Since 2013, the U.S. Centers for Disease Control and Prevention has been saying that, in their conservative estimate, at least 2 million people in the U.S. are infected with an antimicrobial resistant pathogen and at least 23,000 die from it.
But those numbers likely are much higher. By mid-November, the public will know more when the agency is expected to release its second antibiotic resistance threat report. The new numbers are likely to show that antimicrobial resistance is worsening and more people are dying from resistant pathogens than previously believed.
The report is likely to incorporate data from electronic health records that wasn’t utilized when the agency first estimated illnesses caused by drug-resistant pathogens in 2013, reports the Center for Infectious Disease Research and Policy.
“Our hope, with the EHR systems that we’re using, is that we’re actually going to have more cross-cutting, comprehensive data,” said Michael Craig, M.P.P., CDC senior adviser on antibiotic resistance in this CIDRAP article. “We’re also going to have data directly from clinical laboratories that are doing the resistance testing. So, especially for healthcare-associated pathogens, we’re going to have a higher degree of consistency and methodology.”
In January 2019, Washington University School of Medicine researchers looked at inpatient and outpatient hospital deaths from 2010 and estimated that a range of 153,113 to 162,044 patients die from a multi drug-resistant infections annually – at least seven times higher than the CDC’s numbers. If accurate, drug-resistant bugs would become among the top 3 leading causes of death in the U.S., said CIDRAP.
Meanwhile, the CDC continues to work with hospitals to improve stewardship of antibiotics – meaning helping hospitals to reduce inappropriate use of antibiotics. The CDC said that about 30 percent of all antibiotic prescriptions by health providers are likely inappropriate and thus are contributing to rising resistance.
In September, the U.S. Health and Human Services Department’s Centers for Medicare and Medicaid Services, began requiring all U.S. hospitals to implement an antibiotic stewardship program. [Medicare is the federal health insurance program for those 65 and older and Medicaid is the federal and state health insurance program for low-income Americans] About 25 percent of the nation’s 5,000 hospitals had no stewardship programs, according to CIDRAP.
Understanding how to make a hospital stewardship program effective has been evolving, according to Lauri Hicks, director of the CDC’s Office of Antibiotic Stewardship.
“We thought at first that there was a knowledge deficit. And that providers didn’t know what they were supposed to do and how to prescribe [antibiotics]. But we have learned that it is more complicated,” Hicks said at an Oct. 11 webcast on drug-resistant infections, hosted by Harvard T.H. Chan School of Public Health. “Education isn’t enough. It is a psycho, social issue. And it involves how the patient and provider are interacting.”
Hicks, who noted during the forum that the CDC’s new antibiotic report will be published in November, said that the CDC is now providing health providers with communication techniques to help them talk about antibiotics, their potential side effects and how to manage symptoms without an antibiotic prescription. The CDC is also helping local public health organizations furnish physicians with statistics on their prescribing patterns, in comparison to their colleagues.
“Doctors have poor insight into their prescribing practices,” she said.
Ongoing government efforts to curb usage of antibiotics has been showing positive results in the agriculture sector, she said. In 2017, the Food and Drug Administration began requiring medically important antibiotics used in food production to be prescribed by licensed veterinarians, instead of allowing them to be used as over-the-counter drugs without veterinary supervision. Further, antibiotics can no longer be used for growth promotion in food production.
As a result, “we have seen some decrease in resistance, so that is encouraging,” Helen Boucher, director of Tufts Center for Integrated Management of Antimicrobial Resistance, said during the webcast.
For AHCJ members interested in learning more about the CDC’s antibiotic resistance report: email Candice Hoffmann at the CDC’s media affairs department: firstname.lastname@example.org.
And for covering antimicrobial resistance: AHCJ Tip Sheet on what reporters need to know.
To see the Harvard webcast, click here.