Building strength through adversity is an optimistic response to difficulty that serves some people well. Unfortunately, it also applies to microbes. A bug’s ability to resist antibiotics is a long-documented problem (see our blog, “We Don’t Know Enough About Antibiotic Use in Animals”) that’s due largely to our overuse and misuse of drugs we hope will combat infections that might not even be caused by the pathogens they’re intended to kill.
Last week, the Centers for Disease Control and Infection (CDC) issued a troubling report that every year, at least 2 million Americans become ill from antibiotic-resistant bacteria, and at least 23,000 of them die from those infections.
As widely reported, including in the New York Times, the report was the first time federal authorities quantified the effects of organisms “that many antibiotics are powerless to fight.”
For a long time, infectious disease authorities have tried to educate providers and patients alike about the dangers of bugs that evolve to develop defenses against antibiotics that are supposed to kill them. They warn that if we don’t stop popping these meds as if they were cough drops, we face the prospect of regressing to to a time when people died from ordinary infections.
According to The Times, in 2007, the CDC estimated that 100,000 people died every year of infections they contracted as hospital patients. Most of those infections were believed to be resistant to some antibiotics, but not necessarily the most widely used ones. The feds weren’t able to say how many of the deaths were caused by the drug-resistant infections. Last week’s report did.
CDC authorities said that the numbers were underestimated on purpose–researchers were directed to be conservative and cite only deaths that were a direct result of a drug-resistant bacterial infection.
How much animal farming (see our blog) contributes to the problem of antibiotic-resistant infections in humans is still at issue, but the feds estimate that more than 7 in 10 antibiotics dispensed in the U.S. are given to animals to ward off disease when they live in close quarters. Antibiotics also make livestock grow faster. As The Times notes, authorities are trying to stop that use of them.
According to the report, “much of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe.”
But it also made clear that about half of the antibiotic use for people is inappropriate, too.
The report tracks infections from 17 drug-resistant bacteria and one fungus that cause most of the country’s drug-resistant bacterial infections.
As we reported in March, one particularly lethal type of drug-resistant bacteria, known as CRE, has become resistant to nearly all antibiotics on the market. The incidence of infection remains relatively rare-600 deaths per year-but researchers have found the bug in health-care facilities in 44 states.
One type of bacteria, Methicillin-resistant Staphylococcus aureu (MRSA), showed fewer hospital-acquired infections, declining by half from 2005 to 2011, according to the journal JAMA Internal Medicine. (See our blog from last week about the cost of hospital-acquired infections.) But the incidence of invasive MRSA infections contracted outside health-care settings hasn’t really changed, and for the first time, their numbers were higher than the number acquired in hospitals.
Although hospitals are better at preventing drug-resistant infections than they used to be, preventing infections outside hospitals, clinics and nursing homes is trickier. The role of antibiotics and farm animals in boosting resistant germs isn’t well known, and as The Times, reports, the industry has been reluctant to allow data collection.
Another study published in JAMA Internal Medicine examined health records of more than 440,000 people in a network of clinics and hospitals in Pennsylvania. It found that patients who lived near farms and areas where manure was dumped were more than one-third more likely to develop a MRSA infection.
The study didn’t test farm animals or soil for MRSA, and it didn’t find evidence of the type of MRSA usually associated with farm animals, so those infections might have been caused by something other than antibiotics on farms.
But the point remains: Three superbugs identified in the CDC report as “urgent threats”-CRE, drug-resistant gonorrhea and Clostridum difficile (C. diff)-and 12 others, including MRSA identified as “serious threats,” will only get stronger through the adversity of humans overusing antibiotics. (C. diff is not drug-resistant, but it spreads by overusing antibiotics.)
The CDC offered four measures to overcome drug resistance:
- Prevent infections through immunizations, hand-washing and other precautions.
- Track resistant bacteria more thoroughly once they emerge.
- Use antibiotics more judiciously.
- Promote development of new drugs to treat, and tests to detect, infections.