Infections able to thwart most antibiotics have become an “urgent health threat,” striking more than 2 million Americans per year and killing at least 23,000, the federal government said Monday. If action isn’t taken immediately, the Centers for Disease Control and Prevention concluded in a landmark report, our medicine cabinet may become empty of drugs needed to fight these infections.
The report named the three biggest threats from these superbugs. One is an antibiotic-resistant form of the sexually-transmitted disease gonorrhea, while another is a relatively new pathogen called carbapenem-resistant Enterobacteriaceae, which has been spreading quickly through hospitals and now causes 600 deaths a year in the United States.
The third is well-known, Clostridium difficile, which is still treatable with antibiotics but often takes over the gastrointestinal tract when strong antibiotics wipe out the good bacteria that keep C. difficile in check. Some 14,000 Americans die every year from the nasty diarrhea and intestinal inflammation that the bacteria cause.
“This report clearly shows that antimicrobial resistance is happening here in every community,” said CDC director Dr. Tom Frieden in a media briefing. “It will require a lot of action now,” he added, before it’s too late.
Such dire warnings have been sounded before, but the antibiotic-resistance problem continues to get worse. Many doctors and hospitals have already implemented much of what the CDC recommended Monday in its four-part action plan, including curtailing the use of antibiotics except when absolutely necessary and implementing more stringent hygiene rules to prevent the transmission of infections from doctors to patients.
The CDC also said it plans to do a better job tracking drug-resistant infections to determine where they originate and will work with other government entities and pharmaceutical firms to speed the development of novel antibiotics, Frieden said. He emphasized that the number of infections and deaths was a conservative estimate and that the true incidence was likely much higher.
Frieden pointed to some “bright spots,” such as antibiotic stewardship programs recently adopted by many hospitals nationwide. Infections involving methicillin-resistant Staphylococcus aureus, or MRSA, have fallen by half in hospitals that have initiated these programs.
“It’s about using the right antibiotic, in the right patients, at the right dose at the right time,” said infectious disease specialist Dr. Helen Boucher, who started the program at Tufts Medical Center in 2002. The program has resulted in a decline in severe allergic reactions to antibiotics, a curtailing in broad-spectrum antibiotic use, which has helped prevent C. difficile infections, and a cost savings due to reduced use of the drugs overall.
Boucher, who serves on the antimicrobial resistance committee of the Infectious Disease Society of America, said most academic teaching hospitals in Massachusetts have adopted similar stewardship programs, but many community hospitals have not since they’re not required to do so by the state. Three years ago, California became the first state to pass legislation requiring hospitals to adopt such programs.
But infectious disease experts acknowledge that such programs won’t fully solve the problem because bacteria naturally develop a resistance to antibiotics over time, requiring new drugs to be added to the arsenal.
Consumers can also take protective measures to lower their risk of getting them, including using condoms with a new sex partner and making sure doctors wash their hands before any examination, recommended the CDC.
“You should see doctors washing their hands before and after any exam,” Boucher added. “If you don’t, ask about it.” She also said patients shouldn’t go into doctors’ offices expecting to be handed a prescription for an antibiotic if they have lingering symptoms. “Many infections, like colds, don’t require them.”
One consumer activist group criticized the CDC for missing an important opportunity to make recommendations about the overuse of antibiotics in the farming industry.
The “CDC found that 22 percent of the resistant illnesses are linked to foodborne hazards, so the overuse of antibiotics in the animal sector can no longer be ignored,” Caroline Smith DeWaal, director of food safety at the non-profit Center for Science in the Public Interest, said in a statement. “Action is urgently needed to manage the food safety risks posed by the non-therapeutic use of antibiotics in food animals.”
Other federal agencies, such as the US Food and Drug Administration and the US Department of Agriculture, have taken the lead on this issue, Frieden said. But Boucher agreed that antibiotics in the food supply could account for some antibiotic-resistant infections in people.