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The Good and Bad News of Antibiotic Resistance…in a Post-Antibiotic Era
Earlier this month, the Centers for Disease Control and Prevention (CDC) published the second “Antibiotic Resistance Threats in the United States” report. Antibiotic Resistance (AR) is considered one of the most important public health issues we face today. According to the CDC, the new report serves as an up-to-date reference tool on AR, provides the latest AR infection data, including a list of the disease-causing microorganisms (also called “pathogens” or “germs”) of greatest concern, and highlights what needs to be done to ensure that antibiotics are available in the future. The first report on Antibiotic Resistance was published by the CDC in 2013 and was the catalyst for much of the work that has been done since. In this blog, I seek to provide a high level review of the report, share with you what CloroxPro is doing to help, and inspire you to also take action. Whether you act as an individual or as part of an organization, there are things we all can be doing now that will benefit us, our families, and society for years to come.
What Is Antibiotic Resistance and a Post-Antibiotic Era?
Antibiotic resistance is when pathogens or germs develop ways to reduce or eliminate the effectiveness of antibiotics. Bacterial and fungal, but not viral or other types of pathogens, are included in the CDC report. A post-antibiotic era means that we are now living in a time where people are dying from pathogens or germs that we used to be able to cure with antibiotics.
The Report Includes Good News and Bad News
The good news is that progress has been made — the number of antibiotic resistant (AR)-related deaths in the U.S. per year has gone down 18% (from 44,000 to 35,880) since the 2013 estimates were revised (due to some improvements made in how the data was collected). Even greater decreases in deaths were seen in hospitals (down 28%) and decreases in some specific types of infections were also seen (e.g., Vancomycin-resistant Enterococcus or VRE was down 41% and Methicillin-resistant Staphylococcus aureus or MRSA was down 21%) since 2013. This suggests that many of the U.S. efforts (preventing infections, stopping the spread of bacteria and fungi, and improving antibiotic use in humans, animals, and the environment) are working.
The not-such-good news is that the number of AR infections and deaths are still far too great, and in some cases the rate of infections caused by AR pathogens has gone up substantially (e.g., Erthromycin-resistant invasive group A strep was up 315% and ESBL-producing Enterobacteraeae was up 50%). Perhaps the most alarming statistic to come out of the report is that on average, someone in the United States gets an antibiotic-resistant infection every 11 seconds and every 15 minutes someone dies. Moreover,the data used to generate the report was collected in 2017 and are assumed to be underestimates of the true data, as not everyone who gets an infection seeks medical care, and thus becomes a recorded case.
Across Three Threat Levels and 18 Antibiotic-Resistant Pathogens (+ a new Watch List)
The new report identifies 18 AR threats total, and breaks these threats down into three threat levels: urgent, serious, concerning, and a new watch list. The threat levels were determined based on seven factors:
- Clinical impact
- Economic Impact (when available)
- 10-year projection of incidence (new infections over the next 10 years)
- Transmissibility (how easily a germ spreads or causes infections
- Availability of effective antibiotics
- Barriers to prevention
The report includes a lot of valuable information about the pathogen threats, including some of the trends as noted above. I’ve included a couple of the highlights here, but you can find a full list of ARs listed in the report here, as well as information about each pathogen.
Of the five urgent threats, two are new since the 2013 report: drug-resistant Candida auris, a fast-spreading yeast of concern, is completely new to the list, and carbapenem-resistant Acinetobacter was listed as a serious threat (as multidrug resistance Acinetobacter) in the previous report.
Clostridioides difficile (C. difficile), while not technically an AR-resistant pathogen, continues to be on the “urgent” list because it is caused by the same factors that cause AR — antibiotic use and the spread of germs. While cases of C. difficile have declined in hospitals, it is still the most prevalent healthcare associated infection (in 2017, nearly 224,000 people in the U.S. required hospital care for C. difficile and almost 13,000 people died) and infection rates in the community have not followed suit.
The “watch list” is a new addition to the report and includes three threats: Azole-resistant Aspergillus fumigatus, drug-resistant Mycoplasma genitalium, and drug-resistant Bordetella pertussis. These “watch list” pathogens are rare, and/or not completely understood yet, but based on both domestic and international data, the CDC believes there is potential for international spread of these germs, and that they also have the potential to cause significant amounts of illness and death in years to come.
Antibiotic-Resistant Infections Aren’t Just a Healthcare Problem, They Are an Everywhere Problem
AR infections are a significant issue in healthcare because those who receive medical care are often the most vulnerable. They are vulnerable because they are more susceptible to getting an infection, as well as being able to recover from it. It is for these reasons that the CDC says that resistance threats are amplified in healthcare.
But healthcare isn’t the only place AR infections occur. The CDC is also concerned about rising resistant infections in the community, which includes people, animals and plants, and environments in which they exist. To address the cross-sector complexity of AR, a “One Health” approach is the collaborative initiative that has been identified to help reduce the spread of AR, prevent AR infections, and ultimately saves lives. This means that AR is everyone’s problem, and that there is something we all can do to help combat it.
Across settings, industries, and even countries, the CDC believes that addressing AR requires continued aggressive actions, which include:
- Preventing infection in the first place
- Slowing the development of resistance through improved antibiotic use
- Stopping the spread of resistance when it does develop
CloroxPro Is Committed to Fighting Antibiotic Resistance
The CDC identifies contact with contaminated surfaces — such as hospital bedrails, kitchen counters or even personal items like towels — as one way that AR pathogens are spread. Surface disinfection is one way to help combat the spread of AR from these surfaces in both hospitals and communities, by killing the pathogens or germs before they can be spread (usually by hands). To this end, CloroxPro made a pledge to the CDC’s Antimicrobial Resistance (AMR) Challenge earlier this year to educate and advocate for antibiotic resistance education and stewardship. I believe that industry’s involvement in helping to solve large societal issues such as this one is essential, and I am excited that CloroxPro is committed to take continued action on this topic.
Some of the things we are doing or plan to do include:
- Raising awareness about antibiotic resistance and the importance of infection control and antibiotic stewardship.
- Educating on how proper cleaning and disinfecting of surfaces can help prevent the spread of infections in critical settings. Preventing infections will help to limit the need for antibiotics and reduce the spread of antibiotic resistant pathogens/germs.
- Providing high-quality products, protocols and tools help create efficient and effective cleaning and disinfecting programs.
Please join me and CloroxPro by doing your part to combat antibiotic resistance. We all have a role to play. For more details, facts, figures and inspiration, you can find the full report here: https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf