Last week, I had a somewhat animated discussion with an erudite friend who felt that science is so advanced that we don’t have to worry about resistant bacteria. I argued that we did. And although when it comes to bacterial attacks I really don’t want to be the one to say “I told you so”, an article in last week’s JAMA confirmed that I (and all of us) are right to be worried.
The article was titled “Report Reveals Scope of US Antibiotic Resistance Threat”. The author points out that although antibiotic resistance is well known to US clinicians, until now the true scope of the problem has been unclear and underestimated. A new report by the Centers for Disease Control and Prevention (CDC) provides clarity. They stated that more than 2 million people in the United States become infected every year with organisms that are resistant to antibiotics, and at least 23,000 die. They added that nearly 250,000 people acquire Clostridium difficile infections each year, a serious diarrheal illness that is not so much antibiotic resistant but rather is precipitated by antibiotic use.
The report listed at least eight different types of bacteria in the gut that have been found to be resistant to some or all of the most powerful antibiotics, as well as bacteria on the skin (Staphylococcus) and bacteria that inhabit the upper respiratory tract. The director of the CDC said in a recent press briefing that their report shows just the bare minimum and that they up to now that have only counted the infections that are resistant to antibiotics that occur in hospitals. They know however, that there are many more infections in nursing homes, dialysis units, long-term hospitals, assisted-living facilities and communities. The estimate is that hospital infections alone result in significant need for increased and prolonged care as well as loss of productivity and cost more than $50 billion a year! According to the FDA, more than 70% of the bacteria that cause hospital associated infections are now resistant to at least one type of antibiotic most commonly used to treat these infections.
One of the pathways that bacteria learn to become resistant is that genes jump from one organism to another. So, if one type of bacteria is resistant, it can teach others to have the same ability to shrug off antibiotic impact. Now that I’ve rung the bacteria alarm, I want to at least let you know that experts feel that we can try to do something about this. They have set a goal of at least preventing a worsening situation and perhaps improving the one that we currently have. They recommend developing and administering more immunizations, instituting infection prevention actions in healthcare settings, preparing and handling food more safely and being vigilant about hand washing. And to keep up with the natural process of antibiotic resistance that occurs as bacteria become resistant, researchers have to continue to develop new antibiotics. Despite this clear and present danger, the number of new FDA approved antibacterial drugs have been decreasing steadily since the 1980s. The federal government (which plays a very important role in our health) has passed “Generating Antibiotics Incentives Now Act” (GAIN) in 2012. It is (as usual) long and complicated but it essentially is trying to increase the commercial value of antibiotics by extending the length of time an approved drug is free from competition and simplifying the regulatory pathway for FDA approval of new antibiotics.
Perhaps one of the most important things we as physicians and you as patients need to realize is that antibiotics should be used appropriately and safely. Currently, up to half of antibiotic use in humans and much of antibiotic use in animals is absolutely unnecessary. So please remember this the next time you have a slight cough or sore throat and call your doctor to get an antibiotic prescription. There is a good chance that the antibiotic won’t help and moreover it can increase the chance of developing resistance to this and other “bugs” in your body and in the bodies of others.