Antibiotic resistance — bacteria outsmarting the drugs designed to kill them — is already here, threatening to return us to the time when simple infections were often fatal. How long before we have no effective antibiotics left?
It’s painfully easy for me to imagine life in a post-antibiotic era. I trained as an internist and infectious disease physician before there was effective treatment for HIV, and I later cared for patients with tuberculosis resistant to virtually all antibiotics.
We improvised, hoped, and, all too often, were only able to help patients die more comfortably.
To quote Dr. Margaret Chan, Director General of the World Health Organization: “A post-antibiotic era means, in effect, an end to modern medicine as we know it.”
We’d have to rethink our approach to many advances in medical treatment such as joint replacements, organ transplants and cancer therapy, as well as improvements in treating chronic diseases such as diabetes, asthma, rheumatoid arthritis and other immunological disorders.
Treatments for these can increase the risk of infections, and we may no longer be able to assume that we will have effective antibiotics for these infections.
Last September, CDC published our first report on the current antibiotic resistance threat to the United States.
The report conservatively estimates that each year, at least 2 million Americans become infected with bacteria resistant to antibiotics, and at least 23,000 die. Another 14,000 Americans die each year with the complications of C. difficile, a bacterial infection most often made possible by use of antibiotics. WHO has just issued their report on the global impact of this health threat.
It’s a big problem, and one that’s getting worse. But it’s not too late. We can delay, and even in some cases reverse the spread of antibiotic resistance.
Clinicians, health care facility leaders, public health leaders, agriculture leaders and farmers, policymakers, and patients all have key roles to play.
The FY 2015 President’s Budget requests $30 million for the CDC’s Detect and Protect Against Antibiotic Resistance Initiative (known as the AR Initiative), part of a broader CDC strategy to target investment and achieve measurable results in four core areas:
Detect and track patterns of antibiotic resistance.
A new five-region lab network, if funded, will speed up our ability to detect the most concerning resistance threats. The network would increase susceptibility testing for high priority bacteria and keep pace with rapidly mutating bacteria so labs are ready to respond to new threats as they emerge.
A new public data portal will show national trends as well as variations in rates of antibiotic prescribing and resistance among states and regions. An increase of $15 million in the FY 2015 President’s Budget for CDC’s National Healthcare Safety Network (NHSN) will allow full implementation of electronic tracking data from U.S. hospitals on antibiotic use and resistant bacteria. (I’ll talk more about this in a future post.)
Respond to outbreaks involving antibiotic-resistant bacteria.
Enhanced information from hospitals and the new lab network will help detect outbreaks that might previously have gone unnoticed. We’ll be able to better track the movement and evolution of bacteria, helping local and state responders better prepare for and stop outbreaks of antibiotic-resistant bacteria.
Prevent infections, prevent resistant bacteria from spreading, and improve antibiotic prescribing.
We’re establishing AR Prevention Collaboratives, groups of health care facilities around the country working together to implement best practices for inpatient antibiotic prescribing and preventing infections. Hospitals, long-term acute care hospitals, and nursing homes can all work together to protect patients from drug-resistant infections as patients move between medical facilities in a community.
They’ll scale up or extend the reach of interventions proven to reduce or stop antibiotic-resistant threats, improving antibiotic prescribing and stewardship programs and ultimately reduce antibiotic resistance.
Discover new antibiotics and new diagnostic tests for resistant bacteria.
Because antibiotic resistance occurs as part of the natural evolutionary process of bacteria, it can be slowed but not completely stopped. New antibiotics and therapies will always be needed to keep up with resistant bacteria, as will new tests to track the development of resistance.
To support these efforts, CDC will create a Resistance Bacteria Bank that will make drug-resistant samples available to diagnostic manufacturers, pharmaceutical companies, and biotech firms to develop new diagnostic tests and evaluate new antibiotic agents and therapies.
Exciting new molecular diagnostics may be able to determine if patients have an infection, and whether it is resistant, within hours instead of days, allowing treatment to be tailored to the patient’s particular infection.
With $30 million annual funding over the next five years, CDC’s AR Initiative could cut the deadliest resistant organism, CRE, in half, and also cut healthcare-associated C. difficile in half, saving at least 20,000 lives, preventing 150,000 hospitalizations, and cutting more than $2 billion in health care costs.
Other projected outcomes include a 30 percent reduction in healthcare-associated multidrug-resistant Pseudomonas; a 30 percent reduction in invasive MRSA; and a 25 percent reduction in MDR Salmonella infections.
Urgent action is needed now by everyone who manufactures, prescribes, or uses antibiotics. Drug development for new antibiotics and antifungals is necessary but not sufficient to deal with our antibiotic resistance threats.
Doctors and health care systems need to improve prescribing practices. And patients need to recognize that there are both risks and benefits to antibiotics – more medicine isn’t best, the right medicine at the right time is best.
Consider this a down payment for our country to start tackling our biggest drug-resistant threats. The actual funding needed to effectively address all of our drug-resistant threats will likely be many times this amount.
But with this type of significant public health investment, we can open a new chapter in the fight against resistance.
Tom Frieden, MD, MPH (@DrFriedenCDC) is Director of the Centers for Disease Control and Prevention.