Progress and New Challenges in Combatting the Threat of Antimicrobial Resistance: Perspective From an Infectious Diseases Pharmacist

By the time the Centers for Disease Control and Prevention (CDC) released the first Antibiotic Resistance Threats report in 2013, it was clear that antimicrobial resistance (AMR) was a complex public health crisis with potentially catastrophic consequences [1].The report identified 18 antimicrobial resistant pathogens categorized as urgent, serious, and concerning threats, which were responsible for a minimum of 2 million infections and 23,000 deaths annually in the United States.Threats spanned a spectrum of commonly encountered human pathogens, including drugresistant Gram-positive and Gram-negative bacteria, mycobacterium, fungi and Clostridium difficile.Four core actions were proposed, including preventing infections, tracking AMR, improving use of antibiotics, and promoting the development of new antibiotics.Since publication, developments against Gram-negative threats like carbapenem-resistant Enterobacterales (CRE) have become the paradigm for progress in AMR research.For example, in 2013 rates of CRE were rising on every continent, front-line treatment regimens often included highly toxic agents like aminoglycosides or polymyxins, rapid molecular diagnostics tests were not widely implemented, and mortality rates of infected patients typically exceeded 30%.Fast forward a decade and much has changed.Rates of serious and urgent antibiotic resistance threats like CRE, multidrug-resistant Pseudomonas aeruginosa (MDR-Pa), and carbapenem-resistant Acinetobacter baumannii (CRAb) have stabilized or down trended in the United States [2], rapid molecular tests have become standard of care at many hospitals and 8 new antibiotics with enhanced in vitro activity against CRE, MDR-Pa, and/or CRAb have been approved by the Food and Drug Administration (Table ).Most importantly, treatment with newly developed antibiotics has contributed to an 18% reduction in deaths attributable to AMR pathogens in an updated report from the CDC [3].Taken together, the AMR field has witnessed significant advances in the diagnosis, treatment, and prevention of