Antibiotics Overuse as the Driving Force behind Antimicrobial Resistance

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About this Research Topic

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Background

Anti-microbial resistance (AMR) is defined by the WHO as bacteria, viruses, fungi, and parasites that change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness, and death.

Based on the 2019 resistance report of the CDC, more than 2.8 million antibiotic-resistant infections occur annually in the US alone, causing approximately 35,000 deaths.

AMR at its basis is an evolutionary process. The fittest bacteria strains that randomly acquire resistance to antimicrobial agents can continue propagation. Hence, overuse of antibiotics has been identified as the leading driver of AMR.

Physicians’ basic motivation to prescribe antibiotics is to shorten disease duration and reduce complications. Other considerations such as patient satisfaction and pressure, time constraints, and decision fatigue are also involved. For example, cumulative fatigue was demonstrated to play a role in doctors writing more prescriptions for antibiotics towards the end of their working day.

The diagnostic dilemma when suspecting an infection is commonly reduced to whether the etiology is bacterial or viral, and which bacteria or virus. Its accurate resolution is often dependent on lab support. The last two decades brought immense technological advancements to clinical microbiology. Numerous technologies including multiplex PCR, faster culture systems, rapid antigen testing, mass spectrometry-based pathogen detection, rapid susceptibility testing, and NGS-based pathogen detection took clinical microbiology into the 21st century. More advanced approaches are focused on characterizing the host immune response to infection through different modalities such as proteomics and transcriptomics.

Understanding the current role of antibiotic overuse in the development of AMR will allow us to understand and promote programs to reduce antibiotic overuse and AMR rates. This goes from AMR development mechanisms, through the clinical dilemma physicians face and the behavioral psychology behind the decision to issue an antibiotic prescription. This also includes the entire set of tools available to the healthcare practitioner today to make the correct decision.

In this Research Topic, we welcome contributions in the form of reviews, mini-reviews, opinions, perspectives, and translational or fundamental research covering the following topics:
• What are the most recent concepts of AMR mechanisms and driving forces?
• The problem of antibiotic overuse- what makes physicians prescribe antibiotics?
• The ability of traditional tools to correctly identify infection etiology.
• Using AI and other computer-based algorithms to guide antibiotic stewardship
• Translational research – what are the barriers to implementing tests and technologies proven efficacious in clinical studies in the real world.
• The current role of host immune response proteomics and transcriptomics in infectious diseases diagnostics.
• Innovations in methods for detecting resistant pathogens, based on NAAT and NGS.

Keywords: AMR, Antibiotic overuse, infectious disease diagnostics, Host response diagnostics

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