Lee Riley

Although the problem of drug resistance has always been a major clinical and public health concern in infectious diseases, it has become a crisis of global importance in the 21st century. In the past, drug-resistant infections have been largely confined to settings or institutions that utilize large amounts of antimicrobial agents, such as hospitals in developed countries like the United States, Japan, and Western Europe. With the rise of BRIC nations, globalization of food trade, medical tourism, and other human economic activities, drug resistant infections are no longer confined to healthcare settings. Multi-drug and extensively drug resistant tuberculosis, drug resistant HIV, drug resistant malaria, as well as community-acquired food-borne diseases, urinary tract infections, pneumonias, and methicillin-resistant Staphylococcus aureus (MRSA) have now become a pandemic that has yet to be recognized as such. Finally, drug resistance determinants (genes) themselves are causing a silent epidemic among pathogens, spread by nonpathogenic bacteria serving as a Trojan horse. Molecular epidemiology studies have revealed new understanding of the transmission dynamics of this global public health problem.