The End of Antibiotics

Antibiotic resistance; bacteria outsmarting the drugs designed to kill them. The resistance is among us, threatening to return us to a time when simple infections were often fatal, but how long before there is no effective antibiotics left? To quote Dr. Margaret Chan, Director General of the World Health Organization (WHO): “A post-antibiotic era means, in effect, an end to modern medicine as we know it.” The 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 would have to be “re-thought.”

Treatments can increase the risk of infections, and the assumption may no longer be that we will have effective antibiotics for these infections.
Last September, The Centers for Disease Control and Prevention (CDC) published its 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. However, it’s not too late, and it can be delayed. In some cases, the spread of antibiotic resistance can be reversed. 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 the CDC’s 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.

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. The CDC will 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:

The CDC is 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 will 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 well as 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, carbapenem-resistant Enterobacteriaceae (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 (MDR) Pseudomonas, a 30 percent reduction in invasive Methicillin resistant Staphylococcus Aureus (MRSA), and a 25 percent reduction in Salmonella infections. Urgent action is needed by everyone who manufactures, prescribes, or uses antibiotics. Drug development for new antibiotics and anti fungals is necessary but not sufficient to deal with 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 its biggest drug-resistant threats. The actual funding needed to effectively address all of the drug-resistant threats will likely be many times this amount. But with this type of significant public health investment, a new chapter in the fight against resistance can be opened. Let’s work together and do our part; patients, doctors, researcher, pharmacists, and all who is involved with antibiotics!

Centers for Disease Control and Prevention

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