Bolstering concerns about the "continuing threat" that so-called superbugs pose to human health, the Centers for Disease Control and Prevention released a report Wednesday that found antibiotic-resistant bacteria and fungi cause more than 2.8 million infections and 35,000 deaths annually in the United States.
"Stop referring to a coming post-antibiotic era—it's already here."
—CDC Director Robert R. Redfield
"That means, on average, someone in the United States gets an antibiotic-resistant infection every 11 seconds and every 15 minutes someone dies," the CDC said in a statement announcing the report, Antibiotic Resistance Threats in the United States 2019 (pdf).
"When Clostridioides difficile, a bacterium which is not typically resistant but can cause deadly diarrhea and is associated with antibiotic use, is added to these," the statement continued, "the U.S. toll of all the threats in the report exceeds three million infections and 48,000 deaths."
NEW: Antibiotic-resistant bacteria & fungi cause more than 2.8M infections and 35k deaths in the United States each year, according to the second #CDCARthreats Report released today. Progress has been made, but aggressive action must continue. https://t.co/9Xe13lzETS pic.twitter.com/2miM9mA0A3
— CDC (@CDCgov) November 13, 2019
The new release follows the CDC's 2013 AR Threats report (pdf). Since the first report, CDC Director Dr. Robert R. Redfield told reporters Wednesday, "we've reduced the number of deaths from antibiotic-resistance by 18% overall and by nearly 30% in hospitals alone." However, the 2019 report says that "CDC is concerned about rising resistant infections in the community."
"This is a problem that ultimately affects all of us... It literally has the potential to affect every person on the planet."
—Michael Craig, CDC
"This is a problem that ultimately affects all of us," Michael Craig, a CDC senior adviser on antibiotic resistance, told CNN. "It literally has the potential to affect every person on the planet."
The new report also says that "the emergence and spread of new forms of resistance continues to alarm CDC experts," noting that "antibiotic-resistant germs can share their resistance genes with other germs and can make them untreatable." Craig described the interplay as "essentially crowdsourcing."
The CDC classified carbapenem-resistant Enterobacteriaceae (CRE), Neisseria gonorrhoeae, and Clostridioides difficile as urgent threats in 2013 and added two more with this year's report: drug-resistant Candida auris and carbapenem-resistant Acinetobacter. The new report lists 18 antibiotic-resistant bacteria and fungi sorted into three categories: urgent, serious, and concerning.
— MAD-ID The Antimicrobial Stewardship Meeting (@MAD_ID_ASP) November 13, 2019
Reporting on the CDC's findings Wednesday, CNN shared the story of Peggy Lillis, "a healthy, vibrant 56-year-old teacher in Brooklyn, who woke up one morning 10 years ago with severe diarrhea."
Her son Christian Lillis said that "being a kindergarten teacher, she just assumed that she caught something from one of the kids or maybe she had food poisoning. She did not think it was a serious threat. None of us did."
According to CNN:
Five days later, Peggy was so sick she could barely move.
Doctors immediately admitted Peggy to the intensive care unit. She had Clostridioides difficile, or C. diff, one of the urgent threats on the CDC's list.
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Peggy's kidneys were starting to fail, and she was going into septic shock.
The hospital gave Peggy an antibiotic called vancomycin, both intravenously and by enema. But she died the next day—less than a week after becoming ill.
"The doctors at the hospital where she was treated—they did everything they could for her," Christian said. "But bacteria are evolving at a rate that we are not keeping up with."
Christian says they'll never know exactly where or when his mother picked up the C. diff bacteria.
Redfield, in the report's foreward, outlined four actions the United States "must" take to address antibiotic resistance:
- Stop referring to a coming post-antibiotic era—it's already here. You and I are living in a time when some miracle drugs no longer perform miracles and families are being ripped apart by a microscopic enemy. The time for action is now and we can be part of the solution.
- Stop playing the blame game. Each person, industry, and country can affect the development of antibiotic resistance. We each have a role to play and should be held accountable to make meaningful progress against this threat.
- Stop relying only on new antibiotics that are slow getting to market and that, sadly, these germs will one day render ineffective. We need to adopt aggressive strategies that keep the germs away and infections from occurring in the first place.
- Stop believing that antibiotic resistance is a problem "over there" in someone else's hospital, state, or country—and not in our own backyard. Antibiotic resistance has been found in every U.S. state and in every country across the globe. There is no safe place from antibiotic resistance, but everyone can take action against it. Take action where you can, from handwashing to improving antibiotic use.
Redfield told reporters Wednesday that "antibiotic resistance remains a significant enemy and we need to ensure our interventions are effective and monitored through the programs we institute. We must remain vigilant."
Through the CDC's AR Solutions Initiative, he said, "we will continue to invest in our country's public health infrastructure and in states essential programs such as the antibiotic-resistant lab network and by more than 500 local AR experts who will rapidly detect and prevent the spread of antibiotic-resistant germs."
Local health departments are uniquely positioned to work with healthcare and community partners in infection control and containment response to #antibioticresistance: https://t.co/3eR5KVL23f #CDCARthreats #publichealth pic.twitter.com/suwh7jppt8
— NACCHO (@NACCHOalerts) November 13, 2019
The CDC collaborates with the Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality, other federal partners, data analysts, healthcare providers, and veterinarians to improve antibiotic use. The agency also works with private industry to improve food safety, medical devices, and surveillance capabilities, and supplies drug and diagnostic test developers with samples of resistant germs from the CDC's AR Isolate Bank so they can undercover new drugs and treatments.
"We've invested $110 million dollars in researchers who are studying prevention strategies... and we will support these kinds of important discoveries," said Redfield. "Our nation's health departments, protecting us on the front lines, need even stronger lab capacity and specialized technologies, more boots on the ground to stop the spread of bacteria and fungi, and tailored interventions to improve the antibiotics that are used in humans, animals, and in the environment."
“We need to prepare for the kind of resistance that we could never predict. We know from history that bacteria & mother nature are smarter than we are,” IDSA Treasurer Dr. Helen Boucher, FIDSA (@hboucher3) comments on the @CDCgov report. https://t.co/G0KIyEQuLj #DISARMSuperbugs
— IDSA (@IDSAInfo) November 13, 2019
"The global community needs more innovation, new treatment options, reliable diagnostics, and better data that will help protect people and animals," Redfield added. "And our detection, prevention, and innovation strategies that have proven effective in the United States should be scaled up worldwide, where appropriate."
In April, as Common Dreams reported, the U.N. Interagency Coordination Group (IACG) on Antimicrobial Resistance warned that globally, superbugs could kill 10 million people per year by 2050 without urgent action. Already, according to that report, 700,000 people around the world die annually from drug-resistant infections.