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Executive Summary

A colloquium was convened by the American Academy of Microbiology to bring together leading scientists to review the fundamental relationships between the use of antimicrobial agents in humans, animals, agriculture, and aquaculture and their effects on humans, animals, and the environment.The colloquium was held in San Juan, Puerto Rico, on July 16-18, 1999.

Bacteria are everywhere and are inextricably linked to the lives of the organisms and larger environments they inhabit. Resistance to antimicrobial agents is inevitable and irreversible, a natural consequence of bacterial cell adaptation to exposure to antimicrobials. Multiple uses of antimicrobial agents in medicine, production of food animals, and crop protection have caused increasing resistance to those agents.Widespread use of disinfectants in household products may also be contributing to the development of resistance.

As existing antimicrobial agents decline in effectiveness, infections will be more difficult and expensive to treat and epidemics harder to control. The environmental consequences of the widespread use of antimicrobial agents are still little understood.

The medical community, governments, the World Health Organization, and other non-governmental international agencies have begun to institute policies to address the problem of antimicrobial resistance. However, there remains a lack of systematic and coordinated action. Surveillance—the collection, analysis, and reporting of data—is crucial. Different types of surveillance data are needed for each component of the biosphere, and data must be made available for treatment decisions, new drug development, and policy formation.

Further scientific research is required to determine the effects of antimicrobials on the environment, better assess the consequences of resistance to human health and ecology, and develop ways to detoxify antimicrobials.The possibilities for new diagnostic procedures, improved therapies, reintroduction of susceptible microorganisms, and reversal of resistance should be explored. Special efforts and innovative methods must be employed to investigate the global impact of antimicrobial resistance and find more effective ways to educate health care professionals, policy makers, and the public.