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Globalization of Antimicrobial Resistance:

Epidemiological Challenges
Rosamund J. Williams
Anti-infective Drug Resistance Surveillance and Containment, Communicable Disease Surveillance and Response, World Health Organization,

(See the article by Tenover on pages S108–15)

Globalization of antimicrobial resistance is a reality, but before the relative impact of global versus local spread
of resistant microorganisms can be quantified, surveillance capacity and information transfer must be greatly

The globalization of antimicrobial resistance is a reality. widespread in many developing countries, pose little
Over and above the increasing rate of emergence of risk of widespread dissemination in developed coun-
new resistance phenotypes, the opportunities for such tries if adequate standards of hygiene are observed. In
strains to spread from person to person and between contrast, importation and subsequent dissemination in
humans, animals, plants, and other environments are the local population of resistant strains of gonorrhea
increasingly recognized. Transmission of resistant [1] and respiratory pathogens [2], including tubercu-
strains both locally and globally needs to be appreciated losis [3] is well documented. Hospital pathogens such
when designing interventions to contain antimicrobial as methicillin-resistant Staphylococcus aureus have been
resistance. International travel has increased enor- imported, for example, when injured patients are re-
mously over the recent years resulting in the multi- patriated after initial hospital treatment.
plication of opportunities for resistant microorganisms Our ability to detect the emergence and global spread
to be carried rapidly from one geographic location to of resistant microorganisms is hampered by the weak-
another. Furthermore, the globalization of trade and ness, or total lack, of adequate surveillance of anti-
the increased contribution that developing countries are microbial resistance [4]. Interpretation of existing sur-
making to the global market in, for example, meat, veillance data is hampered by the multiplicity of
provide additional chances for the spread of resistant methods used to detect resistance and by difficulties in
strains (and/or resistance genes). assessing the quality of the data. Considerable effort
Once imported by the returning traveller, resistant and resources are being committed by the World Health
strains vary in their propensity for spread according to Organization and other partners including the phar-
the route of transmission of the species. The spread of maceutical industry, to improve surveillance capacity
drug-resistant Plasmodium species from an infected through training, laboratory strengthening, and pro-
traveller returning to North America or northern Eu- vision of external quality assurance schemes [5], but
rope to other individuals is extremely unlikely. Resistant there is still much to do.
strains of Salmonella typhi and Shigella dysenteriae, both Even where good quality resistance surveillance data
exist, they are frequently not translated into informa-
tion for public health action. For too long, the sur-
Reprints or correspondence: Dr. Rosamund J. Williams, World Health veillance of antimicrobial resistance has operated
Organization, 20 Ave Appia, 1211 Geneva, Switzerland (
among a relatively “closed” circle of hospital micro-
Clinical Infectious Diseases 2001; 33(Suppl 3):S116–S7
 2001 by the Infectious Diseases Society of America. All rights reserved.
biologists, clinicians, and infection control staff, pro-
1058-4838/2001/3306S3-0003$03.00 viding information for local action and publications,

S116 • CID 2001:33 (Suppl 3) • Williams

but not adding to the understanding of the impact of resistance References
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