title: Understanding the mechanisms and drivers of antimicrobial resistance.
abstract: 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 affected 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 fitness cost, an effect 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 five 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 effective antimicrobials.
authors.affiliation: National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, and Department of Infectious Diseases, Imperial College London, London, UK. Electronic address: alison.holmes@imperial.ac.uk.
authors.forename: Alison H
authors.initials: AH
authors.lastname: Holmes
authors.affiliation: National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, and Department of Infectious Diseases, Imperial College London, London, UK.
authors.forename: Luke S P
authors.initials: LS
authors.lastname: Moore
authors.affiliation: Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Clinical Microbiology and Infection Control, University Hospital of North Norway, Norway; Department of Medical Biology, University of Tromsø, Tromsø, Norway.
authors.forename: Arnfinn
authors.initials: A
authors.lastname: Sundsfjord
authors.affiliation: Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Martin
authors.initials: M
authors.lastname: Steinbakk
authors.affiliation: Institute for Science, Ethics and Innovation (iSEI), University of Manchester, Manchester, UK.
authors.forename: Sadie
authors.initials: S
authors.lastname: Regmi
authors.affiliation: Oxford Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal.
authors.forename: Abhilasha
authors.initials: A
authors.lastname: Karkey
authors.affiliation: Worldwide Antimalarial Resistance Network (WWARN), and Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Philippe J
authors.initials: PJ
authors.lastname: Guerin
authors.affiliation: Antimicrobials Research Group, Institute for Microbiology and Infection, University of Birmingham, Birmingham, UK.
authors.forename: Laura J V
authors.initials: LJ
authors.lastname: Piddock
mesh_terms: D000383:Agriculture; D000822:Animal Husbandry; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000635:transmission; D004352:Drug Resistance, Microbial; D004777:Environment; D006291:Health Policy; D006801:Humans; D057970:Inappropriate Prescribing; D014611:Vaccination
chemical_list: D000900:Anti-Bacterial Agents