A petri dish containing the deadly bacteria
carbapenem-resistant Enterobacteriaceae, or CRE.
(CDC)
Antibiotic-resistant gonorrhea, a
diarrhea-causing superbug and a class of
fast-growing killer bacteria dubbed a
"nightmare" were classified as urgent
public-health threats in the United States
on Monday.
According to a new report by the U.S.
Centers for Disease Control and Prevention
(CDC), at least 2 million people in the
United States develop serious bacterial
infections that are resistant to one or more
types of antibiotics each year, and at least
23,000 die from the infections.
"For organism after organism, we're
seeing this steady increase in resistance
rates," Dr Thomas Frieden, director of the
CDC, said in a telephone interview. "We
don't have new drugs about to come out of
the pipeline. If and when we get new drugs,
unless we do a better job of protecting
them, we'll lose those, also."
Overprescribing of antibiotics is a chief
cause of antibiotic resistance, affording
pathogens the opportunity to outwit the
drugs used to treat them. Only a handful of
new antibiotics have been developed and
brought to market in the past few decades,
and only a few companies are working on
drugs to replace them.
In addition to resistant gonorrhea, the
others now seen as urgent threats, according
to the first-of-its-kind report released on
Monday, are C. difficile and the killer
class known as carbapenem-resistant
Enterobacteriaceae, or CRE.
The report was conceived to bring
together as much information as possible
about drug-resistant superbugs and how to
slow their spread, with a hope of preserving
the remaining drugs that still work, Frieden
said.
The United States is not alone in raising
the alarm over antibiotic drug resistance.
Last March the chief medical officer for
England said antibiotic resistance poses a
"catastrophic health threat". That followed
a report last year from the World Health
Organization that found a "superbug" strain
of gonorrhea had spread to several European
countries.
The CDC report ranks the threat of
drug-resistant superbugs into three
categories - urgent, severe and concerning -
based on factors such as their health and
economic impacts, the total number of cases,
the ease with which they are transmitted and
the availability of effective antibiotics.
Among the top three threats deemed
"urgent" is CRE, which Frieden last March
called a "nightmare bacteria" because even
the strongest antibiotics are not effective
against it.
According to the report, CRE accounts for
9,300 healthcare-associated infections. The
two most common types of CRE -
carbapenem-resistant Klebsiella spp. and
carbapenem-resistant E. coli - account for
some 600 deaths each year.
"For CRE, we're seeing increases from 1
state to 38 states in the last decade,"
Frieden said.
HOSPITAL THREAT
C. difficile, the most common
hospital-based infection in the United
States, made the list of urgent threats both
because it has begun to resist antibiotics
and because it preys on the overuse of
antibiotics.
C. difficile, which causes
life-threatening diarrhea, spreads from
person to person on contaminated equipment
and on the hands of healthcare workers and
visitors. It is especially stubborn in
hospitals because of the widespread use of
antibiotics, which kill protective bacteria
in the gut for months, allowing invaders
such as C. difficile to flourish.
According to the report, C. difficile
causes 250,000 infections and kills 14,000
people in the United States each year,
adding $1 billion annually in excess medical
costs. Deaths from C. difficile rose 400
percent from 2000 to 2007 due to the
emergence of a drug-resistant strain of the
bacteria.
The third "urgent" threat in the report
is drug-resistant Neisseria gonorrhea, which
causes 246,000 U.S. cases of the sexually
transmitted disease gonorrhea each year.
Gonorrhea is increasingly becoming resistant
to tetracycline, cefixime, ceftriaxone and
azithromycin - formerly the most successful
treatments for the disease.
Gonorrhea is especially troublesome
because it is easily spread, and infections
are easily missed. In the United States,
there are approximately 300,000 reported
cases, but because infected people often
have no symptoms the CDC estimates the
actual number of cases is closer to 820,000.
If left untreated, gonorrhea can lead to
pelvic inflammatory disease, ectopic
pregnancy, stillbirths, severe eye
infections in babies and infertility in men
and women.
"The three organisms that have been
chosen as urgent are all increasing at an
alarming rate to which therapies are
limited," said Dr Edward Septimus, an
infectious disease expert at HCA Healthcare
System in Houston, Texas, and a member of
the Infectious Diseases Society of America's
Antimicrobial Resistance Workgroup.
Septimus, who was not involved with the
CDC report, said the pathogens in the urgent
and serious categories - which include
Methicillin-resistant Staphylococcus aureus,
or MRSA, and drug-resistant tuberculosis -
are "certainly worthy of immediate response.
I do believe it's a looming public-health
crisis," he said.
In addition to ranking the threat of
superbugs, the report outlines a four-point
plan to help fight the spread of antibiotic
resistance.
Not surprisingly, it underscores the need
for new antibiotics, citing ever-slowing
development efforts by pharmaceutical
companies due to the high cost of such
programs and relatively low profit margins
of the drugs.
It also stresses the need for hospitals
to prevent infections from occurring and to
contain the spread of resistant infections;
carefully tracking the spread of resistant
bacteria; and ensuring that antibiotics are
prescribed only to patients who need them.
"It's not too late," Frieden said. "There
are things we can do that can stop the
spread of drug resistance. We need to scale
up the implementation of those strategies."
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