Oredope, D.; Atkins, L.; Beech, E.; Hopkins, S.; Jones, L.; McNulty, C.;Shaw, K.; et al. How Can National Antimicrobial Stewardship Interventions in Primary Care Be Improved?A Stakeholder Consultation. Antibiotics 2019, 8, 207. [CrossRef] [PubMed]16. Holmes, E.A.F.; Hughes, D.A. Challenges for Economic Evaluation of Health Care Strategies to ContainAntimicrobial Resistance. Antibiotics 2019, 8, 166. [CrossRef] [PubMed]17. Singh, S.R.; Chua, A.Q.; Tan, S.T.; Tam, C.C.; Hsu, L.Y.; Legido-Quigley, H. Combating AntimicrobialResistance in Singapore: A Qualitative Study Exploring the Policy Context, Challenges, Facilitators, andProposed Strategies. Antibiotics 2019, 8, 201. [CrossRef] [PubMed]18. Vianna, J.S.; Machado, D.; Ramis, I.B.; Silva, F.P.; Bierhals, D.V.; Abril, M.A.; von Groll, A.; Ramos, D.;Lourenço, M.C.S.; Viveiros, M.; et al. The Contribution of Eﬄux Pumps in Mycobacterium abscessusComplex Resistance to Clarithromycin. Antibiotics 2019, 8, 153. [CrossRef] [PubMed]19. Costa, J.P.; Pinheiro, M.J.F.; Sousa, S.A.; Botelho do Rego, A.M.; Marques, F.; Oliveira, M.C.; Leitão, J.H.; PMira, N.; Carvalho, N.N.; Fernanda, M.; et al. Antimicrobial Activity of Silver Camphorimine Complexesagainst Candida Strains. Antibiotics 2019, 8, 144. [CrossRef] [PubMed]20. Gavilán, R.E.; Nebot, C.; Patyra, E.; Vazquez, B.; Miranda, J.M.; Cepeda, A. Determination of Florfenicol,Thiamfenicol and Chloramfenicol at Trace Levels in Animal Feed by HPLC–MS/MS. Antibiotics 2019, 8, 59.[CrossRef] [PubMed]© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open accessarticle distributed under the terms and conditions of the Creative Commons Attribution(CC BY) license (http://creativecommons.org/licenses/by/4.0/).

Antimicrobial Resistance: We Must Pursue a Collaborative, Global Approach and Use a "One Health" Approach.

Treating infection is a key part of the work of most clinicians [...

Dagan O Lonsdale

Jeffrey Lipman

Multidisciplinary Digital Publishing Institute

Antimicrobial Resistance: We Must Pursue a Collaborative, Global Approach and Use a “One Health” Approach

Lonsdale, Dagan O.

Lipman, Jeffrey

University of Queensland eSpace

Antimicrobial resistance: we must pursue a collaborative, global approach and use a “one health” approach

http://openaccess.sgul.ac.uk/111658/1/antibiotics-08-00237-v2.pdf

Antimicrobial Resistance: We Must Pursue a Collaborative, Global Approach and Use a "One Health" Approach.

Abstract

Similar works

Full text

Available Versions

St George's Online Research Archive

Multidisciplinary Digital Publishing Institute

University of Queensland eSpace