A new report issued by the Centers for Disease Control and Prevention says that antimicrobial resistance is now one of our most serious health threats, noting that each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics, at least 23,000 people die each year as a direct result of these infections, and many more die from other conditions that were complicated by an antibiotic-resistant infection. Additionally, almost 250,000 people each year require hospital care for Clostridium difficile (C. difficile) infections, in most of which use (and/or mis-use) of antibiotics was a major contributing factor leading to the illness. At least 14,000 people die each year in the United States from C. difficile infections, and the CDC maintains that many of these infections could have been prevented.
The threats are ranked in categories: urgent, serious, and concerning, and were assessed according to seven factors associated with resistant infections: health impact, economic impact, how common the infection is, a 10-year projection of how common it could become, how easily it spreads, availability of effective antibiotics, and barriers to prevention.
Infections classified as urgent threats include carbapenem-resistant Enterobacteriaceae (CRE), drug-resistant gonorrhea, and Clostridium difficile, a serious diarrheal infection usually associated with antibiotic use. C. difficile causes about 250,000 hospitalizations and at least 14,000 deaths every year in the United States.
The report says some pathogens have even become resistant to multiple types or classes of antibiotics (antimicrobial drugs used to treat bacterial infections), and that the loss of effective antibiotics will undermine our ability to fight infectious diseases, and to manage the infectious complications common in vulnerable patients undergoing chemotherapy for cancer, dialysis for renal failure, and surgery — especially organ transplantation — for which the ability to treat secondary infections is crucial.
Antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U .S . healthcare system. The report cites data estimating the total economic cost of antibiotic resistance to the U .S . economy as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars).
First used to treat serious infections in the 1940s, antibiotics have saved millions of lives and transformed modern medicine, but unhappily during the last 70 years, have shown the ability to mutate and become resistant to every antibiotic that has been developed. And the more antibiotics are used, the more quickly bacteria develop resistance.
The CDC observes that when first-line and then second-line antibiotic treatment options are limited by resistance or are unavailable, healthcare providers are forced to use antibiotics that may be more toxic to the patient and are also frequently more expensive and less effective, and that even when alternative treatments exist, research reveals that patients with resistant infections are often much more likely to die, and survivors to have significantly longer hospital stays, delayed recuperation, and higher rates of consequential long-term disability.
Looking for more information about Clostridium Difficile? Read our info page: Clostridium Difficile: What You Need To Know.
The use, over-use, unnecessary use, and abuse of antibiotics is the single most important factor leading to antibiotic resistance around the world, antibiotics being among the most commonly prescribed drugs used in human medicine, to say nothing of their use in agriculture. Reportedly, in 1954, some 2 million pounds of antibiotics were produced in the United States. By 2000, the annual figure had risen to an estimated 50 million pounds, nearly half of which are fed to livestock. The CDC notes that antibiotics are commonly used in food animals to prevent, control, and treat disease, and to promote the growth of food-producing animals, noting that the use of antibiotics for promoting growth is not necessary, and contends that the practice should be phased out. To help ensure that medically important antibiotics are used judiciously in food-producing animals, the U.S. Food and Drug Administration recently proposed guidance describing a pathway for using these drugs only when medically necessary and targeting their use to only address diseases and health problems.
However, in any instance where antibiotics are used, it exerts more biological pressure on bacteria and consequently promotes the development of resistance. When antibiotics are genuinely needed to prevent or treat disease, the CDC affirms that they should always be used, but observes that research has revealed that as much as 50% of the time, antibiotics are prescribed when they are not needed or they are misused (for example, a patient is given the wrong dose). This not only fails to help patients; it might cause harm.
Prescribing antibiotics when they are not needed or prescribing the wrong antibiotic in outpatient settings such as doctors offices is common, the CDC report observes, noting for instance that in some cases, doctors might not order laboratory tests to confirm that bacteria are actually causing the infection, and therefore an antibiotic may be, and often is, unnecessarily prescribed. In other cases, patients demand treatment for conditions such as a cold when antibiotics are not needed and will not help, and healthcare providers can be too willing to relent to pressure to satisfy a patient’s expectation for an antibiotic prescription as an imagined quick fix for routine viral infections. Thus antibiotic abuse is partly a cultural phenomenon, exacerbated by factors like working parents who don’t want to stay home with sick kids, and who therefore demand that the doctor “give them something” — usually an antibiotic. Such inappropriate use of antibiotics unnecessarily promotes antibiotic resistance.
For example a study in the March, 2007 issue of the Archives of Otolaryngology found that even though there are no approved drugs to treat sinus infections, more than 90 percent of which are caused by fungi and not bacteria according to the Mayo Clinic, in cases of acute infection cited in the study, roughly 83 percent were treated with antibiotics, as were 70 percent of chronic cases.
Speaking of fungi, the CDC notes that in addition to antibiotic-resistant bacteria, Candida, a fungus that commonly causes serious illness, especially among hospital patients, is included in the threat report data because it, too, is showing increasing resistance to the drugs used for treatment, and are included when referencing bacteria for simplicity. Also, infections caused by the bacteria Clostridium difficile (C. difficile) are included in this report, even though C. difficile infections are not yet significantly resistant to the drugs used to treat them, but In most of these infections, the use of antibiotics was a major contributing factor leading to the illnesses which are thus directly related to antibiotic use, and thousands of Americans are affected each year.
Evidencing our society’s increasing “germophobia” (irrational hatred of germs or the idea of germs), an estimated more that 1000 antimicrobial products have reportedly been introduced into consumer products on the market since 1992, such as dish washing liquids, antibacterial soaps, deodorant soaps, lotions, mouthwash, toothpaste, antiperspirants, body washes, plastic toys, high-chair food trays, cosmetics, socks, underwear, sheets, pillow cases, and cutting boards to give these products antibacterial properties. It’s also been suggested that the growing popularity of antibacterial consumer products may not only be catalyzing development of antibiotic resistant bacteria, but allegedly also disrupting normal immune system development in children through a phenomenon known as the “hygiene hypothesis.” It is posited that young children need exposure to a variety of bacteria to stimulate their immune systems and make them more resistant to disorders like allergies and asthma.
The CDC cautions that while antibiotic therapy when appropriately employed is generally safe and can be very helpful in fighting disease, antibiotics are powerful drugs not devoid of side-effects, and there are times when they can actually be harmful .
Side effects can include allergic reactions and a potentially deadly diarrhea caused by the bacteria Clostridium difficile (C. difficile). Antibiotics can also interfere with the action of other drugs a patient may be taking for another condition — unintended reactions called “adverse drug events,” so when someone takes an antibiotic they don’t need, for example as essentially a placebo in virally-caused illnesses like uncomplicated colds or flu, they are needlessly exposed to the side effects of the drug and get no benefit from it. Moreover, taking an antibiotic when it is not needed contributes to the development of antibiotic resistance, which eventually leads to antibiotics not being able to stop future infections. The report notes that every time someone takes an antibiotic they don’t need, they increase their risk of developing a resistant infection in the future.
“This process can happen with alarming speed,” says Steve Solomon, M.D., director of CDC’s Office of Antimicrobial Resistance in a CDC release. “These drugs are a precious, limited resource — the more we use antibiotics today, the less likely we are to have effective antibiotics tomorrow.
To address the social/cultural factors contributing to antibiotic overuse, at least in clinical contexts, the CDC has launched the Get Smart program, a national campaign to improve antibiotic prescribing and use in both outpatient and inpatient settings. The program supports a variety of state-based programs modeled on the national effort. Each November, CDC publicizes its annual “Get Smart About Antibiotics Week” to raise awareness among patients, healthcare providers, hospital administrators, and policy makers about the threat of antibiotic resistance and the need to decrease inappropriate antibiotic use.
The CDC provides public health messages and resources for improving antibiotic use in healthcare settings and is now working with a variety of partners to improve the use of antibiotics in healthcare settings.
The report observes that antibiotics are a limited resource, and the more they are are used today, the less likely they will still be effective in the future. Therefore, doctors and other health professionals around the world are being encourages to adopt the principles of responsible antibiotic use, often called “antibiotic stewardship.”
Stewardship is a commitment to always use antibiotics only when they are necessary to treat, and in some cases prevent, disease; to choose the right antibiotics; and to administer them in the right way in every case. Effective stewardship ensures that every patient gets the maximum benefit from the antibiotics, avoids unnecessary harm from allergic reactions and side effects, and helps preserve the life-saving potential of these drugs for the future. The CDC report says efforts to improve the responsible use of antibiotics have not only demonstrated these benefits but have also been shown to improve outcomes and save healthcare facilities money in pharmacy costs. One core activity is the development and implementation of the Antibiotic Stewardship Drivers and Change Package, a tool that provides healthcare facilities with a menu of interventions they can select from to improve antibiotic use. CDC developed and tested this tool with the Institute for Healthcare Improvement.
The Drivers and Change Package can be found at:
Additional information about Get Smart About Antibiotics Week activities and messages can be found on CDCs website:
“Antibiotic resistance is rising for many different pathogens that are threats to health,” says CDC Director Tom Frieden, M.D., M.P.H in the release. “If we don’t act now, our medicine cabinet will be empty and we won’t have the antibiotics we need to save lives.”
The loss of effective antibiotic treatments will also undermine treatment of infectious complications in patients with other diseases. Many medical advances — joint replacements, organ transplants, cancer therapy, rheumatoid arthritis therapy — are dependent on the ability to fight infections with antibiotics. If the ability to effectively treat those infections is lost, the ability to safely offer people many of the life-saving and life-improving modern medical advances will be lost with it. Because antibiotic resistance occurs as part of a natural process in which bacteria evolve, it can be slowed but not completely stopped. Therefore, new antibiotics always will be needed to keep up with resistant bacteria, as will new tests to track the development of resistance, but the CDC contends that perhaps the most important action needed to greatly slow the development and spread of antibiotic-resistant infections is to change the way antibiotics are used.
The full Antibiotic Resistance Threats In The United States, 2013 report can be viewed and downloaded at:
For more information about drug resistance and the serious impacts it has on human health, visit: