U.S. fatalities associated with antibiotic-resistant pathogens have declined, but threats remain as resistance emerges in previously susceptible organisms.
Those mixed results come from the U.S. Centers for Disease Control and Prevention (CDC), which this week release its 2019 Antibiotic Resistance Threats Report. The most recent previous report was issued in 2013, and CDC officials outlined progress over the past six years during a Nov. 13 news briefing.
During the briefing, CDC Director Robert R Redfield, M.D., and Michael Craig, MPP, with the CDC’s Antibiotic Resistance Coordination and Strategy Unit, noted that antibiotic-resistant (AR) bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the United States each year.
Back in 2013, the CDC study provided an estimate of 23,000 U.S. deaths from AR bacteria and fungi. However, using more comprehensive methodology developed for the 2019 report, the agency revised their 2013 estimate to 44,000 deaths. Using those revised figures, the 2019 report shows a, 18% reduction in annual AR-associated deaths since 2013.
Redfield notes that infections acquired during visits to hospitals or other health-care facilities account for about 85% of fatalities associated with antibiotic resistance. Since 2013, the report indicates a 30% decline in deaths from infections acquired in hospitals. He attributes the improvement to better infection prevention and control in healthcare facilities, better diagnostics and early intervention, improvements in food safety and other preventive measures such as vaccination. Redfield stresses that vaccination remains our most powerful tool for preventing infectious diseases and thus slowing emergence of antibiotic-resistant pathogens.
The report lists 18 urgent, serious and concerning threats, with threats rated as urgent including:
- Carbapenem-resistant Acinetobacter
- Candida auris (C. auris)
- Clostridioides difficile (C. difficile)
- Carbapenem-resistant Enterobacteriaceae (CRE) Drug-resistant Neisseria gonorrhoeae (N. gonorrhoeae)
In his introduction to the report, Dr. Redfield notes that combatting antibiotic resistance and protecting public health in the future will require fundamental mindset changes, including these steps:
- Stop referring to a coming post-antibiotic era—it’s already here. You and I are living in a time when some miracle drugs no longer perform miracles. Stop playing the blame game. Each person, industry, and country can affect the development of antibiotic resistance.
- Stop relying only on new antibiotics that are slow getting to market and that, sadly, these germs will one day render ineffective. We need to adopt aggressive strategies that keep the germs away and infections from occurring in the first place.
- Stop believing that antibiotic resistance is a problem “over there” in someone else’s hospital, state, or country—and not in our own backyard.
“Simply, here’s what works,” Redfield writes. “Preventing infections protects everyone. Improving antibiotic use in people and animals slows the threat and helps preserve today’s drugs and those yet to come. Detecting threats and implementing interventions to keep germs from becoming widespread saves lives.”
The report’s authors note the important role of livestock producers and veterinarians, and suggest these actions for veterinarians
Prevent Disease: Implement best practices for animal husbandry, vaccination, nutrition, and biosecurity (e.g., infection control). Educate people who engage with animals on how to prevent disease.
Maintain Accurate Records of Treatment & Outcomes: Document and review diagnostic test results and patient response to therapy. Re-evaluate reason for prescribing, dose, and duration as needed.
Stay Current: Stay up-to-date on disease prevention tools; consensus and prescribing guidelines; local, state, and federal requirements; and professional standards for antibiotic use.
Clean Your Hands & Equipment: Wash your hands regularly to remove germs, avoid getting sick, and prevent spread of germs between animals and people. Disinfect equipment to help prevent spread among animals and between farms.
Select & Use Antibiotics Appropriately: Follow regulatory requirements (antibiotic use should involve veterinary oversight per U.S. guidance). Use current established guidelines and diagnostic tests to assess the need, selection, dose, frequency, and duration of antibiotics.
Prevent Environmental Contamination: Dispose of unused or expired antibiotics appropriately.
Commit to Antibiotic Stewardship: Implement practice-level stewardship activities, including documenting antibiotic use data, examining use practices, and serving as an educational resource for clients. Engage veterinary diagnostic labs to provide antibiograms to help determine which antibiotics will effectively treat infections. Become familiar with and use the American Veterinary Medical Association established antibiotic use principles to build an antibiotic stewardship plan for your practice settings.
View the full 2019 Antibiotic Resistance Threat Report from the CDC.
For more on antibiotic-resistance trends, see these articles from BovineVetOnline: