Despite Some Prevention Successes, Antimicrobial Resistance Remains a Global Challenge

November 14, 2019 | Marcus Plescia

For the past 80 years, antibiotics have allowed doctors to treat bacterial infections and control infectious disease outbreaks that would previously have become wide-scale epidemics. However, much of this progress could be undermined by the increasing prevalence of antibiotic resistance. Although some antibiotic resistance is a natural result of normal antibiotic use, widespread antibiotic use—often for inappropriate reasons—has escalated this process. Nov. 18-24 is U.S. Antibiotic Awareness Week, an annual observance to increase awareness of antibiotic resistance.

Risks of Antibiotic Resistance

Antibiotics are among the most commonly prescribed drugs in the United States, where patients receive approximately 260 million antibiotic prescriptions each year. However, studies have shown that 30 percent of antibiotics prescribed in hospital and outpatient settings are unnecessary or inappropriate, such as those prescribed for viral infections. According to CDC, each year at least 2.8 million people in the United States become infected with antibiotic-resistant bacteria or fungi, and at least 35,000 people die as a direct result, with many more deaths caused by complications from resistant infections.

Patients are particularly at risk for acquiring an antibiotic-resistant infection in healthcare settings, where infections can spread quickly across individuals and facilities. Antibiotics are also given to food animals to treat bacterial infections. The improper and overuse of antibiotics for food animals can impact human health when resistant bacteria contaminate meat or persist in the environment.

As the 2018 National Biodefense Strategy outlines, antibiotic resistance can also adversely impact our nation’s ability to respond effectively to a bioterrorism attack or to everyday public health threats. An outbreak with limited or no treatment options could overwhelm health systems and disrupt economies, both domestic and international.

How States Can Help

Antibiotic resistance is an important public health and national security issue and is one of CDC’s Winnable Battles and a priority of CDC Director Robert Redfield. Public health professionals can play a significant role in both increasing public information about antibiotic resistance and implementing the following systems change interventions to promote appropriate antibiotic use.

• Advancing policy solutions that mandate reporting both antibiotic use and specific infections that are commonly linked with antibiotic resistance.
• Strengthening surveillance of local, regional, and statewide antibiotic use and resistance patterns to identify potential antibiotic-resistant outbreaks to share with other public health and healthcare partners to inform action.
• Leading or assisting in antibiotic-resistant organism outbreak investigations.
• Supporting public awareness campaigns, such as CDC’s Be Antibiotics Aware effort to raise public awareness about appropriate antibiotic use and the issue of antibiotic resistance.
• Providing education and guidance to support antibiotic stewardship program (ASP) development and implementation.
• Supporting initiatives that aim to promote appropriate antibiotic use in humans, animals, and the environment through a One Health approach.

State public health agencies can also work with and encourage hospital systems to address inappropriate antibiotic use through quality improvement processes. On Sept. 30, the Centers for Medicare and Medicaid Services finalized a new conditions of participation rule that requires all acute care and critical access hospitals to develop and implement hospital-wide ASPs within six months in order to continue to receive payments from CMS. ASPs are coordinated programs designed to decrease the incidence of antibiotic resistance and improve patient care by providing guidance on appropriate antibiotic use so that only the right antibiotic is prescribed, at the right time, at the right dose, and for the right duration.

Studies have shown that healthcare facilities that develop, implement, and promote ASPs report greater improvements in patient outcomes, reduced inappropriate antibiotic use that could lead to antibiotic resistance, and an overall reduction in healthcare costs. State health agencies can help guide healthcare facilities in developing and implementing ASPs using nationally-recognized resources such as CDC’s Core Elements of Antibiotic Stewardship, the Joint Commission’s Antimicrobial Stewardship Toolkit, and the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America’s “Guidelines on Implementing an Antibiotic Stewardship Program.”

Antibiotic Resistance Resources and Action

On Nov. 13, CDC published Antibiotic Resistance Threats in the United States, 2019, which describes the top antibiotic-resistant threats in the United States. The report updates data first reported in 2013 and outlines the current burden of infections and deaths associated with antibiotic-resistant bacteria and fungi. The report describes several areas of recent prevention success, while emphasizing that work is still needed. Key findings from the report include data showing that deaths from antibiotic-resistant infections are down by 18 percent overall and by nearly 30 percent in hospitals. In the community, rapid detection and prevention strategies have helped protect people from two community-associated germs: Streptococcus pneumoniae and the drug-resistant TB.

ASTHO supports health agency efforts to limit antibiotic resistance, and its infographic, “10 Ways State and Territorial Health Department Leaders Can Support Healthcare-Associated Infection and Antimicrobial Resistance Prevention, Detection, and Response” discusses how health agencies can contribute to the fight against antibiotic/antimicrobial resistance. ASTHO also serves as a co-lead for the Council for Outbreak Response: Healthcare-Associated Infections and Antimicrobial-Resistant Pathogens. This group is funded by CDC’s Division of Healthcare Quality Promotion and provides a forum for healthcare and public health partners to work together to enhance communication, patient notification, and laboratory practices in support of healthcare-associated infection and antimicrobial resistance activities.

Finally, all 50 states made formal commitments to participate in the AMR Challenge, a global effort led by CDC and HHS to accelerate the fight against antibiotic/antimicrobial resistance across the globe. As of September 2019, nearly 350 governments, private companies, and nongovernmental organizations worldwide made formal commitments that further the progress against antimicrobial resistance. The commitments demonstrate the breadth of work happening internationally and domestically and highlight the partnerships needed to address this critical issue.

The specter of wide-scale antibiotic resistance is frightening, but also largely preventable. Like many other public health challenges, the solutions are complex and require changes in social norms, clinical practice, and public policy. These are the challenges that draw us to public health leadership roles, and the time has come for us to take action to prevent deaths and other harms from antibiotic resistance.