Differential Drivers of Antimicrobial Resistance across the World

• DOI: 10.1021/acs.accounts.8b00643
• Publication Date: 2019-03-08T20:22:06Z
• Authors: Peter Vikesland; Emily Garner; Suraj Gupta; Seju Kang; Ayella Maile-Mosk...; Ni Zhu
• Keywords: Horizontal Gene Transfer

ConspectusAntimicrobial resistance (AMR) is one of the greatest threats faced by humankind. The development in clinical and hospital settings has been well documented ever since initial discovery penicillin subsequent introduction sulfonamides as antibiotics. In contrast, environmental (i.e., community-acquired) dimensions dissemination have only more recently delineated. global spread antibiotic resistant bacteria (ARB) genes (ARGs) between air, water, soil, food now documented, while factors that affect ARB ARG (e.g., water air quality, fluxes, urbanization, sanitation practices) these other matrices are just beginning to be fully appreciated.In this Account, we discuss how perpetuation dictated highly interconnected socioeconomic risk illustrate status should considered when developing strategies address AMR. We first differentiate low middle income countries (LMICs) high-income (HICs), then summarize modes action commercially available antibiotics, four primary mechanisms which develop those Resistance disseminated via both vertical gene transfer (VGT; parent offspring) horizontal (HGT; cell transference genetic material). A key challenge hindering attempts control presence native, can harbor ARGs. Such "resistomes" potential pathogens HGT. Of particular concern antibiotics last-resort such cephalosporins, carbapenems, polymyxins.We use differs LMICs relative HICs terms volumes used their fate within local environments. Antibiotic remained flat over past 15 years, same period increased substantially a result economic improvements changes diet. These differences impact citizens thus Various physical, social, circumstances potentially favor AMR dissemination. focus on three physical factors: changing population density, infrastructure, solid-waste disposal. show high densities cities suffer from poor disposal resistance. final section, monitoring approaches quantify HICs. posit culture-based approaches, molecular cutting-edge nanotechnology-based methods for ARGs and, appropriate, LMICs.