- U.S. NEWS
- Updated September 16, 2013, 7:32 p.m. ET
Antibiotics Losing Battle Against Bugs: Report
- BETSY MCKAY
More than two million people in the U.S. develop infections every year that are resistant to antibiotics, and at least 23,000 of them die as a result, according to a government report Monday that called for aggressive steps to counter a worsening public health problem.
Another 250,000 people annually develop a bacterial infection, clostridium difficile, and about 14,000 of those cases prove fatal, the Centers for Disease Control and Prevention said in its first report to give an overview of the threat and toll of antibiotic-resistant bugs that cause most infections.
C.D.C.A government microbiologist demonstrates a test used to identifyantibiotic resistance in bacteria known as Enterobacteriaceae.
Public-health experts are increasingly sounding the alarm about the number of microbes, from normally harmless intestinal bacteria to tuberculosis, that are winning a Darwinian battle of sorts for survival of the fittest against the antibiotics meant to kill them. Some, like gonorrhea or certain “superbugs” that have been found spreading in medical facilities, have outsmarted nearly all the drugs used to treat them.
“If we’re not careful and we don’t take action, the medicine cabinet may be empty for patients with life-threatening infections in the coming months and years,” CDC Director Tom Frieden said in a conference call with reporters. The pipeline of new drugs to overcome these powerful infections “is nearly empty for the short term,” he said. and some new drugs could be a decade away.
The report was blunt in summing up the reasons for greater resistance to antibiotics, including excessive use. “Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe,” it said.
Bacteria evolve quickly to evade the antibiotics meant to kill them, so greater use of antibiotics will tend to lead to more drug-resistant germs. Such bugs can spread easily in hospitals or communities, carried by unclean hands or medical equipment, or even pass through the air. They cross borders and continents easily, and also complicate treatment of the conditions which land people in the hospital or a medical facility in the first place. They are expensive to treat, costing as much as $20 billion a year in excess direct health costs, estimates cited in the report said.
The report also said more antibiotics in the U.S. are given to animals than humans, and people can be infected with drug-resistant germs through food. Giving antibiotics to food-producing animals to promote their growth isn’t necessary and should be “phased out,” it said.
The CDC ranked 18 drug-resistant bacteria and fungi by threat level. Three are ranked “urgent,” meaning they have few treatment options and the potential to become widespread. They include carbapenem-resistant enterobacteriaceae—”nightmare bacteria” that “can resist essentially all antibiotics and kill a high number of people who get it in their blood,” Dr. Frieden said. More than 9,000 health-care-associated infections are caused by CRE each year, the report said, with infections identified in 44 states. Carbapenems are a class of drugs seen as the antibiotic of last resort.
Also marked urgent is clostridium difficile, a life-threatening infection that occurs mostly in people who have recently been given antibiotics and undergone medical care. The number of deaths from c. difficile has risen more than five times between 2000 and 2007, in part because of a stronger strain of the bacteria that emerged in 2000. That strain spreads rapidly and is resistant to a common class of antibiotics, the CDC said.
The third urgent threat is gonorrhea, a sexually transmitted infection that can cause infertility. It is increasingly resistant to the last line of medicines available to treat it. although researchers recently identified three combinations of existing antibiotics as fall-back options.
Another 12 infections are ranked “serious,” including drug-resistant forms of candida fungus, salmonella, and tuberculosis, which is a worsening problem globally and requires often two years or more of toxic drugs to cure. One staphylococcus and two streptococcus are ranked “concerning.”
Many hospitals now have “antibiotic stewardship” programs that oversee how the drugs are prescribed. But more needs to be done, said Edward Septimus, a professor of internal medicine at the Texas A&M University Health Science Center, and a member of the Infectious Diseases Society of America’s antimicrobial resistance committee. “These things we’re talking about have to be done across the continuum of care” in doctors’ offices and throughout communities, he said.