Antimicrobial Resistance: Newest Thugs without Drugs

Alexander Fleming noted the importance of drug-resistant microbes when he accepted the Nobel Prize in 1945 for the discovery of the first "wonder drug"—penicillin. Since then, we have benefitted from the development of more than 100 antibacterial drugs and many other products that target viruses and fungi, but unfortunately, the emergence of drug resistance has stayed in lockstep with these discoveries. Initially, most antibacterial resistance was intrinsic—inherent in the particular genomic make-up of the organism. The next wave of resistance emerged through horizontal gene transfer that promotes the spread and accumulation of resistance factors under the selection pressure of antimicrobial treatment, especially in relatively closed populations like healthcare facilities. Today we are seeing an even more ominous phenomenon—the geographic translocation and hence globalization of multiple-resistant organisms on an unprecedented scale. Widespread availability of powerful antimicrobials for human and animal use (often without prescription requirements), urbanization, crowding, social migration, global travel, and medical tourism have produced the perfect storm promoting “superbugs” throughout our ecosystem. Traditional approaches to drug discovery and development simply cannot keep pace with the scale of emergence we are currently experiencing, and finding novel solutions is a global imperative. The domains of innovation must include not only new therapies that target resistant infections in individual human and animal patients, but also bold global geopolitical engagement in effective antimicrobial stewardship efforts. Absent these, we will be left with ominous bugs and no drugs to treat them.