- Category: Opportunistic Illness (OIs)
- Published on Friday, 27 September 2013 00:00
- Written by Liz Highleyman
Bacterial resistance to multiple antibiotics is a growing problem, affecting at least 2 million people each year in the U.S. and resulting in at least 23,000 deaths, according to a new report from the Centers for Disease Control and Prevention (CDC), which is available free online. The consequences of inaction, according to the report, are "potentially catastrophic."
"The loss of effective antibiotics will undermine our ability to fight infectious diseases and manage the infectious complications common in vulnerable patients undergoing chemotherapy for cancer, dialysis for renal failure, and surgery, especially organ transplantation, for which the ability to treat secondary infections is crucial," CDC director Tom Frieden wrote in the report's foreword. Antibiotic resistance is also a threat to immunocompromised individuals, including people with HIV.
When first-line and then second-line antibiotic treatment options are limited by resistance or are unavailable, healthcare providers are forced to use antibiotics that may be more toxic to the patient and frequently more expensive and less effective," he continued. "Even when alternative treatments exist, research has shown that patients with resistant infections are often much more likely to die, and survivors have significantly longer hospital stays, delayed recuperation, and long-term disability."
According to this first-ever snapshot of the burden of resistant bacteria -- as well as Candida, a fungal infection that is also increasingly resistant -- a majority of such infections occur in the general community, though most deaths related to antibiotic resistance occur in healthcare settings such as hospitals and nursing homes.
The most urgent threats, according to the report, are Clostridium difficile (which is not yet significantly resistant to drugs used to treat it, but infections are usually directly related to antibiotic use), carbapenem-resistant Enterobacteriaceae, and drug-resistant Neisseria gonorrhoeae, the bacteria that cause gonorrhea.
In 2012 the CDC revised its gonorrhea treatment recommendations to address the threat of emerging resistance Earlier this year the first documented failure of oral treatment for gonorrhea in North America was reported in Toronto.
"By highlighting gonorrhea as one of the most critical drug resistant threats, this report continues to sound the clarion call that NCSD, its member health departments, and the CDC have been raising for many years now -- that gonorrhea has shown a remarkable ability to develop resistance quickly to all of our existing families of antibiotics," William Smith of the National Coalition of STD Directors stated in a press release. "We continue to need additional investments in public health to be prepared for an untreatable gonorrhea epidemic,” continued Smith."
More than dozen other organisms were listed as "serious" or "concerning" threats, including fluconazole-resistant Candida, drug-resistant Salmonella, Shigella, and Streptococcus, methicillin-resistant Staphylococcus aureus (MRSA), and drug-resistant tuberculosis.
The report includes a discussion of measure than can be taken to reduce the growing threat, including immunization, infection control (including hand-washing), protecting the food supply, better tracking of resistant bacteria, "antibiotic stewardship" (using drugs only as needed), and developing new antibiotics and diagnostic tests. According to the report, antibiotics are currently overused in humans and even more so in animals, including livestock.
"Preventing the spread of antibiotic resistance can only be achieved with widespread engagement, especially among leaders in clinical medicine, healthcare leadership, agriculture, and public health," the report concludes. "Although some people are at greater risk than others, no one can completely avoid the risk of antibiotic-resistant infections."
"If we’re not careful, the medicine chest will be empty when we go there to find a life-saving antibiotic for someone with a deadly infection," he added in a media briefing coinciding with the report's release. "Antibiotic stewardship is the single most important action...By doing that, we can save lives and preserve antibiotics, which are a precious national resource."
Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013.
National Coalition of STD Directors. New CDC Report Terms Drug Resistant Gonorrhea an "Urgent Threat." Press release. September 16, 2013.