late Joshua Lederberg, humans and microbes continue to be locked in a contest between “our wits and their genes” (Lederberg, 2000).

It should be noted at the outset of this document that the meaning of the phrase “antimicrobial resistance” is wholly context-dependent. Most commonly, it refers to infectious microbes that have acquired the ability to survive exposures to clinically relevant concentrations of drugs that would kill otherwise sensitive organisms of the same strain. The phrase is also used to describe any pathogen that is less susceptible than its counterparts to a specific antimicrobial compound (or combination thereof). Resistance manifests as a gradient based on genotypic and phenotypic variation within natural microbial populations, and even microbes with low levels of resistance may play a role in propagating resistance within the microbial community as a whole (American Academy of Microbiology, 2009).

Pathogens resistant to multiple antibacterial agents, while initially associated with the clinical treatment of infectious diseases in humans and animals, are increasingly found outside the healthcare setting. Therapeutic options for these so-called community-acquired pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA) are extremely limited, as are prospects for the development of the next generation of antimicrobial drugs.

On April 6 and 7, 2010, the Institute of Medicine’s (IOM’s) Forum on Microbial Threats convened a public workshop in Washington, DC, to consider the nature and sources of AMR, its implications for global health, and strategies to mitigate the current and future impacts of AMR. Through invited presentations and discussions, participants explored the evolutionary, genetic, and ecological origins of AMR and its effects on human and animal health worldwide. Participants also discussed host and environmental factors associated with the expansion of AMR, strategies for extending the useful life of antimicrobials, alternative approaches for treating infections, incentives and disincentives for prudent antimicrobial use, and prospects for the discovery and development of ”next generation” antimicrobial therapeutics. While it was the “intent” of the workshop planners and organizers to cover the phenomenon of AMR broadly, workshop presentations and discussions focused almost exclusively on bacterial resistance to antibacterial drugs.

Organization of the Workshop Summary

This workshop summary was prepared by the rapporteurs for the Forum’s members and includes a collection of individually authored papers and commentary. Sections of the workshop summary not specifically attributed to an individual reflect the views of the rapporteurs and not those of the Forum on Microbial Threats, its sponsors, or the IOM. The contents of the unattributed sections are based on the presentations and discussions at the workshop.

The workshop summary is organized into sections as a topic-by-topic description of the presentations and discussions that took place at the workshop.

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