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     1. Implications of Microbial Resistance

1. Implications of Microbial Resistance

Quantifying the burden of AMDR is a challenge. Deaths from acute respiratory infections, diarrheal diseases, measles, AIDS, malaria, and tuberculosis account for more than 85% of the mortality from infections worldwide. Rising resistance to first-line drugs in most of the pathogens that cause these diseases ranges from zero to almost 100% (Cassell and Mekalanos 2001). It has been suggested that the use of quinine versus chloroquine as first-line therapy in 150 million patients with malaria would increase spending by as much as US $100 million (Phillips and Phillips-Howard 1996). Costs associated with patient fear of infection and behavior change in populations living in high-prevalence areas also contribute to the overall morbidity, mortality, and cost associated with AMDR pathogens (Philipson and Posner 1993).


Prolonged illness and hospitalization are costly, and the use of expensive first-line antibiotics can further increase cost, making newer antibiotics unaffordable for many governments and patients, especially in developing countries (World Health Organization 2005; Naber 2009). In 1995, the US Congressional Office of Technology Assessment (COTA) estimated that antibiotic resistance costs the United States US $1.3 billion annually (US Congress, Office of Technology Assessment 1995). An Institute of Medicine report estimated that the total cost to society of antimicrobial resistance in the United States was at least US $4 to 5 billion annually (Harrison and Lederberg 1998). Reliable estimates worldwide are not available.

“The next frontier for microbiology may well be determining the causal relationships between infections and a wide range of chronic diseases, from the nation’s biggest health problems, cancer and heart disease, to more obscure ailments.”

 National Institutes of Health/National Institute of Allergy and Infectious Diseases Council News (1999). “Focus is Sharpening on the Role of Microbes and Chronic Diseases.”


Table of Contents

SECTION ONE: The global threat of AMDR
SECTION TWO: Understanding AMDR
    1. Etiology and Epidemiology
    2. Incidence and Prevalence of Microbial Resistance
    3. Major AMDR Pathogens
       a. Acinetobacter baumanii
       b. Clostridium difficile
       c. Escherichia coli
       d. HIV/AIDS and Sexually Transmitted Infection
       e. Influenza virus
       f. Malaria (Plasmodium)
       g. Methicillin-resistant Staphylococcus aureus (MRSA)
       h. Streptococcus pneumoniae
       i. Tuberculosis and MDR-TB
       j. Vancomycin-Resistant Enterococcus (VRE)
SECTION THREE: Control and Prevention of AMDR
    1. Implications of Microbial Resistance
    2. Infections and Chronic Diseases
    3. Policies and Best Practices
       a. Antimicrobial Drug Stewardship
       b. Surveillance
       c. Environmental Decontamination
       d. Infection Control
       e. Patient Education
    4. Antibiotic Development Pipeline
SECTION FOUR: Conclusions
Test Questions
Program Evaluation
Self Assessment

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