The antimicrobial resistance crisis: management through gene monitoring.
Antimicrobial resistance (AMR) is an acknowledged crisis for humanity. Its genetic origins and dire potential outcomes are increasingly well understood. However, diagnostic techniques for monitoring the crisis are currently largely limited to enumerating the increasing incidence of resistant pathogens. Being the end-stage of the evolutionary process that produces antimicrobial resistant pathogens, these measurements, while diagnostic, are not prognostic, and so are not optimal in managing this crisis. A better test is required. Here, using insights from an understanding of evolutionary processes ruling the changing abundance of genes under selective pressure, we suggest a predictive framework for the AMR crisis. We then discuss the likely progression of resistance for both existing and prospective antimicrobial therapies. Finally, we suggest that by the environmental monitoring of resistance gene frequency, resistance may be detected and tracked presumptively, and how this tool may be used to guide decision-making in the local and global use of antimicrobials.
School of Life Sciences, University of Technology Sydney, Sydney 2007, Australia carolyn.michael@uts.edu.au camcon@ozemail.com.au.
Carolyn A
0000-0002-3846-3380
CA
Michael
Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Melbourne, Victoria, Australia.
Ashley E
0000-0003-1664-6060
AE
Franks
School of Life Sciences, University of Technology Sydney, Sydney 2007, Australia.|ithree institute, University of Technology Sydney, Sydney 2007, Australia.
Maurizio
0000-0003-1428-3382
M
Labbate
D000900:Anti-Bacterial Agents; D001419:Bacteria / Q000235:genetics*; D001426:Bacterial Proteins / Q000235:genetics*; D024881:Drug Resistance, Bacterial; D019143:Evolution, Molecular; D005787:Gene Frequency; D016680:Genome, Bacterial; D006801:Humans; D011446:Prospective Studies; D012641:Selection, Genetic
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins
antimicrobial resistance; crisis management; evolution; horizontal gene transfer