Journal
LANCET
Volume 387, Issue 10014, Pages 176-187Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/S0140-6736(15)00473-0
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Funding
- National Institute of Health Research Imperial Biomedical Research Centre
- UK Clinical Research Collaboration, Centre for Infection Prevention and Management [UKCRC G0800777]
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London
- Public Health England (PHE)
- Research Council of Norway
- Northern Norway Regional Health Authority Medical Research Programme
- Norwegian Ministry of Health and Care Services
- Norwegian Institute of Public Health
- UK BBSRC
- MRC
- Roche Extending Innovation Network award
- MRC [G0800777] Funding Source: UKRI
- Medical Research Council [G0800777] Funding Source: researchfish
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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 aff ected 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 fi tness cost, an eff ect 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 fi ve 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 eff ective antimicrobials.
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