Antibiotic Resistance: A Rising Health Crisis
Antibiotic-resistant bacteria and drug-resistant pathogens are rising at an accelerated pace. The CDC reported that every year 2.8 million people in the United States become infected with antibiotic-resistant organisms and 35,000 of those people die. The rise of antibiotic resistance has been blamed on the overuse and misuse of antibiotics. Antibiotic-resistant bacteria and pathogens limit treatment options for potentially life-threatening infections. Examples of the types of bacteria that have become resistant to antibiotics include those that cause skin infections, urinary tract infections, meningitis, sexually transmitted diseases, and respiratory tract infections such as pneumonia. This increase in the prevalence of drug-resistant pathogens and bacteria is occurring at a time when the discovery and development of new antibiotics are slowing down dramatically. Consequently, there is concern that in the not-too-distant future, we may be faced with a growing number of untreatable infections.
Healthcare facilities such as hospitals, intensive care units, and long-term care facilities are known breeding grounds for antibiotic-resistant bacteria. This is the consequence of exposure to heavy antibiotic use in a high-density patient population in frequent contact with healthcare staff with the risk of cross-infection. One of the more well-known antibiotic-resistant infections is Methicillin-resistant Staphylococcus aureus or MRSA. MRSA has been in and out of the public eye for several years, as its presence rises and falls in the world. However, MRSA is not only spread in hospitals, MRSA is common in community settings where people are prone to share items. For example, daycares, schools, and military barracks are all breeding grounds for MRSA and similar infections. MRSA often begins as a skin infection that resembles a spider bite, but in some cases causes pneumonia (lung infection) and other infections. If left untreated, MRSA infections can become severe and cause sepsis.
Diving into the misuse and overuse of antibiotics, one of the most common causes is improper prescribing. The CDC estimates that more than half of antibiotic prescribing in hospitals was not consistent with recommended prescribing practices. Additionally, 30% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or suboptimal. Insufficient training in infectious diseases and antibiotic treatment, the difficulty of selecting the appropriate anti-infective drugs empirically, insufficient use of microbiological information, need for self-reassurance, and fear of litigation are prompting the use of broad-spectrum drugs in hospital settings. Most bacteria are responsive to antibiotics, but when an antibiotic is overused or misused it helps the bacteria become resistant. Bacterias can develop resistance in a couple of ways. Some bacterias mutate their chromosomal DNA, while others transfer resistance to other bacterias. Optimizing the use of antibiotics is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance. In 2014, the CDC called on all hospitals in the United States to implement antibiotic stewardship programs and released the Core Elements of Hospital Antibiotic Stewardship Programs (Core Elements) to help hospitals achieve antibiotic optimization.
Another cause of antibiotic resistance is the agricultural use of antibiotics. Before 2013, when the FDA asked farmers to reduce antibiotic use, livestock farmers gave their animals antibiotics to improve the overall health of the animals, producing larger yields and a higher-quality product. When farmers use antibiotics in food-grade livestock the antibiotics and resistant bacteria are then ingested by humans. On a smaller scale livestock pass antibiotics through stool and urine which are then dispersed through fertilizer into groundwater and runoff. Yet another small-scale application occurs when fruit trees are sprayed with tetracycline and streptomycin as pesticides. This is a much smaller scale of environmental antibiotic resistance that still has a considerable effect on the onset of antibiotic resistance.
The CDC, FDA, and the WHO are all aware of the growing antibiotic-resistant crisis. The FDA and the CDC have launched a campaign called Get Smart: Know When Antibiotics Work, a campaign that offers Web pages, brochures, fact sheets, and other information sources aimed at helping the public learn about preventing antibiotic-resistant infections. The WHO has created a global action plan aimed at ensuring the prevention and treatment of infectious diseases with safe and effective medicines. The CDC, FDA, and National Institute of Health have created an Interagency Task Force on Antimicrobial Resistance, which was created in 1999 to combat antibiotic resistance. The Task Force created an Action Plan that included four focus areas: surveillance, prevention and control, research, and product development. Unfortunately, since 2001, without additional resources, the Task Force has been unable to implement the surveillance, prevention and control, and research elements of the Action Plan. Furthermore, even though it was a top priority in the Action Plan, no additional measures have been proposed by the US government to stimulate research and development of antibiotics. There has been a measurable decline of new antibiotics over the past 25 years. The cause of the decline of antibiotic development is multifactorial, but fundamentally, each factor relates to return on investment. Antibiotics are short-term use compared to chronic illness treatments, resulting in less revenue for pharmaceutical companies. Another problem pharmaceutical makers face is the lack of FDA guidance regarding studies, safety, and effectiveness of new antibiotics.
When considering your role in the fight against antibiotic resistance keep in mind that you have a large part to play. It is important to realize that a doctor will not prescribe antibiotics when they aren't needed. And when you are prescribed antibiotics you should take them as your doctor tells you. Don't share antibiotics with anyone, people or pets, and don't take antibiotics that aren't prescribed to you. Being aware that your impact on the antibiotic resistance crisis can help slow down the progression.
Antibiotic resistance is a growing crisis that is a danger to our health.
Misuse and overuse are the most common causes of antibiotic resistance.
The FDA, CDC, National Institute of Health, and the WHO are all working on reducing antibiotic resistance worldwide.
Be aware of the role you play in antibiotic resistance and follow the guidelines provided by the CDC.