Lancet Review: Understanding Antimicrobial Resistance Mechanisms Across Healthcare, Agriculture, and Environment
This comprehensive Lancet review examines the mechanisms and drivers of antimicrobial resistance across the healthcare, agriculture, and environmental sectors. It argues that strategies to reduce AMR by removing selective pressure alone are insufficient, since resistance does not always impose a fitness cost. The authors advocate for a five-level research framework spanning resistance mechanism, microorganism, antimicrobial drug, host, and context, emphasizing the need for diagnostics to guide treatment and surveillance.
The original study
Understanding the mechanisms and drivers of antimicrobial resistance.
- Authors
- Holmes AH, Moore LS, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, et al.
- Journal
- Lancet (London, England)
- Type
- Journal Article, Research Support, Non-U.S. Gov't, Review
- PMID
- 26603922
Original abstract
To combat the threat to human health and biosecurity from antimicrobial resistance, an understanding of its mechanisms and drivers is needed. Emergence of antimicrobial resistance in microorganisms is a natural phenomenon, yet antimicrobial resistance selection has been driven by antimicrobial exposure in health care, agriculture, and the environment. Onward transmission is affected by standards of infection control, sanitation, access to clean water, access to assured quality antimicrobials and diagnostics, travel, and migration. Strategies to reduce antimicrobial resistance by removing antimicrobial selective pressure alone rely upon resistance imparting a fitness cost, an effect not always apparent. Minimising resistance should therefore be considered comprehensively, by resistance mechanism, microorganism, antimicrobial drug, host, and context; parallel to new drug discovery, broad ranging, multidisciplinary research is needed across these five levels, interlinked across the health-care, agriculture, and environment sectors. Intelligent, integrated approaches, mindful of potential unintended results, are needed to ensure sustained, worldwide access to effective antimicrobials.