Antibiotic Resistant Bacteria in Hospitals: A Time for Action

Every few years there are reports of antibiotic resistant microbes that prompt a series of predictions about “the end of antibiotics.”  It happened in the 90s with multi-drug resistant tuberculosis and then again earlier this decade with methicillin-resistant Staphylococcus aureus or MRSA.  It’s happening again with carbapenem-resistant Enterobacteriaceae or CRE. Predictably, over time these bacteria have become resistant to more and more antibiotics.  Almost just as predictably, they could be treated by a category of powerful antibiotics known as carbapenems – until now.

Today, 35 states have reported cases of CRE infection to the Centers for Disease Control and Prevention in Atlanta. And they are dangerous. In a recent study of almost 100 cases, more than a third of the patients died from the infection.  The concern over these bacteria is compounded by the fact that there are no new antibiotics to treat them coming anytime soon.  Most experts agree that even in the most optimistic scenario it will likely be about 10 years before effective new drugs are developed.  A variety of efforts are being debated to speed the development of new antibiotics, but these discussions often overlook one critically important issue.  One of the reasons our current antibiotics are losing their effectiveness is because we don’t use them properly.  Studies have shown, repeatedly, that up to 50% of antibiotic prescriptions are either unnecessary or inappropriate – a statistic that is disappointingly consistent across both in-patient hospitals and out-patient clinics.  Not only does this overuse reduce the effectiveness of our current antibiotics, it threatens the utility of any new antibiotics that come along in the future.

While we work on new antibiotics for the future, there is much that must be done right now to both preserve the lifespan of the antibiotics we currently have and to pave the way to ensure prolonged usefulness of new antibiotics that are developed.  The most important immediate need is to reducing the overuse of these drugs. Reducing antibiotic over-use is good for society as a whole but it is also good for individual patients.  A recent study showed that exposure to a carbapenem antibiotic was the single greatest risk factor for getting an infection with CRE, increasing the risk by 15-fold.

This week, the CDC and its partners have launched the “Get Smart for Healthcare” program to complement the existing “Get Smart: Know When Antibiotics Work” program. This is an expansion of CDC’s existing Get Smart programs targeting outpatient clinics and pediatricians offices to include hospitals and nursing homes.  Promoting appropriate antibiotic use, as basic as it seems, can carry our drugs a great deal further.

It can be helpful to view antibiotics much like we view natural resources that benefit from concerted, coordinated conservation efforts.  Conservation requires collaboration and recognition that individual actions have an impact on the common good.  Reducing overuse means engaging everyone in the effort—for example, by urging the passage of innovative policies aimed at hospitals, other healthcare facilities, and even pharmaceutical companies, to encourage stewardship.  By aligning incentives for hospitals and healthcare facilities to focus on infection control and prevention, we can reduce the prevalence of resistant infections that jump from healthcare facilities into the community.  By motivating pharmaceutical companies to care about drug resistance, we can encourage them to stop overselling their drugs. Consumers also need to stop demanding antibiotics when they suffer from a viral infection.

We do need new antibiotics–urgently. But, in the meantime, we must focus on using the ones we already have in a sustainable fashion. Not only will this extend the utility of the drugs we have on the market today, but it will also ensure that drugs approved in the future will stay effective for longer periods.

It is easy to make frightening predictions about the end of antibiotics. It is harder but no less possible, to take definitive steps to ensure that such a day never comes. It is time for action.

Arjun Srinivasan, M.D., is Medical Director for the Center for Disease Control and Prevention’s “Get Smart for Healthcare” program and Associate Director for Healthcare-associated Infection Prevention Programs for CDC’s Division of Healthcare Quality Promotion.

Ramanan Laxminarayan, Ph.D., is the director of Extending the Cure, a project that examines policy solutions to the growing problem of antibiotic resistance. Extending the Cure is funded in part by the Robert Wood Johnson Foundation’s Pioneer Portfolio which powers ideas to transform health, seeking breakthroughs with the potential to generate significant health and social impact.