ing in number and power the drugs available for combating infectious diseases. Resistance to available therapies is a major confounding factor in effective treatment of human pathogens that account for the majority of the global infectious disease burden—malaria, tuberculosis, and AIDS. Today, some pathogenic strains of bacteria that were previously readily amenable to antibiotic therapy have become resistant to all available antibiotics, while strains of many other serious pathogens are now resistant to all but one easily administered drug, placing them on the brink of being untreatable. Coupled with the unrelenting emergence of antimicrobial resistance among common pathogens, there is a growing sense that drug discovery efforts are yielding fewer and fewer truly new leads toward novel classes of antimicrobial agents. This raises the specter of a real shift in the balance of the battle being fought by health professionals against a wide array of infectious agents.

Concerns about microbial resistance are further compounded by the possibility, made vivid during autumn 2001, that terrorists or a rogue nation might use biological weapons to trigger large-scale disease outbreaks. The ability to respond effectively to such events could be significantly compromised by the purposeful introduction of genetically engineered drug-resistant pathogens. Furthermore, the use of prophylactic antimicrobials or biologics in large populations of humans and/or animals in response to such a threat also may hasten the development of drug resistance and thus compound the risks of both immediate and longer-term problems in treating infectious diseases.

The Forum on Emerging Infections convened a two-day workshop discussion—the subject of this summary—to take a fresh look at a variety of issues related to microbial resistance. The goal was not to lament continuing shortcomings, but to reconsider our understanding of the relationship between microbes, disease vectors, and the human host, and to identify possible new strategies for meeting the challenge of resistance. Central to the discussion was an exploration of the many similarities inherent in the emergence of resistance to antimicrobial drugs, and the development of resistance to pesticides among insect vectors of serious pathogens such as the malaria parasite.

FRAMING THE ISSUE

Drug-resistant bacterial, viral, and protozoan pathogens pose a serious and growing menace to all people, regardless of age, gender, or socioeconomic background—a picture that holds true for developed and developing nations alike. Indeed, microbial resistance threatens to reverse many of the therapeutic miracles of the past half century. A rapidly expanding list of antimicrobial-resistant organisms is affecting us in a variety of ways.



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