National Academies Press: OpenBook
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

COMBATING ANTIMICROBIAL
RESISTANCE AND
PROTECTING THE MIRACLE
OF MODERN MEDICINE

Gillian J. Buckley and Guy H. Palmer, Editors

Committee on the Long-Term Health and Economic Effects of
Antimicrobial Resistance in the United States

Board on Population Health and Public Health Practice

Health and Medicine Division

A Consensus Study Report of

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This project has been funded in whole or in part with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN263201800029I, Task Order No. 75N98020F00003. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-26945-2
International Standard Book Number-10: 0-309-26945-8
Digital Object Identifier: https://doi.org/10.17226/26350
Library of Congress Control Number: 2021949602

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2022 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Combating antimicrobial resistance and protecting the miracle of modern medicine. Washington, DC: The National Academies Press. https://doi.org/10.17226/26350.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

Image

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

Image

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

COMMITTEE ON THE LONG-TERM HEALTH AND ECONOMIC EFFECTS OF ANTIMICROBIAL RESISTANCE IN THE UNITED STATES1

GUY H. PALMER (Chair), Regents Professor of Pathology and Infectious Diseases, The Jan and Jack Creighton Endowed Chair, Paul G. Allen School for Global Health, Washington State University; Senior Director of Global Health, Washington State University System

MICHAEL BAYM, Assistant Professor, Biomedical Informatics, Harvard University

CÉSAR DE LA FUENTE-NUNEZ, Presidential Assistant Professor, Perelman School of Medicine, School of Engineering and Applied Science, University of Pennsylvania

JENNIFER DIEN BARD, Director, Clinical Microbiology and Virology Laboratory, Associate Professor of Pathology (Clinical Scholar), Keck School of Medicine, University of Southern California

MARTA GOMEZ-CHIARRI, Professor, Department of Fisheries, Animal, and Veterinary Sciences, College of the Environment and Life Sciences, The University of Rhode Island

GUILLAUME LHERMIE, Associate Professor, Animal Health Economics and Veterinary Public Health, College of Veterinary Medicine; Director, Simpson Centre for Agricultural and Food Innovation and Education, School of Public Policy, University of Calgary, Canada

PREETI MALANI, Chief Health Officer, University of Michigan, Professor of Medicine, Division of Infectious Diseases, University of Michigan School of Medicine

ELEFTHERIOS MYLONAKIS, Charles C.J. Carpenter, MD, Professor of Infectious Diseases, Professor of Medicine, Assistant Dean of Medicine, Professor of Molecular Microbiology and Immunology, Warren Alpert Medical School of Brown University; Director, Rhode Island Hospital and The Miriam Hospital

IRUKA N. OKEKE, Professor, Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan

EMMANUEL OKELLO, Assistant Specialist in Cooperative Extension, Population Health, and Reproduction, School of Veterinary Medicine, University of California, Davis

AYLIN SERTKAYA, Vice President and Senior Economist, Eastern Research Group

___________________

1 See Appendix B, Disclosure of Unavoidable Conflict of Interest.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

MICHELLE SOUPIR, Associate Chair for Research and Extension, Equity Advisor, College of Engineering; Professor, Department of Agriculture and Biosystems Engineering, Iowa State University

ANDY STERGACHIS, Professor of Pharmacy and Global Health, Adjunct Professor of Health Metrics Sciences, Epidemiology, and Health Systems and Population Health; Associate Dean of Pharmacy; Director, Global Medicines Program & Biomedical Regulatory Affairs Program, University of Washington Schools of Pharmacy and Public Health

MARY E. WILSON, Clinical Professor of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco; Adjunct Professor, Global Health and Population, Harvard T.H. Chan School of Public Health

QIJING ZHANG, Clarence Hartley Covault Distinguished Professor, Associate Dean for Research and Graduate Studies, Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University

Study Staff

GILLIAN J. BUCKLEY, Study Director

KARA LANEY, Senior Program Officer

ROBERTA WEDGE, Senior Program Officer (from May 2021)

AASHAKA SHINDE, Research Associate (from October 2020)

LEILA MEYMAND, Senior Program Assistant (from October 2020)

MISRAK DABI, Finance Business Partner

ROSE MARIE MARTINEZ, Senior Director, Board on Population Health and Public Health Practice

JULIE PAVLIN, Senior Director, Board on Global Health

ROBIN SCHOEN, Director, Board on Agriculture and Natural Resources

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by JIM E. RIVIERE, North Carolina State University, and ELLEN WRIGHT CLAYTON, Vanderbilt University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

Preface

I was in the lobby of the Fred Hutchinson Cancer Research Center in Seattle, waiting to meet with a colleague, when a wall display of the timeline of successful hematopoietic bone marrow transplants caught my attention. The timeline, in the form of a spiral, starts slowly in the 1970s—successes were few and failures many as scientists strove to understand the basic immunology underlying transplantation and clinicians to establish the optimal procedures and patient care. The successes slowly and then suddenly accelerate, providing life-saving transplants where previously no hope existed. Today, bone marrow transplants are performed in hospitals worldwide. Indeed, it is paradoxical that one of the highest accolades for the incredible achievements in modern medicine over recent decades is that we can take them for granted. The same is true for numerous medical procedures: organ transplants, joint replacements, improved cancer treatment, even safe childbirth. All of us know someone whose lives have been touched by these advances. Underlying this remarkable progress is the reliance on effective antibiotics to prevent and treat infections in patients at their most vulnerable moments. Addressing the challenges of the emergence and spread of resistant microbes; improving laboratory, diagnostics, and surveillance; and catalyzing the development of new classes of medicines is highly complex, cutting across scientific disciplines, medical specialties, institutions, and agencies. However, the goal is clear: preserve the medical advances of the past and allow continued progress, all afforded by and dependent on the availability of effective antibiotics.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

Given the complexity of antibiotic resistance and the inherent multidisciplinary and interdisciplinary approaches required to address resistance, and to ensure a robust pipeline of effective medicines, the committee brought together expertise from across human, animal, and environmental health sectors. The committee has endeavored to examine the full range of initiatives and programs incorporated into the National Strategy and Action Plan for Combating Antibiotic-Resistant Bacteria and the progress in meeting the goals of the plan. The responsiveness of the multiple U.S. government agencies engaged in carrying out the plan was deeply appreciated as was the evaluation conducted by the Center for Infectious Disease Research and Policy at the University of Minnesota. Equally, given the need for global solutions to a challenge that knows no borders, the committee benefited from the multiple international organizations engaged in preserving antibiotic effectiveness and appreciates their willingness to share their expertise and perspectives. The committee was respectful of prior reports on antibiotic resistance and endeavored to assess their recommendations in the context of the committee’s statement of task. On behalf of the committee, I want to express my appreciation for the openness of these organizations and agencies and their efforts in working to ensure access to effective antibiotics.

A study of this magnitude requires a tremendous commitment from the committee members. All have sacrificed evenings, weekends, and holidays—without financial compensation—in this commitment and in their desire to bring the best possible science to bear on a challenging issue. Their commitment was all the more impressive as the study took place during the COVID-19 pandemic. Several of our committee members had frontline clinical care responsibilities; others increased commitments in laboratory testing, surveillance, and modeling—all were impacted by the pandemic by increased responsibilities at work and at home. Despite these increased responsibilities and the ability to only meet and work together virtually, the committee, individually and collectively, brought their expertise, experience, and knowledge to the task. I cannot thank them enough.

On behalf of the committee, I would like to express our thanks and appreciation to the National Academies leadership and staff: Rose Marie Martinez, Senior Director of the Board on Population Health and Public Health Practice; Kara Laney, Senior Program Officer; Roberta Wedge, Senior Program Officer; Aashaka Shinde, Research Associate; and Leila Meymand, Senior Program Assistant. A special thank you and deep appreciation to the Study Director, Gillian Buckley, who provided exceptional leadership throughout the study. Without her leadership and the work of the staff in planning, organization, and editing, this report would not have been possible.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

The evolutionary basis of antimicrobial resistance dictates that there will be no magic bullets or simple solutions. Ensuring that modern medicine can continue to rely on effective antibiotics will require continual innovation and process improvement. Minimizing the need for antibiotics through preventive health care and improved sanitation, housing, and access to clean water is achievable, as is ensuring that the right antibiotic is available and given at the appropriate dose for the appropriate duration. Achieving those goals is fundamental to meeting the National Academy of Medicine’s vision of “a healthier future for everyone.”

Guy H. Palmer, Chair
Committee on the Long-Term Health and Economic Effects of Antimicrobial Resistance in the United States

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

This page intentionally left blank.

Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

Acknowledgments

This report is a product of the cooperation and contributions of many people. The committee and staff are grateful for the support of the National Academies of Sciences, Engineering, and Medicine’s Health and Medicine Division (HMD) staff who contributed to producing this report. The committee and staff thank Tina Seliber, Lauren Shern, Leslie Sim, and Taryn Young in the HMD Executive Office; Anne Marie Houppert, Christopher Lao-Scott, and Rebecca Morgan in the National Academies Research Center; Sadaf Faraz, Devona Overton, Esther Pak, and Marguerite Romatelli in the Office of the Chief Communications Officer; Stephanie Miceli in the Office of News and Public Information; Julie Eubank in the Office of Congressional and Government Affairs; and Mandy Enriquez, Dempsey Price, and Alejandro Velazquez in the Office of Conference Management. We extend particular thanks to Roberta Wedge for joining the project and providing invaluable analysis and Rebekah Hutton for her work on the cover design.

The committee’s work was enhanced by the systematic analysis of Kristine Moore and Anje Mehr whose commissioned paper informed this report. We also thank Yunxin Joy Jiao for graciously sharing her graphic designs for reprint in Chapter 1.

The committee thanks all the speakers and moderators who participated in committee meetings, as well as others who provided information, input, and assistance. They include the following: Frank Møller Aarestrup, Mark Albrecht, Neena Anadaraman, Anand Balachandran, Manica Balasegaram, Helen Boucher, Susan Bright, Felipe C. Cabello, Angela Caliendo, Amanda Cash, Clare Chandler, Ryan Cirz, Michael Craig, Chris Crnich,

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

Peter Panduro Damborg, Gautam Dantas, Mary Denigan-Macauley, Lynn Filpi, William Flynn, Heather Fowler, Jay Garland, Cyril Gay, Claire Gordon, Luca Guardabassi, Tim Jinks, Bill Keleher, Wes Kim, Jane Knisely, Kevin Krause, Ramanan Laxminarayan, Brian Lubbers, John Lynch, Marc Mendelson, Mark Miller, Chris Murray, Kevin Outterson, Mark Papich, Timothy Persons, Carmem L. Pessoa-Silva, Jessica Petrillo, Tom Pilcher, John Rex, Jennifer Schneider, Anand Shah, Gunnar Skov Simonsen, Brad Spellberg, Padmini Srikantiah, Bruce Stewart-Brown, Fred C. Tenover, Paige Waterman, Craig Wilson, and Barbara Zimmer. To Dr. Christopher Murray, Institute for Health Metrics and Evaluation, University of Washington, and the Global Research on Antimicrobial Resistance team, we extend particular thanks for sharing key findings from their Lancet paper in review.

Finally, we extend special thanks to the National Institute of Allergy and Infectious Diseases of the National Institutes of Health for generously funding this project.

Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

6-1 Plazomicin and Achaogen

6-2 The Global Antibiotic Research and Development Partnership

6-3 The Onshoring Essential Antibiotics Act

6-4 Legal and Regulatory Pull Incentives in the United States

7-1 Five Goals and Objectives of the National Strategy for Combating Antibiotic-Resistant Bacteria

7-2 National Targets to Combat Antimicrobial-Resistant Bacteria

7-3 GAO Recommendations for Improving Progress on the National Action Plan

7-4 GAO Recommendations on the Use of Medically Important Drugs in Food Animals

7-5 Building Off the Previous 5-Year Action Plan

7-6 Challenges to Reaching the Goals in the National Action Plan on Combating Antimicrobial-Resistant Bacteria 2020–2025

FIGURES

1-1 Selective pressure encourages antimicrobial resistance

1-2 Resistance genes can pass through vertical or horizontal mechanisms

1-3 Microbes and resistomes travel across habitats

1-4 Carbapenemase-producing Enterobacteriaceae confirmed by Public Health England’s Antimicrobial Resistance and Healthcare Associated Infections unit, from UK laboratories

1-5 The timeline of key U.S. government publications on antimicrobial resistance

2-1 A conceptual framework for the role of modifiable drivers of antimicrobial resistance

2-2 Historic use of antibiotics in Norwegian aquaculture

2-3 Drivers of antimicrobial resistance in the environment

2-4 Prevalence of third-generation cephalosporin-resistant (3GCR) E. coli3 (A) and Klebsiella spp. (B) against gross national income per capita; predicted values with 95% confidence intervals

2-5 Estimated neonatal sepsis deaths caused by bacteria resistant to first-line antibiotics in five high-burden countries; estimates with maximum and minimum values from Latin Hypercube Sampling

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

2-6 Antibiotic availability at health facilities; survey data from 20 low- and middle-income countries, 2014–2017

3-1 Trends in antimicrobial resistance across OECD countries, 2005 to 2014

3-2 Projected average annual number of deaths from resistant infections and mortality rate per 100,000, 2015 to 2050

3-3 Projected average annual burden of antimicrobial resistance expressed in disability-adjusted life years (DALYs), 2015 to 2050

3-4 Shortfalls in global economic output assuming low and high burden of resistance relative to a baseline scenario, 2019 to 2050

3-5 Costs to the economy of antimicrobial resistance compared to those of the 2008–2009 financial crisis; annual cost expressed as percentage of GDP

3-6 Number of people falling into extreme poverty (living on < $1.90 a day, adjusted for purchasing power parity) by 2050

3-7 Estimates of the burden of drug-resistant bacterial infections in DALYs by age group, European Union and European Economic Area, 2015 data

3-8 Additional infections per year in the United States under 10 percent, 30 percent, 70 percent, and 100 percent reduction in efficacy of antibiotic prophylaxis

3-9 Number of additional deaths per year in the United States under 10 percent, 30 percent, 70 percent, and 100 percent reduction in efficacy of antibiotic prophylaxis

3-10 Interactions between COVID-19 and the emergence of antimicrobial resistance

3-11 Estimates of excess length of hospitalization caused by antimicrobial resistance and different analytic methods; (i) through (iii) indicate different methods used in a single study

3-12 Seven key challenges in collecting data to inform estimates of the burden of resistance

3-13 The global antimicrobial resistance platform for ONE-burden estimates

4-1 Sunburst chart of international networks performing surveillance for antimicrobial resistance in low- or middle-income countries since 2000

4-2 Requirements for the flow of surveillance data and proposed solutions to key challenges

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

4-3 Steps in disk diffusion

4-4 A microdilution tray viewed from above; microtubes filled with progressively more concentrated dilutions of drug in both are inoculated with an equal number of bacterial cells

4-5 Whole genome sequencing compares DNA sequence data to AMR determinants in reference databases

4-6 Examples of metagenomic analysis of antimicrobial resistance in microbial communities

4-7 Antimicrobial resistance resources in the National Center for Biotechnology Information pathogen detection project and the relationships among them

4-8 Key environmental matrices and flows relevant to the dissemination of antimicrobial resistance in the environment

5-1 Percentage of hospitals meeting all seven core elements of hospital antibiotic stewardship programs by state, 2019

5-2 The CDC’s core elements of hospital antibiotic stewardship programs

5-3 New antibiotics introduced into country markets, 1999–2014

5-4 Mechanisms through which vaccines can contribute to reducing antimicrobial resistance

6-1 Push and pull incentives operate at different stages of antimicrobial development

6-2 Research and development cost, both direct and cost of capital, by clinical trial phases

6-3 Failure is increasingly less likely as drug candidates move to later stages of development

6-4 NIAID’s research grants in basic science inform a broad understanding of antimicrobial resistance

6-5 Overview of the preclinical pipeline for antimicrobials and related products

6-6 Distribution of CARB-X applications based on stage of technology in development

6-7 BARDA’s antimicrobial portfolio, fall 2021

6-8 Estimated contributions of the Generating New Antibiotic Incentives Now Act’s 5-year extensions on market exclusivity

6-9 Antimicrobial drug pipeline, by stage of development over time

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

6-10 Simulation of an adaptive randomized controlled trial for gram-negative bloodstream infections

6-11 Major questions in assessing the safety of micro-organisms being considered for use in animal feed

6-12 Main participants in a public–private partnership and their core strengths for medical product development

8-1 Environmental conditions in health facilities in 78 low- and middle-income countries

8-2 The iterative steps of antimicrobial stewardship design

TABLES

3-1 Change in Infections Caused by Some CDC Priority Pathogens Between 2013 and 2019

3-2 Costs Attributable to Antimicrobial-Resistant Pathogens in the United States, in Constant 2017 Dollars

3-3 Key Results from the RAND and KPMG Analyses Informing the O’Neill Report and from the O’Neill Report

3-4 The Social Costs of Hospital-Acquired Infections

3-5 Adjusted Attributable Cost by Pathogen for Community and Hospital Onset Infections

3-6 Estimates of the Effect of Antimicrobial Resistance on Mortality from Recent Prominent Reports

4-1 Advantages and Disadvantages of Current Methods Available to Characterize Antimicrobial Resistance

4-2 Concordance Between Phenotypic Susceptibility Testing and Whole Genome Sequencing-Based Predicted Antimicrobial Resistance

5-1 Vaccines Can Work Through Many Pathways to Reduce Bacterial Infections

6-1 Comparison of CDC and BSA Priority Bacterial Threats

6-2 Antimicrobial Susceptibility Testing Challenges Addressed by the 21st Century Cures Act and Remaining Needs

6-3 Clinical Needs for Rapid Point-of-Care Diagnostics for Respiratory Tract Infections

6-4 Regulation of Directly Fed Micro-Organisms (Probiotics) by FDA

Page xxii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page xxiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×

Acronyms and Abbreviations

3GC third-generation cephalosporin
AACTING Network on quantification of veterinary Antimicrobial usage at herd level and Analysis Communication and benchmarking to improve responsible usage
ABSSSI acute bacterial skin and skin structure infections
ACTIV Accelerating COVID-19 Therapeutic Interventions and Vaccines
AIDS acquired immunodeficiency syndrome
AMR antimicrobial resistance
AMU antimicrobial use
AR antibiotic resistance
ARG Argentina
ARLG Antibacterial Resistance Leadership Group
ARLN Antibiotic Resistance Laboratory Network
ASPR HHS Office of the Assistant Secretary for Preparedness and Response
AUS Australia
AUT Austria
AVMA American Veterinary Medical Association
AWaRe WHO’s Access, Watch, Reserve classification of antibiotics
Page xxiv Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
BARDA Biomedical Advanced Research and Development Authority
BGR Republic of Bulgaria
BL beta-lactam
BLI beta-lactamase inhibitor
BSI bloodstream infection
C. auris Candida auris
C. difficile Clostridioides difficile
CABP community-acquired bacterial pneumonia
CARB National Action Plan for Combating Antibiotic-Resistant Bacteria
CARB-X Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator
CDC Centers for Disease Control and Prevention
CDI Clostridioides difficile infection
CHE Switzerland
CHL Chile
CI confidence interval
cIAI complicated intra-abdominal infection
CLIA Clinical Laboratory Improvement Amendments of 1988
CLSI Clinical and Laboratory Standards Institute
CLSI-VAST veterinary antimicrobial susceptibility testing
CMS Centers for Medicare & Medicaid Services
CO-ADD Community for Open Antimicrobial Drug Discovery
COVID-19 coronavirus disease 2019
CR carbapenem-resistant
CRAB carbapenem-resistant Acinetobacter baumannii
CRE carbapenem-resistant Enterobacterales
cUTI complicated urinary tract infection
CYP Cyprus
CZE Czech Republic
DALY disability-adjusted life year
DARPA Defense Advanced Research Projects Agency
DFUI diabetic foot ulcer infections
DISARM Act Developing an Innovative Strategy for Antimicrobial-Resistant Microorganisms Act
DNA deoxyribonucleic acid
DNDi Drugs for Neglected Diseases Initiative
ECU Ecuador
EMA European Medicines Agency
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
EPA Environmental Protection Agency
EQS Environmental Quality Standard
ESBL extended-spectrum beta-lactamase
ESP Spain
EST Estonia
EUCAST European Committee on Antimicrobial Susceptibility Testing
FAO Food and Agriculture Organization of the United Nations
FDA Food and Drug Administration
GAIN Act Generating Antibiotic Incentives Now Act
GARDP Global Antibiotic Research and Development Partnership
GBR United Kingdom
GCI gonococcal infection
GCOA Global Coalition on Aging
GDP gross domestic product
GHA Ghana
GLASS Global Antimicrobial Resistance and Use Surveillance System
GLASS-EAR Emerging Antimicrobial Resistance Reporting
GN gram-negative
GRC Greece
HABP/VABP Hospital-associated bacterial pneumonia/ventilator-associated bacterial pneumonia
HHS Department of Health and Human Services
Hib Haemophilus influenzae type b
HIC high-income country
HIV human immunodeficiency virus
HRV Croatia
HUN Hungary
hVISA heterogeneous vancomycin-intermediate Staphylococcus aureus
ICU intensive care unit
IDSA Infectious Diseases Society of America
IHME Institute for Health Metrics and Evaluation
IMF International Monetary Fund
IMI imipenem-hydrolyzing ß-lactamases
IMP imipenemase metallo-ß-lactamase
Page xxvi Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
IND India
IPPS inpatient prospective payment system
ISL Iceland
ITA Italy
KPC Klebsiella pneumoniae carbapenemases
LIMS Laboratory Information Management System
LMIC low- and middle-income country
LTU Lithuania
LUX Luxembourg
LVA Latvia
MDR multidrug-resistant
MDR G– multidrug-resistant gram-negative bacteria
MIC minimal inhibitory concentration
MKD Republic of North Macedonia
MLST multilocus sequence
MRSA methicillin-resistant Staphylococcus aureus
NAHMS National Animal Health Monitoring System
NARMS National Antimicrobial Resistance Monitoring System
NCATS National Center for Advancing Translational Sciences
NCBI National Center for Biotechnology Information
NDARO National Database of Antibiotic Resistant Organisms
NDM New Delhi metallo-ß-lactamase
NGO nongovernmental organization
NIAID National Institute of Allergy and Infectious Diseases
NIDDK National Institute of Diabetes and Digestive and Kidney Diseases
NIH National Institutes of Health
NITAG National Immunization Technical Advisory Group
NLM National Library of Medicine
NOR Norway
NZL New Zealand
OECD Organisation for Economic Co-operation and Development
OIE World Organisation for Animal Health (formerly Office International des Epizooties)
OXA-48 Oxacillinase-48
Page xxvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
PACCARB Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria
PCAST President’s Council of Advisors on Science and Technology
PCORI Patient-Centered Outcomes Research Institute
PCR polymerase chain reaction
PCV pneumococcal conjugate vaccine
PEPFAR U.S. President’s Emergency Plan for AIDS Relief
POCIS polar organic chemical integrative sampler
POL Poland
PPE personal protective equipment
QIDP qualified infectious disease product
qPCR quantitative polymerase chain reaction
R&D research and development
rCDI recurrent Clostridioides difficile infection
REVAMP Act Re-Valuing Anti-Microbial Products Act
RNA ribonucleic acid
ROM Romania
rUTI recurrent urinary tract infection
S. pneumonia Streptococcus pneumonia
SAB Staphylococcus aureus bacteremia
SfAM Society for Applied Microbiology
SRB Serbia
SVK Slovakia
SVN Slovenia
SWE Sweden
TCV typhoid conjugate vaccine
THA Thailand
TUR Turkey
UN United Nations
U.S. United States
USAID U.S. Agency for International Development
USD U.S. dollars
USDA U.S. Department of Agriculture
UTI urinary tract infection
UW University of Washington
UW tele-ASP University of Washington Tele-Antimicrobial Stewardship Program
Page xxviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
VA Department of Veterans Affairs
VEN Venezuela
VetCAST EUCAST subcommittee for Veterinary Antimicrobial Susceptibility Testing
VIM Verona integron-encoded metallo-ß-lactamases
VNM Vietnam
VRE vancomycin-resistant Enterococci
WASH water, sanitation, and hygiene
WFD Water Framework Directive
WHO World Health Organization
WWTP wastewater treatment plant
ZAF South Africa
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R1
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R2
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R3
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R4
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R5
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R6
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R8
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R10
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R11
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R13
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R14
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R15
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R16
Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R17
Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R18
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R19
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R20
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R21
Page xxii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R22
Page xxiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R23
Page xxiv Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R24
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R25
Page xxvi Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R26
Page xxvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R27
Page xxviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. doi: 10.17226/26350.
×
Page R28
Next: Summary »
Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine Get This Book
×
Buy Paperback | $45.00 Buy Ebook | $36.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Antimicrobial resistance is a health problem that threatens to undermine almost a century of medical progress. Moreover, it is a global problem that requires action both in the United States and internationally.

Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine discusses ways to improve detection of resistant infections in the United States and abroad, including monitoring environmental reservoirs of resistance. This report sets out a strategy for improving stewardship and preventing infections in humans and animals. The report also discusses the strength of the pipeline for new antimicrobial medicines and steps that could be taken to bring a range of preventive and therapeutic products for humans and animals to the market.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!