Antimicrobial Resistance: A Call to Action!

To the Editor—On 21 September, the United Nations (UN) General Assembly brought together world leaders to convene a high-level meeting focused on the public health crisis of antimicrobial resistance (AMR) [1]. The meeting outlined a plan to mitigate the more than 200 000 deaths and $20 billion in excess healthcare spending attributable to drug-resistant pathogens each year [2]. As a cohort of recently graduated infectious diseases (ID) fellows, we believe that this meeting heralds a unique moment in history for the ID community to shape political discourse. We envision 2 distinct, but equally important, venues for action.

First, we can leverage the momentum of a renewed global spotlight on AMR to make an impact at a local level. We can build on the enthusiasm of the UN meeting to bolster programs at our own institutions that support the judicious use of antimicrobials. We can take this opportunity to educate our colleagues in other specialties not only about antibiotic algorithms but also about the global importance of wise local antimicrobial prescribing.

A comprehensive approach to reducing AMR cannot take place without a full workforce of ID-trained physicians, midlevel providers, nurses, and pharmacists. However, it is widely known that there has been a steep drop in applicants to ID fellowships over recent years [3] Although the reasons for this drop are complex, in its open letter to the US House of Representatives on 13 June 2016, the Infectious Diseases Society of America cited unpublished data showing that low salary is the reason most often cited by internal medicine residents for not applying to the ID field [4]. In this setting, we can encourage our own institutions to increase remuneration to ID providers and leverage this important moment to inspire the next generation of providers to join us in making a difference.

The UN General Assembly meeting highlights a second way in which we in the ID community can take action on this important issue beyond our local practice settings. As experts in AMR, our opinions are valued, and our voices carry substantial weight in venues such as newspaper editorials, community town halls, government testimony, and legislative petitions (eg, the Infectious Diseases Society of America's petition to the UN [5]). The case of plasmid-mediated colistin resistance recently reported for the first time in the United States [6] has made us keenly and humbly aware of global interconnectedness and the direct connection between environmental antimicrobial use and the development of AMR. To have a meaningful impact on global AMR, we must advocate for policies that reduce the indiscriminant and widespread use of antibiotics in agriculture and livestock [2, 7, 8].

ID clinicians are uniquely qualified to leverage this moment of national and international political interest and shape the future in meaningful ways. We have the power to change the tide and paradigm of policies that are compromising the last antimicrobials we have available, but accomplishing this will require us to step out of our typical roles and speak together on this critical global issue to elicit change.