Landmark CDC Report Details Threat of 'Postantibiotic Era'

Lara C. Pullen, PhD

Disclosures

September 16, 2013

The Centers for Disease Control and Prevention (CDC) released its "landmark" report today on the rising and lethal threat of antibiotic resistance, titled Antibiotic Resistance Threats in the United States, 2013.

The report describes a complex problem and the steps that must be taken to prevent catastrophic consequences.

In it, experts describe "what happens when the microbes can outsmart our best antibiotics," explained CDC Director Tom Frieden, MD, MPH, at a press conference. He elaborated by describing his hope that the report will prioritize pathogens and propel action to curb antibiotic resistance.

"We see this as a landmark report. In writing it, we set out to paint the big picture of antimicrobial resistance," said Steve Solomon, MD, director of the CDC's Office of Microbial Resistance, in an interview with Medscape.

Often discussions of antimicrobial resistance suggest resistance is a problem of other people in other places. "This report clearly shows that antimicrobial resistance is happening here," said Dr. Frieden.

The CDC describes an infectious disease landscape in which 2 million people in the United States are sickened annually with antibiotic-resistant infections. The report estimates that at least 23,000 people a year die from antibiotic-resistant infections. Dr. Frieden emphasized that these numbers are very conservative estimates.

In addition, the report quantifies the effects of antibiotic use on the number of illnesses and deaths resulting from Clostridium difficile infections. The report estimates that at a minimum, 250,000 illnesses and 14,000 deaths from C difficile are directly related to antibiotic use and resistance.

Urgent, Serious, and Concerning

In the report, bacteria are prioritized into 1 of 3 categories: urgent, serious, and concerning. Urgent threats include carbapenem-resistant Enterobacteriaceae (CRE), drug-resistant gonorrhea, and C difficile. CRE can now resist virtually all antibiotics, and a growing percentage of the organisms that cause gonorrhea are resistant to even the last line of medications currently available.

Serious threats include methicillin-resistant Staphylococcus aureus (MRSA) and nontyphoidal Salmonella infections. Dr. Frieden explained that although progress has been made in controlling MRSA infections, there are still 80,000 serious MRSA infections each year in the United States.

The "concerning" category includes group A Streptococcus, often referred to as "flesh-eating bacteria."

Call for Action

Dr. Frieden described civilization as having a preantibiotic era and an antibiotic era. He warned that we may soon be entering a postantibiotic era.

He explained that, if we do not act now, antibiotics will no longer be an arsenal in our medicine chests. "We believe that we have a 4-part solution that will make a really big difference.... It is not too late," emphasized Dr. Frieden.

The 4-part solution includes

  1. preventing infections,

  2. tracking resistance patterns,

  3. practicing antibiotic stewardship, and

  4. developing new antibiotics and diagnostic tests.

Infection prevention includes simple measures such as immunizations and hand washing. It also includes more complex infection control procedures.

Antibiotic Stewardship

The CDC estimates that half of antibiotic use is unnecessary. Stewardship programs should be developed and used to optimize the use of antibiotics. Although this is currently happening, the CDC calls for acceleration in the implementation of these efforts.

Until recently, there has been a steady pipeline of antibiotics entering the marketplace. Unfortunately, at this point, new drugs may be a decade away.

The report includes descriptions of bacteria that cause human infections, as well as the antibiotics that are used to treat the infections. It does not include viral infections such as HIV and influenza or parasitic infections such as malaria.

The authors have disclosed no relevant financial relationships.

Antibiotic Resistance Threats in the United States, 2013. CDC. Published online September 16, 2013. Full text

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