CDC: Antibiotic resistance causes 1 death every 15 minutes in US

Photo of Robert Redfield 
Robert R. Redfield
Hilary Babcock, MD, MPH 
Hilary M. Babcock

According to newly updated estimates published by the CDC, more than 2.8 million infections are caused by antibiotic-resistant pathogens annually in the United Sates, resulting in at least 35,000 deaths.

That is one infection every 11 seconds and one death every 15 minutes.

“We must remain vigilant,” CDC director Robert R. Redfield, MD, said during a news conference. “Antibiotic resistance threatens both our nation’s health and our global security, and that’s why we all play an important role in stopping it.”

New numbers

Based on several data sources, the report — Antibiotic Resistance Threats in the United States, 2019 — updated oft-cited estimates published by the CDC in 2013 that had recently been called into question.

The 2013 report estimated that drug-resistant infections caused more than 2 million illnesses and at least 23,000 deaths in the U.S. each year.

“CDC used the best data available at the time, but we knew that our estimate was likely conservative and underestimated the true burden of antibiotic resistance,” Michael Craig, MPP, of the CDC’s Antibiotic Resistance Coordination and Strategy Unit, said in the news conference.

A revision of the 2013 estimates using the 2019 methodology, which included data from more than 700 hospitals, revealed that drug-resistant infections actually caused more than 2.6 million illnesses and 44,000 deaths each year when the 2013 report was published. According to the 2019 report, deaths attributed to antibiotic-resistant infections have decreased 18% overall and 30% in hospitals since 2013.

The Society for Healthcare Epidemiology of America said the report shows that prevention efforts in hospitals are working.

“We must continue to fund and support effective infection prevention and antibiotic stewardship programs in every health care setting and use every tool we have to prevent the spread of antibiotic resistance,” SHEA president Hilary M. Babcock, MD, MPH, said in a statement.

Corneilus (Neil) J. Clancy, MD 
Cornelius (Neil) J. Clancy
Jason Burnham, MD 
Jason P. Burnham

The report also noted the burden of Clostridioides difficile infections (CDI) because, although the pathogen is not “typically resistant,” CDI is caused by antibiotic use and the spread of bacteria, which are factors that also drive resistance. When including C. difficile, the burden exceeded 3 million infections and 48,000 deaths.

“The report is a major public service that's been provided by CDC, which provides both a stern warning antibiotic resistance continues to increase in the U.S., including among people in good health who are not in hospitals and some encouragement even as numbers of resistant infections have increased, the percentages of patients who have died as a result of these infections has decreased,” Cornelius (Neil) J. Clancy, MD, associate professor of medicine and director of the extensively drug-resistant pathogen lab and mycology program at the University of Pittsburgh, told Infectious Disease News.

Jason P. Burnham, MD, assistant professor of medicine in the division of infectious diseases at Washington University School of Medicine in St. Louis, called the report “a great and massive undertaking, including additional data sources to more accurately estimate the burden of drug-resistant infections.”

In a 2018 paper, Burnham and colleagues suggested that the number of deaths caused by drug-resistant infections may be nearly seven times higher than the old CDC estimate. Comparatively, the CDC estimates are still low, but Burnham explained that this is because his study had a more expansive definition of drug-resistant infection and the CDC used more recent data.

“The rates of hospital-acquired infections have been decreasing over the last 10 years, so this explains some of the difference,” Burnham, who was not involved in the CDC report, told Infectious Disease News. “In addition, they are calculating mortality attributable directly to a drug-resistant infection — ie, it is the primary cause of death — whereas with our estimates, a patient may have died with a drug-resistant infection, but it was not necessarily the primary cause.”

Clancy, who was also not involved in the CDC report, noted that the methodology the agency used to calculate the infection estimates is “very conservative,” and believes that the numbers are still higher than what has been reported.

“For example, our group at the University of Pittsburgh and the DRIVE-AB consortium independently have used other methodologies to estimate that there are about 35,000 carbapenem-resistant Enterobacteriaceae (CRE) infections one of the ‘urgent threats’ in the report annually in the U.S., rather than 13,100 as estimated by CDC,” he said. “These discrepancies highlight the need for better national and global reporting and surveillance of antibiotic resistance, so we can make plans based on definitive numbers and don't have to rely upon estimates.”

Infectious Diseases Society of America member Sarah Doernberg, MD, MAS, associate professor of clinical medicine and medical director of adult antimicrobial stewardship at the University of California, San Francisco, also characterized the CDC estimates as “conservative” and said they were “based on detection of resistant bacteria meeting specific definitions and reported in the electronic health record.”

“The discrepancy, though, highlights the need for a more robust system for surveillance for drug-resistant bacteria,” she said.

The report included a list of pathogens considered “urgent” threats to public health — carbapenem-resistant Acinetobacter, Candida auris, C. difficile, CRE and drug-resistant Neisseria gonorrhoeae — as well as a watch-list of pathogens that “have yet to spread resistance widely or are not well understood in the United States, but that CDC and other public health experts closely monitor,” the CDC explained. Those included azole-resistant Aspergillus fumigatus, drug-resistant Mycoplasma genitalium and Bordetella pertussis. Another 13 pathogens were included as “serious” or “concerning” threats.

Antibiotic resistance does not only concern those who are already sick or hospitalized. Rates of extended-spectrum beta-lactamase-producing Enterobacteriaceae increased between 2013 and 2018 and, according to the report, 47% of these infections were community-associated.

“The report makes abundantly clear that antibiotic resistance is a major problem now, not only something to worry about for the future; in the U.S., not solely in other countries; and in everyone, not just people with serious diseases or being treated in hospitals,” Clancy said.

Taking action

Although the report shows that there have been some gains in the fight against drug resistance, more action is needed. According to Clancy, continued investment is needed in antibiotic development, surveillance and prevention.

“I would encourage people who want to get involved in the fight against superbugs to get their congressional representatives to support the DISARM Act, which has gotten bipartisan sponsorship in both chambers of Congress, as a critical piece of legislation that would assure hospital reimbursements for use of new antibiotics cover the costs of developing and using these drugs,” he said.

The CDC report outlined ways that the public can protect against resistance, including getting vaccinated, practicing good hand hygiene, preventing STDs and using antibiotics appropriately. It also included action items for veterinarians.

Burnham imparted how doctors in clinical practice can utilize the information from this report to improve their practice and fight resistance.

“We have to continue to be diligent about prescribing antibiotics only when necessary to reduce drug resistance as much as we can,” he said.

Craig called the report a “snapshot” and said it shows that “we cannot rely on antibiotics alone.”

“But we can take action against resistance,” he said. “Infection prevention and control in health care facilities works. Improving the use of antibiotics we already have works. Proper food handling works, safe sex works, vaccines and keeping hands clean works.” – by Marley Ghizzone

Reference:

CDC. Antibiotic Resistance Threats in the United States, 2019. http://www.cdc.gov/drugresistance/Biggest-Threats.html. Accessed November 13, 2019.

Disclosures: Babcock, Burnham, Craig and Redfield report no relevant financial disclosures. Clancy reports receiving investigator-initiated research grants from Astellas, Cidara, Melinta and Merck for projects unrelated to the report, serving on advisory boards or consulting for Astellas, Cidara, the Medicines Company, Merck, Needham & Company, Scynexis, Shionogi and Qpex, and speaking at symposia sponsored by Merck and T2Biosystems. Doernberg reports being a consultant for Basilia Pharmaceutica and Genentech.

Photo of Robert Redfield 
Robert R. Redfield
Hilary Babcock, MD, MPH 
Hilary M. Babcock

According to newly updated estimates published by the CDC, more than 2.8 million infections are caused by antibiotic-resistant pathogens annually in the United Sates, resulting in at least 35,000 deaths.

That is one infection every 11 seconds and one death every 15 minutes.

“We must remain vigilant,” CDC director Robert R. Redfield, MD, said during a news conference. “Antibiotic resistance threatens both our nation’s health and our global security, and that’s why we all play an important role in stopping it.”

New numbers

Based on several data sources, the report — Antibiotic Resistance Threats in the United States, 2019 — updated oft-cited estimates published by the CDC in 2013 that had recently been called into question.

The 2013 report estimated that drug-resistant infections caused more than 2 million illnesses and at least 23,000 deaths in the U.S. each year.

“CDC used the best data available at the time, but we knew that our estimate was likely conservative and underestimated the true burden of antibiotic resistance,” Michael Craig, MPP, of the CDC’s Antibiotic Resistance Coordination and Strategy Unit, said in the news conference.

A revision of the 2013 estimates using the 2019 methodology, which included data from more than 700 hospitals, revealed that drug-resistant infections actually caused more than 2.6 million illnesses and 44,000 deaths each year when the 2013 report was published. According to the 2019 report, deaths attributed to antibiotic-resistant infections have decreased 18% overall and 30% in hospitals since 2013.

The Society for Healthcare Epidemiology of America said the report shows that prevention efforts in hospitals are working.

“We must continue to fund and support effective infection prevention and antibiotic stewardship programs in every health care setting and use every tool we have to prevent the spread of antibiotic resistance,” SHEA president Hilary M. Babcock, MD, MPH, said in a statement.

PAGE BREAK

Corneilus (Neil) J. Clancy, MD 
Cornelius (Neil) J. Clancy
Jason Burnham, MD 
Jason P. Burnham

The report also noted the burden of Clostridioides difficile infections (CDI) because, although the pathogen is not “typically resistant,” CDI is caused by antibiotic use and the spread of bacteria, which are factors that also drive resistance. When including C. difficile, the burden exceeded 3 million infections and 48,000 deaths.

“The report is a major public service that's been provided by CDC, which provides both a stern warning antibiotic resistance continues to increase in the U.S., including among people in good health who are not in hospitals and some encouragement even as numbers of resistant infections have increased, the percentages of patients who have died as a result of these infections has decreased,” Cornelius (Neil) J. Clancy, MD, associate professor of medicine and director of the extensively drug-resistant pathogen lab and mycology program at the University of Pittsburgh, told Infectious Disease News.

Jason P. Burnham, MD, assistant professor of medicine in the division of infectious diseases at Washington University School of Medicine in St. Louis, called the report “a great and massive undertaking, including additional data sources to more accurately estimate the burden of drug-resistant infections.”

In a 2018 paper, Burnham and colleagues suggested that the number of deaths caused by drug-resistant infections may be nearly seven times higher than the old CDC estimate. Comparatively, the CDC estimates are still low, but Burnham explained that this is because his study had a more expansive definition of drug-resistant infection and the CDC used more recent data.

“The rates of hospital-acquired infections have been decreasing over the last 10 years, so this explains some of the difference,” Burnham, who was not involved in the CDC report, told Infectious Disease News. “In addition, they are calculating mortality attributable directly to a drug-resistant infection — ie, it is the primary cause of death — whereas with our estimates, a patient may have died with a drug-resistant infection, but it was not necessarily the primary cause.”

Clancy, who was also not involved in the CDC report, noted that the methodology the agency used to calculate the infection estimates is “very conservative,” and believes that the numbers are still higher than what has been reported.

“For example, our group at the University of Pittsburgh and the DRIVE-AB consortium independently have used other methodologies to estimate that there are about 35,000 carbapenem-resistant Enterobacteriaceae (CRE) infections one of the ‘urgent threats’ in the report annually in the U.S., rather than 13,100 as estimated by CDC,” he said. “These discrepancies highlight the need for better national and global reporting and surveillance of antibiotic resistance, so we can make plans based on definitive numbers and don't have to rely upon estimates.”

Infectious Diseases Society of America member Sarah Doernberg, MD, MAS, associate professor of clinical medicine and medical director of adult antimicrobial stewardship at the University of California, San Francisco, also characterized the CDC estimates as “conservative” and said they were “based on detection of resistant bacteria meeting specific definitions and reported in the electronic health record.”

“The discrepancy, though, highlights the need for a more robust system for surveillance for drug-resistant bacteria,” she said.

PAGE BREAK

The report included a list of pathogens considered “urgent” threats to public health — carbapenem-resistant Acinetobacter, Candida auris, C. difficile, CRE and drug-resistant Neisseria gonorrhoeae — as well as a watch-list of pathogens that “have yet to spread resistance widely or are not well understood in the United States, but that CDC and other public health experts closely monitor,” the CDC explained. Those included azole-resistant Aspergillus fumigatus, drug-resistant Mycoplasma genitalium and Bordetella pertussis. Another 13 pathogens were included as “serious” or “concerning” threats.

Antibiotic resistance does not only concern those who are already sick or hospitalized. Rates of extended-spectrum beta-lactamase-producing Enterobacteriaceae increased between 2013 and 2018 and, according to the report, 47% of these infections were community-associated.

“The report makes abundantly clear that antibiotic resistance is a major problem now, not only something to worry about for the future; in the U.S., not solely in other countries; and in everyone, not just people with serious diseases or being treated in hospitals,” Clancy said.

Taking action

Although the report shows that there have been some gains in the fight against drug resistance, more action is needed. According to Clancy, continued investment is needed in antibiotic development, surveillance and prevention.

“I would encourage people who want to get involved in the fight against superbugs to get their congressional representatives to support the DISARM Act, which has gotten bipartisan sponsorship in both chambers of Congress, as a critical piece of legislation that would assure hospital reimbursements for use of new antibiotics cover the costs of developing and using these drugs,” he said.

The CDC report outlined ways that the public can protect against resistance, including getting vaccinated, practicing good hand hygiene, preventing STDs and using antibiotics appropriately. It also included action items for veterinarians.

Burnham imparted how doctors in clinical practice can utilize the information from this report to improve their practice and fight resistance.

“We have to continue to be diligent about prescribing antibiotics only when necessary to reduce drug resistance as much as we can,” he said.

Craig called the report a “snapshot” and said it shows that “we cannot rely on antibiotics alone.”

“But we can take action against resistance,” he said. “Infection prevention and control in health care facilities works. Improving the use of antibiotics we already have works. Proper food handling works, safe sex works, vaccines and keeping hands clean works.” – by Marley Ghizzone

Reference:

CDC. Antibiotic Resistance Threats in the United States, 2019. http://www.cdc.gov/drugresistance/Biggest-Threats.html. Accessed November 13, 2019.

Disclosures: Babcock, Burnham, Craig and Redfield report no relevant financial disclosures. Clancy reports receiving investigator-initiated research grants from Astellas, Cidara, Melinta and Merck for projects unrelated to the report, serving on advisory boards or consulting for Astellas, Cidara, the Medicines Company, Merck, Needham & Company, Scynexis, Shionogi and Qpex, and speaking at symposia sponsored by Merck and T2Biosystems. Doernberg reports being a consultant for Basilia Pharmaceutica and Genentech.

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