The 2017 Garrod Lecture: Genes, guts and globalization

Area of Science:

• Microbiology
• Epidemiology
• Public Health

Background:

• Widespread antibacterial drug use over 70 years has led to increasing drug inefficacy.
• Antibacterial agents promote the proliferation of resistant bacterial strains, particularly in healthcare settings.
• Enterobacteriaceae have emerged as a significant challenge, surpassing concerns over Gram-positive pathogens like Staphylococcus aureus.

Discussion:

• Enterobacteriaceae possess efficient genetic exchange mechanisms, facilitating the rapid spread of resistance genes, such as CTX-M β-lactamases and carbapenemases.
• The natural colonization of the mammalian gut by Enterobacteriaceae leads to environmental release and community-wide exposure, posing a substantial public health threat.
• Antimicrobial use in agriculture, coupled with global trade and travel, exacerbates the diversity and prevalence of antibiotic resistance.

Key Insights:

• Enterobacteriaceae represent the most significant challenge in antibiotic resistance due to their genetic adaptability and environmental dissemination.
• The emergence and spread of specific resistance mechanisms (e.g., CTX-M β-lactamases, carbapenemases) highlight the rapid evolution of bacterial defense.
• Community-wide exposure to antibiotic-resistant bacteria is amplified by environmental contamination originating from human and animal reservoirs.

Outlook:

• Effective control of antibiotic resistance necessitates globally coordinated interventions, drawing parallels with strategies for addressing climate change.
• Future strategies must address the One Health perspective, integrating human, animal, and environmental health approaches.
• Continued surveillance and research into novel control measures are essential to mitigate the escalating threat of antimicrobial resistance.