HSS highlights recent progress against antibiotic resistance
As part of World Antibiotic Awareness Week, HHS has released a progress report summarizing achievements made during the first 2 years of implementing a national strategy to combat antimicrobial resistance.
Developed in response to an executive order from former President Barack Obama in 2015, the National Action Plan for Combating Antibiotic-Resistant Bacteria is a government-wide strategy that aims to prevent, detect and control antibiotic-resistant infections.
The progress report, compiled by the Interagency Combating Antibiotic-Resistant Bacteria (CARD) Task Force, highlighted progress toward the five major goals of the National Action Plan.
Goal 1: Slowing the emergence and spread of resistant bacterial infections
As an initial step in support of the National Action Plan, members of the CDC and Pew Charitable Trusts worked with clinical experts to establish targets for reducing inappropriate antibiotic use in the United States. While examining trends, they found that approximately 30% of antibiotic prescriptions in the U.S. are unnecessary.
“Despite prescribing guidelines, some health care professionals report giving antibiotics when they aren’t needed because of fear of misdiagnosis or pressure from patients,” Lauri Hicks, DO, director of the CDC’s Office of Antibiotic Stewardship, said in a press release. “CDC encourages health care professionals and patients to talk through the best ways to feel better and what treatment options are most effective.”
Since the National Action Plan was launched, several organizations and agencies have issued guidance to promote appropriate antibiotic use in both humans and animals, thereby slowing the emergence and spread of resistant bacterial infections. For example, the CDC released recommendations for implementing antimicrobial stewardship programs in small and critical access hospitals as well as outpatient settings; the Agency for Healthcare Research and Quality released a toolkit for reducing catheter-associated urinary tract infections and other health care-associated infections (HAIs) in long-term care facilities; and the FDA finished implementing guidance for reducing antibiotics in food-producing animals.
According to preliminary data in the progress report, the percentage of U.S. hospitals with antibiotic stewardship programs that satisfy all of the CDC’s Core Elements of Hospital Antibiotic Stewardship Programs increased from 39% in 2014 to 64% in 2016. Additional efforts through the National Veteran’s Health Administration (VHA) Stewardship Initiative resulted in a more than 10% decline in inpatient antimicrobial use in VHA medical centers.
Goal 2: Strengthening national One Health surveillance efforts
The ability to effectively detect and respond to antibiotic resistance requires broad data collection and surveillance in humans, animals and the environment, the report said. The CDC has worked with hospitals to increase data on antibiotic use in humans. As of July 2017, 330 hospitals and more than half of all VHA hospitals have reported antibiotic use data to the CDC’s National Healthcare Safety Network. Among other improvements in antibiotic surveillance, the FDA doubled the annual rate of retail meat testing from 6,700 food samples in 2015 to approximately 17,280 in 2017. In addition, chicken meat testing at USDA’s Food Safety and Inspection Service (FSIS) establishments increased from 3,850 in 2015 to 8,000 in 2016. FSIS establishments also began sampling raw pork products in 2015.
Goal 3: Advancing the development and use of new rapid diagnostic tests
The FDA approved or cleared several new diagnostic devices over the past 2 years that may enhance antibiotic resistance detection, according to the report. These devices include rapid molecular devices that can detect carbapenemase genes from stool samples, rapid tests for assessing phenotypic bacteria and serum tests for identifying bacterial respiratory infections. The Multidrug Resistant Organism Repository and Surveillance Network at the Walter Reed Army Institute of Research (WRAIR) also validated a device for screening mcr-1 in less than 45 minutes.
In April 2015, the NIH awarded more than $11 million in first-year funding to support the development of diagnostics that can rapidly detect antibiotic-resistant bacteria. In September 2016, the NIH and Biomedical Advanced Research and Development Authority (BARDA) launched the Antimicrobial Resistance Diagnostic Challenge, which encourages the development of tests that can distinguish between viral and bacterial infections. In June 2017, the NIH released the Partnerships for Development of Clinically Useful Diagnostics for Antimicrobial-Resistant Bacteria initiative to support the development of diagnostic platforms that can detect bacterial pathogens mentioned in the CDC’s 2013 report, “Antibiotic Resistance Threats in the United States.”
Goal 4: Accelerating research and development of new antibiotics, therapeutics and vaccines
The U.S. government has worked collaboratively to advance research through private and public sectors. In July 2016, BARDA launched a 5-year, $450 million partnership with the NIH and the Wellcome Trust, known as CARB-X. The goal of the partnership is to bolster innovation in antimicrobial development, the report said.
Recently, WRAIR established an initiative to screen, evaluate and advance new antibiotics. The institute developed cooperative R&D agreements with researchers at Vanderbilt University, Calvin College, Entasis Therapeutics and the Department of Veterans Affairs — all of which possess later-stage antibiotic candidates.
Government agencies are also advancing research in animal health. For example, the USDA’s Agricultural Research Service (ARS) is working on projects that are focused on developing vaccines, bacterial-derived products, immune-related products and phytochemicals to replace antibiotic use in animals.
Goal 5: Improving international collaboration and the capacity to prevent, monitor, control and study antibiotic resistance
To enhance global action against antibiotic resistance, the U.S is garnering political support from other countries, as well as global organizations such as WHO, the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE). U.S. agencies enhanced efforts in more than 30 countries through the Global Health Security Agenda — an international partnership that addresses infectious disease threats and improves global health security.
According to the report, recent achievements in antibiotic resistance on a global scale include:
- the adoption of a U.N. Resolution calling for international multisectoral actions to combat antimicrobial resistance during the 71st United National Nations General Assembly High-Level Meeting on Antimicrobial Resistance;
- the endorsement of the WHO Global Action Plan on resistance during the 68th World Health Assembly;
- resolutions passed by the FAO and OIE to address resistance; and
- the launch of the first World Antibiotic Awareness Week in November 2015. – by Stephanie Viguers
Department of Health and Human Services. National Action Plan for Combating Antibiotic-Resistant Bacteria Progress Report for Years 1 and 2. October 2017. https://aspe.hhs.gov/pdf-report/national-action-plan-combating-antibiotic-resistant-bacteria-progress-report-years-1-and-2. Accessed November 16, 2017.
Disclosure: Hicks reports no relevant financial disclosures.