CDC ranks antibiotic-resistant infections

Many with <i>C. difficile</i> receive unnecessary antimicrobials
Many with C. difficile receive unnecessary antimicrobials

HealthDay News -- Antibiotic-resistant infections cause two million infections and claim the lives of 23,000 people in the United States every year, taking a tremendous financial toll on the already overburdened healthcare system, according to the CDC. 

"Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed," Steve Solomon, MD, director of the CDC's Office of Antimicrobial Resistance, said in a statement. "These drugs are a precious, limited resource -- the more we use antibiotics today, the less likely we are to have effective antibiotics tomorrow."

A new report from the agency, Antibiotic Resistance Threats in the United States, 2013, is the first of its kind to present a snapshot of the disease burden and threats to human health posed by antibiotic-resistant germs. The threats are ranked as urgent, serious and concerning based on seven factors: clinical and economic impact, current and 10-year projected incidence, transmissibility, availability of effective antibiotics and barriers to prevention. 

Topping the list of urgent bugs to watch are Clostridium difficile, carbapenem-resistant Enterobacteriaceae (or CREs) and drug-resistant Neisseria gonorrhoeae. Pathogens of concern include vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA).

Although C. difficile itself is not resistant to many of the drugs used to treat it, the illness's increased prevalence is considered an unintended consequence of antibiotic overuse. C. difficile-associated diarrhea is responsible for approximately 14,000 deaths in U.S. hospitals annually, and evidence points to emerging resistance to fluoroquinolones among certain strains.

Carbapenem-resistant Enterobacteriaceae cause about 9,000 infections and 600 deaths annually. CREs have developed resistance to nearly all available antibiotics, cause significant morbidity and mortality, and also spread genetic material that contribute to growing antibiotic resistance in other species of bacteria.

Drug-resistant gonorrhea causes about 246,000 infections in the United States each year. If the bug becomes resistant to first-line ceftriaxone (Rocephin) and other drugs in the cephalosporin class, the CDC predicts an additional 75,000 cases of pelvic inflammatory disease, 15,000 cases of epididymitis and 222 HIV infections, which would result in an additional $235 million in direct medical costs over a 10-year period.

Antibiotic overuse and misuse are the leading factors that contribute to antibiotic resistance, the agency warns. Antibiotics are commonly used in animals raised for food, and up to half of all antibiotics prescribed to humans are unnecessary or are inappropriately prescribed. The CDC has pinpointed four core actions critical for preventing antimicrobial resistance:

  1. Avoiding infection through use of immunizations, infection control measures in healthcare settings, safe food handling and better hand hygiene 
  2. Tracking antibiotic-resistant infections to understand the cause and develop better preventive strategies
  3. Improving antibiotic use and stewardship
  4. Developing new drugs and diagnostic tests. Because antibiotic resistance can only be slowed and never stopped, new drugs will be necessary to fight infections.

Although several new antibiotics are currently in the pipeline -- including oritavancin and dalbavancin, both lipoglycopeptides, and tedizolid, an oxazolidinone -- many of these medications belong to existing drug classes.

Additional incentives are needed to encourage pharmaceutical companies to develop drugs that promise only limited returns, due to necessary stewardship precautions to delay and prevent renewed drug resistance.

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