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Beyond Antimicrobial Use: A Framework for Prioritizing Antimicrobial Resistance Interventions

Authors
  • Noyes, Noelle R.
  • Slizovskiy, Ilya B.
  • Singer, Randall S.
Type
Published Article
Journal
Annual Review of Animal Biosciences
Publisher
Annual Reviews
Publication Date
Feb 15, 2021
Volume
9
Pages
313–332
Identifiers
DOI: 10.1146/annurev-animal-072020-080638
Source
Annual Reviews
Keywords
License
Yellow

Abstract

Antimicrobial resistance (AMR) is a threat to animal and human health. Antimicrobial use has been identified as a major driver of AMR, and reductions in use are a focal point of interventions to reduce resistance. Accordingly, stakeholders in human health and livestock production have implemented antimicrobial stewardship programs aimed at reducing use. Thus far, these efforts have yielded variable impacts on AMR. Furthermore, scientific advances are prompting an expansion and more nuanced appreciation of the many nonantibiotic factors that drive AMR, as well as how these factors vary across systems, geographies, and contexts. Given these trends, we propose a framework to prioritize AMR interventions. We use this framework to evaluate the impact of interventions that focus on antimicrobial use. We conclude by suggesting that priorities be expanded to include greater consideration of host–microbial interactions that dictate AMR, as well as anthropogenic and environmental systems that promote dissemination of AMR.

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