September 17, 2013
The overuse of antibiotics has caused three kinds of bacteria—one that causes life-threatening diarrhea, one that causes bloodstream infections and one that transmits sexually—to become urgent threats to health in the USA, federal officials say in a landmark report out Monday.
The Centers for Disease Control and Prevention (CDC) report is the first to categorize the threat of such germs, from "urgent" to "serious" to "concerning." It is also the first to quantify the toll of "superbugs," which cause at least 2 million infections and 23,000 deaths each year.
"It's not too late" to respond, rein in the infections and keep antibiotics working by reserving them for when they are truly needed, but several steps must be taken right away, CDC Director Tom Frieden said Monday. "If we are not careful ... the medicine cabinet may be empty for patients with life-threatening infections in the coming months and years."
On the urgent list:
Carbapenem-resistant Enterobacteriaceae (CRE), bacteria that cause 9,000 infections in hospitals and other facilities each year. The CDC says nearly half of patients who get CRE infections die of them. It's a "nightmare infection," Frieden says.
Drug-resistant gonorrhea, a sexually transmitted infection that resists several antibiotics that used to cure it. CDC estimates 30% of the 800,000 cases a year are resistant.
Clostridium difficile (C. diff), a serious diarrhea-causing infection that is not highly resistant to antibiotics but thrives when they are overused. It causes 250,000 infections and 14,000 deaths each year.
The "serious" list includes 11 drug-resistant bacteria and one fungus (Candida); the "concerning" list includes three more. The bugs were categorized based on health impact, economic impact, how common they are, how common they could become, how easily they spread, how well they still respond to medication and how difficult they are to prevent.
The gist of the problem: the more often these bugs encounter antibiotics, the more likely they are to adapt in ways that make the drugs less effective—and eventually, useless.
With the new numbers and urgent tone, "the CDC is signaling that this is a major, major public health threat," says Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy, Washington, D.C. It puts the threat in terms the public and lawmakers can grasp and "is long overdue," he says.
The CDC says unneeded antibiotic use in people and animals must be cut. Other steps include preventing infections with vaccines, hospital infection-control plans, better tracking of resistant infections and new antibiotics and tests for drug resistance.
Even more should be done, says infectious disease specialist Helen Boucher of Tufts Medical Center in Boston. That includes giving companies more financial incentives to develop antibiotics, giving the Food and Drug Administration more power to quickly approve and then limit the use of new antibiotics and making sure all hospitals, nursing homes and rehabilitation facilities follow best practices for using antibiotics.
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