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Threat of Antibiotic Resistance in US Higher Than Thought, CDC Says

Megan Brooks
November 13, 2019

Antibiotic resistance is a greater threat in the United States than previously estimated and is not going away, according to the US Centers for Disease Control and Prevention (CDC) in a report released today.

Each year, antibiotic-resistant bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the United States. On average, someone in the United States develops an antibiotic-resistant infection every 11 seconds, and every 15 minutes, someone dies from such an infection, according to the CDC.

Those figures don't include cases of infection with Clostridioides difficile, a bacterium that is not typically resistant but can cause deadly diarrhea and is associated with antibiotic use. When C difficile is included, the US toll of all current antibiotic-resistant threats exceeds 3 million infections and 48,000 deaths annually, the CDC notes.

Antibiotic resistance remains a "significant enemy [that] threatens both our nation's health and our global security, and we all play an important role in stopping it," CDC Director Robert R. Redfield, MD, said during a press briefing.

Using data sources not previously available and new methodology, the 2019 AR threats report shows that there are nearly twice as many annual deaths from antibiotic-resistant infections as the CDC originally reported in 2013.

"The good news," said Redfield, "is that we are seeing progress nationwide." Since the first AR threats report in 2013, prevention efforts have reduced deaths from antibiotic-resistant infections by 18% overall and by nearly 30% in hospitals.

"CDC data show that comprehensive prevention strategies are saving lives," he said.

Two New Urgent Threats

The updated report establishes a new national baseline of infections and deaths from antibiotic-resistant germs. The report lists 18 antibiotic-resistant threats, which are classified on the basis of level of concern to human health urgent, serious, or concerning.

There are two new "urgent" threats on the list drug-resistant Candida auris and carbapenem-resistant Acinetobacter. These additions bring the number of urgent threats to five. Three other threats were identified in 2013 carbapenem-resistant Enterobacteriaceae (CRE), Neisseria gonorrhoeae, and C difficile.

Redfield noted that Candida auris has only recently emerged as a deadly germ. "It emerged on five continents at the same time. One in three patients infected with invasive Candida auris dies, and some samples of resistant and rare fungus have been shown to be resistant to all three classes of antifungal drugs," said Redfield.

The report notes that so-called "nightmare" CRE infections have remained stable, which is a noteworthy accomplishment given how quickly and broadly CRE spread across the United States in the early 2000s.

The 11 "serious" threats on the list are drug-resistant Campylobacter; Candida; extended-spectrum beta-lactamase (ESBL)–producing Enterobacteriaceae; vancomycin-resistant Enterococci; multidrug-resistant Pseudomonas aeruginosa; drug-resistant nontyphoidal Salmonella; Salmonella serotype typhi; Shigella; methicillin-resistant Staphylococcus aureus (MRSA); drug-resistant Streptococcus pneumoniae; and tuberculosis (TB).

Overall, resistance to essential antibiotics is increasing in seven of the 18 germs on the list.

The new report identifies three additional germs that are on a "watch list." Resistance in these germs has yet to spread widely, or they are not well understood in the United States, and the CDC and other public health experts are closely monitoring them. They are azole-resistant Asergillus fumigatus and drug-resistant Mycoplasma genitalium and Bordetella pertussis.

The CDC says rapid detection and prevention strategies have helped protect people from two community-associated germs: drug-resistant Streptococcus pneumoniae and drug-resistant TB. Vaccines have helped reduce infections from Streptococcus pneumoniae in many at-risk groups, and the number of drug-resistant TB cases in the United States has remained stable as a result of effective TB control strategies.

The CDC is particularly concerned about three antibiotic-resistant infections that are on the rise in US communities:

  • Drug-resistant Neisseria gonorrhoeae: More than half a million resistant gonorrhea infections occur each year, twice as many as reported in 2013. Gonorrhea-causing bacteria have developed resistance to all but one class of antibiotics, and half of all infections are resistant to at least one antibiotic, according to the CDC.
  • ESBL-producing Enterobacteriaceae: Drug-resistant organisms are a leading cause of death. They make urinary tract infections harder to treat, especially in women, and could undo progress made in hospitals if allowed to spread there, the CDC says.
  • Erythromycin-resistant group A Streptococcus: Invasive infections from these germs have quadrupled since 2013. If resistance continues to increase, infections and deaths could rise, the CDC notes.

"We must remain vigilant," said Redfield. Through its AR Solutions Initiative, the CDC will continue to take a comprehensive approach to tackling antibiotic resistance, he said.

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Reviewed on 11/14/2019
References
SOURCE: Medscape, November 13, 2019. CDC. Antibiotic Resistance Threats in the United States 2019.

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