By Bara Vaida
Health journalists should know that antibiotic resistance is a quiet, but big threat to modern medicine. The threat has become so dire, that for some patients, the medical community has reached a “post-antibiotic” era, the CDC says.
At the end of 2019, the CDC said at least 2.8 million people in the U.S. contract an antimicrobial-resistant pathogen annually, with at least 35,000 dying as a result. When the agency includes infections from Clostridioides difficile, or C. diff (a gut bacterium that isn’t typically resistant but can become so with antibiotic use) the number of resistant infections exceeds 3 million and deaths rise to 48,000 annually.
The CDC lists 18 resistant pathogens that are increasingly becoming problematic in medicine. Many of these pathogens used to cause infections that could be easily cured with an antibiotic but now have become more difficult to eradicate, causing longer illnesses, requiring them to seek treatment at a hospital.
One is a bacterium that causes urinary tract infections (one of the most common infections to impact women) and another causes gonorrhea, a sexually transmitted disease.
The pandemic worsened the situation in that many health care providers THAT had been on a path to slow the expansion of antibiotic resistance through antibiotic stewardship programs WERE DISTRACTED CARING FOR COVID-19 PATIENTS. Stewardship programs are efforts to prevent the overuse of antibiotics in patients. THERE WAS a 15% increase in hospital-acquired infections and deaths in 2020, the CDC said.
For reporters covering this topic, click through this slide deck from Brad Spellberg, M.D. chief medical officer at LA County-University of Southern California Medical Center, who clearly explains the history of antibiotics, antibiotic resistance and why antibiotic stewardship programs are essential at hospitals, nursing homes and outpatient clinics.
Also read this background on understanding antibiotic resistance:
First introduced to the public in 1944, antibiotics — drugs that kill harmful bacteria — have all but eliminated the threat of diseases, such as sepsis, tuberculosis, plague, and cholera, which once killed millions. But overuse of these drugs in people and animal farming has resulted in the breeding of “superbugs” — germs that are resistant to most or all existing antibiotics.
Bacteria and fungi become resistant to antibiotics naturally. When an antibiotic is used, most bacteria and fungi are eliminated. A few resistant strains survive, however and continue to multiply and spread. Some microbes become resistant due to a genetic mutation or an acquired resistance from other bacteria. Mutations, which are rare spontaneous changes in the pathogen’s genetic material, also enable microbes to inactivate or close off from an antibiotic. Bacteria and other pathogens also can acquire resistance by “mating” and transferring genetic material with antibiotic resistance. Bacteria can collect multiple resistance traits, making it resistant to many, if not all, antibiotics.
Until the early 1980s, pharmaceutical companies invested in developing new antibiotics to keep ahead of evolving resistance. But the scientific and economic challenges of developing new antibiotics have led to a steep decline in the availability of new strains of antibiotics even as superbugs have spread. In the 1950s, drug companies introduced at least nine new types of antibiotics. Since 1984, there have been no new registered classes of antibiotics. The lack of antibiotics in the pipeline is a key story for reporters looking to write about this topic.
Below are some resources gathered from my experience reporting on antibiotic resistance.
Experts to contact
- David Hyun, director of The Pew Charitable Trusts Antibiotic Resistance Project; media contact is Heather Cable (hcable@pewtrusts.org)
- Emily Heil, infectious diseases pharmacist and coordinator of the University of Maryland Medical Venter’s antibiotic stewardship program, Twitter: @emilylheil
- Shruti Gohil, M.D., M.P.H., associate medical director of epidemiology and infection prevention at the University of California, Irvine School of Medicine; skgohil@uci.edu.
- James M. Hughes, M.D.: co-director of Emory University School of Medicine’s Antibiotic Resistance Center; jmhughe@emory.edu
- Ramanan Laxminarayan: founder and director of the Center for Disease Dynamics, Economics & Policy (CDDEP) and senior research scholar and lecturer at Princeton Environmental Institute; ramanan@cddep.org
- Evan Loh, M.D., CEO of Paratek Pharmaceuticals and a former faculty member at both Harvard Medical School and the University of Pennsylvania School of Medicine. Reach him through Christine Fanelle: christine@scientpr.com.
- Michael Osterholm, Ph.D., M.P.H., director of the Center for Infectious Disease Research and Policy; mto@umn.edu
- Eli Perencevich, M.D., M.S., director of HRS&D and CADRE (Comprehensive Access & Delivery Research & Evaluation, at Iowa City US Department of Veteran’s Affairs Healthcare System) Center of Innovation in the Department of Internal Medicine at the University of Iowa Carver College of Medicine; eli-perencevich@uiowa.edu
- Lance B. Price, Ph.D., professor of environmental and public health at George Washington University’s Milken Institute School of Public Health and founding director of the Antibiotic Resistance Action Center. Contact: lprice@gwu.edu
- Saskia Popescu, Ph.D., M.P.H., M.A., C.I.C., adjunct professor of public health, epidemiology and biostatistics at the University of Arizona Mel & Enid Zuckerman College of Public Health. Contact: spopescu@email.arizona.edu
- John Rex, M.D., the chief medical officer and director at F2G and former expert-in-residence at the London-based Wellcome Trust. You can contact him through Maggie Servais: maggie@keybridge.biz.
- Eddie Stenehjem, M.D., M.S.c., senior medical director at Intermountain Healthcare; eddie.stenehjem@imail.org
- Arjun Srinivasan, M.D., associate director for health care-associated infection prevention programs in the Division of Healthcare Quality Promotion at CDC. Contact: CDC Media: (404) 639-3286, media@cdc.gov
- Anthony So, M.D., M.P.A., professor of the practice and founding director of Johns Hopkins Bloomberg School of Public Health’s Innovation and Design Enabling Access Initiative,; aso5@jhu.edu
- Brad Spellberg, M.D., chief medical officer at LA County-University of Southern California Medical Center, Contact: bspellberg@dhs.lacounty.gov
- Kathy Talkington, M.P.A., director of health programs, The Pew Charitable Trusts; ktalkington@pewtrusts.org
- Matthew Wellington, director, U.S. PIRG’s Public Health campaigns; mwellington@pirg.org
AHCJ Blog posts with story ideas for reporters
- How is the U.S. preparing for the ‘second punch’ from antibiotic resistance? (September 2022)
- Fungal infections are next chapter in reporting on superbugs (May 2022)
- Antibiotic resistance: How to cover this ongoing health story beyond the COVID-19 pandemic (November 2021)
- Tips for covering the latest news about antimicrobial resistance (December 2019)
- How a journalist overcame challenges of covering antibiotic resistance (July 2019)
- Consider the business angle when covering antibiotic resistance (November 2019)
Advocacy groups
- Association for Professionals in Infection Control and Epidemiology: A 15,000-member organization tracks infection trends and works to fight hospital-acquired infections. It also provides a monthly alert for consumers on new infection threats. Contact: Aaron Cohen, 301-633-6773
- American Society for Microbiology: A 50,000-member organization that promotes infectious disease research, including antibiotic resistance.
- Antibiotic Resistance Action Center: Based at the George Washington University Milken Institute School of Public Health, this organization brings together epidemiologists, microbiologists, communications experts and policy experts to combat antibiotic resistance.
- Infectious Disease Society of America: An 11,000-member professional organization representing infectious disease practitioners and often sponsors reports about antibiotic resistance.
- The Pew Charitable Trusts Antibiotic Resistance Project: An initiative to spur the development of new antibiotics, establish stewardship programs to ensure antibiotics are prescribed only when necessary and end the overuse of antibiotics used in animals.
- U.S. Public Interest Research Group’s Stop the Overuse of Antibiotics: The long-time consumer and public interest advocacy group focuses money and staff on reducing the inappropriate use of antibiotics by consumers and in farming.
Reports
- “Antibiotic Resistance Threats in the United States, 2019″ (2019 AR Threats Report) The CDC’s December 2019 report [the last available] on the threat of antibiotic resistance.
- COVID-19 Reverses Progress in Fight Against Antimicrobial Resistance in U.S. (July 2022 report on the damage the pandemic did to progress in slowing antibiotic resistance)
- CDC’s funding announcements for investing in antimicrobial resistance. Reporters can look here to find local stories on efforts to slow antibiotic resistance.
- FDA’s National Antimicrobial Resistance Monitoring System: The FDA’s surveillance of bacteria from animals, people and retail meats. This can be another source for local stories for journalists.
- Fast Food Scorecard (2021 update): A group of environment and consumer groups rate fast food companies on their efforts to stop buying and selling food products from producers that feed antibiotics to their animals.
Antibiotic research and development pipeline
- Antibiotics Currently in Clinical Development
The World Health Organization’s analysis of antimicrobials in clinical development. - The Collaborative Hub for Early Antibiotic Discovery (CARB-X)
A U.S. public/private partnership, based at the Broad Institute, that aims to fund early-stage research and development of antibiotics. - Antibiotics – The Perfect Storm
A former drug executive writes up-to-date posts on the ins and outs of antibiotic research and development.
Government agencies
- The Presidential Advisory Council on Combatting Antibiotic-Resistance Bacteria, which was codified into law in June 2019 and operates within the U.S. Department of Health and Human Services. The group provides advice and recommendations on policies to combat antibiotic resistance.
- Antibacterial Resistance Leadership Group (ARLG): Funded by the National Institutes of Health, and based at Duke Clinical Research Institute, this group of 100 leading infectious disease experts is prioritizing public health clinical research on antibiotic resistance.
- Department of Agriculture One Health Collaborative on antibiotic resistance: An inter-governmental agency effort to work with human health and veterinary and environmental health communities to ensure the health of animals and humans.
- Center for Disease Control and Prevention’s Antibiotic/Antimicrobial division: Branch within the CDC focused on fighting antibiotic resistance.
- CDC PulseNet: A network developed in 1995 that links the CDC’s foodborne diseases lab with state public health laboratories. The labs use DNA technology to track outbreaks of new diseases including foodborne illnesses.
- Food and Drug Administration Antimicrobial Resistance Information: Website where the FDA posts its work and strategies to stem growing antibiotic resistance.
- Food and Drug Administration’s Foodborne Pathogen’s page: Division that oversees the safety of domestic and imported food.
- National Antimicrobial Resistance Monitoring System for Enteric Bacteria: A CDC, Food and Drug Administration and USDA effort to track antibiotic resistance cases in the U.S.
- World Health Organization’s AMR Surveillance and Quality Assessment Collaborating Centers Network : The WHO’s hub for halting antibiotic resistance worldwide.
Hospitals and Antibiotic Stewardship programs
- 2020 National and State Healthcare-Associated Infections Progress Report: Updated in 2021, this CDC report provides a summary of select health care associated infections across hospitals, long-term care facilities and rehabilitation centers.
- The Core Elements of Hospital Antibiotic Stewardship Programs: The CDC’s core requirements for all hospitals to follow in implementing an antibiotic stewardship program.
- Centers for Medicare and Medicaid Services Require All Hospitals to Antimicrobial Stewardship Programs: A September 2019 rule requiring any hospital that takes Medicare patients to adhere to CDC requirements for antibiotic stewardship.
