What reporters need to know about antibiotic resistance

By Bara Vaida

At the end of 2019, the Centers for Disease Control and Prevention (CDC) updated its data on just how big a threat antibiotic resistance is to modern medicine.

Using electronic health record data, and hospitals’ reporting data, the agency now says at least 2.8 million people in the U.S. contract an antimicrobial-resistant pathogen, with at least 35,000 dying annually as a result.

Further, it elevated the threat from the bacteria that causes urinary tract infections [one of the most common infections to affect women] and the pathogen that causes gonorrhea, a sexually transmitted disease. More and more people are developing illness from a resistance bacteria that causes these infections, potentially requiring them to seek treatment at a hospital.

The last time the CDC reported on antibiotic resistance was in 2013, when it estimated at least 2 million people in the U.S. were sickened by an antibiotic resistance bug and 23,000 were dying from it. The threat has become so dire, that for some patients, the medical community has reached a “post-antibiotic” era, the CDC says.

For reporters covering this topic, here is a little background on 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 become resistant to antibiotics naturally. When an antibiotic is used, most bacteria 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 bacteria’s genetic material, also enable bacteria to inactivate or close off from an antibiotic. Bacteria 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 has 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.

Most antibiotic-resistance cases have been associated with health care settings such as hospitals and nursing homes. Increasingly, however, there are cases of antibiotic resistance, such as methicillin-resistant staphylococcus aureus (MRSA) infections or drug-resistant tuberculosis, outside health care settings. These cases are hard to treat with existing antibiotics.

Here are some resources for your reporting:

Reports

• “Antibiotic Resistance Threats in the United States, 2019” (2019 AR Threats Report) The CDC’s updated report on the threat of antibiotic resistance. And the transcript of the media briefing with CDC officials on the report.
• The Kaiser Family Foundation polled on the issue last year to get a sense of the public’s knowledge and concern on the issue. See the data note here for the details.
• The CDC’s National Center for Emerging and Zoonotic Infectious Diseases budget request. This outlines the 2020 fiscal budget request for federal funding for fighting infectious diseases, including antibiotic resistance, in the U.S.
• FDA’s National Antimicrobial Resistance Monitoring Systemp Integrated Report: The FDA’s report on food-borne outbreaks in 2016-2017, the most recent data available, as of November 2019.
• Fast Food Scorecard – Chain Reaction V: 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.

Experts

• Greg Frank, Ph.D.: director, infectious disease policy, Biotechnology Innovation Organization, He can be reached via his PR agent: Lauren Archambeault, at laurena@keybridge.biz
  Expertise: At BIO, he represents 50 companies seeking solutions to antibiotic resistance.
• James M. Hughes, M.D.: co-director, Emory University School of Medicine’s Antibiotic Resistance Center; jmhughe@emory.edu
  Expertise: A known leader on emerging global health threats, with a focus on the rise of antibiotic resistance. Hughes is former director of the CDC’s National Center for Infectious Diseases and former vice president of the Infectious Diseases Society of America.
• Ramanan Laxminarayan: founder and director of the Center for Disease Dynamics, Economics & Policy (CDDEP), senior research scholar and lecturer at Princeton Environmental Institute; ramanan@cddep.org
  Expertise: A senior research scholar who has been working on improving the understanding of antibiotic resistance as a global public health threat. Laxminarayan also has served on the U.S. President’s Council of Advisors on Science and Technology’s antibiotic resistance working group.
• Michael Osterholm, Ph.D., M.P.H.: director of the Center for Infectious Disease Research and Policy and a member of the National Science Advisory Board on Biosecurity; mto@umn.edu
  Expertise: A prolific researcher and recognized leader on national and global biosecurity and public health issues, particularly in pandemic preparedness. Osterholm served in many roles at the Minnesota Department of Public Health and was director of the National Institutes of Health-supported Minnesota Center of Excellence for Influenza Research and Surveillance. He co-authored “Deadliest Enemy: Our War Against Killer Germs,” a 2017 book about the many potential ways the U.S. could face a pandemic.
• 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
  Expertise: An infectious disease physician and epidemiologist studying emerging pathogens and nosocomial infections. Perencevich is particularly interested in identifying the most effective and cost-effective methods for controlling these pathogens.
• Lance B. Price, Ph.D.: Professor at George Washington University’s Milken School of Public Health and founding director of GW’s Antibiotic Resistance Action Center; Lprice@gwu.edu
  Expertise: Works at the interface between science and policy to address the growing crisis of antibiotic resistance. Price’s research has traced the evolution and epidemiology of resistant bacteria.
• Saskia Popescu, Ph.D., M.P.H., M.A., C.I.C.: Epidemiologist and infection preventionist at HonorHealth, ELBI fellow at Johns Hopkins Center for Health Security, and managing editor of the Pandora Report; spopesc2@masonlive.gmu.edu
  Expertise: A frontline worker on infection control at a busy urban hospital. Popescu is also a regular contributor on infectious disease issues for Contagion Live.
• 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, director of the strategic policy program of ReAct – Action on Antibiotic Resistance; aso5@jhu.edu
  Expertise: Part of a global network fighting antibiotic resistance. So is working to increase access to antibiotics to people living in low-income and middle-income countries.
• Arjun Srinivsan, M.D., (Capt., U.S.P.H.S.): Associate director of health care-associated infection prevention programs at the Centers for Disease Control and Prevention, division of healthcare quality promotion, National Center for Emerging and Zoonotic Infectious Diseases; media@cdc.gov, phone: 404-639-3286
  Expertise: The CDC’s spokesman on all issues related to antibiotic resistance.
• Brad Spellberg, M.D.: professor of clinical medicine and associate dean for clinical affairs at University of Southern California Keck School of Medicine and chief medical officer of Los Angeles County-USC Medical Center; spellber@usc.edu
  Expertise: A national voice in the medical community, raising awareness of the threat of antibiotic resistance and the decline in new antibiotics on the market. Spellberg is working to develop vaccines to prevent infections caused by staphlyococcus aureus bacteria and the candida fungus.
• Kathy Talkington, M.P.A.: project director of The Pew Charitable Trusts’ Antibiotic Resistance Project; ktalkington@pewtrusts.org
  Expertise: Leads Pew’s significant investment in working to change government policy to encourage responsible use of antibiotics and to increase the antibiotic pipeline. Before Pew, Talkington managed the Association of State and Territorial Health Offices’ immunization and infectious disease programs.
• Matthew Wellington : director, U.S. PIRG’s Campaign to Stop the Overuse of Antibiotics; mwellington@pirg.org
  Expertise: Leads US PIRG’s efforts to address the growing problem of antibiotic-resistant infections by stopping the overuse of antibiotics on factory farms.

Advocacy groups

• 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.
• Association for Professionals in Infection Control and Epidemiology: This 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.
• 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.

Agriculture

• “Antibiotic resistance in food animals has tripled since 2000”
  A 2019 report published by Princeton University examined antibiotic resistance in low and middle income countries between 2000 and 2018, showing Brazil and Kenya are new hotspots for antibiotic ressistance.
• Antibiotics and Animal Agriculture – A Primer
  A 2018 Pew Charitable Trusts’ report on how animal farming is contributing to antibiotic resistance.
• Food and Food Animals and Antibiotic Resistance
  In November 2019, the CDC updated its information page on the use of antibiotics in food and how consumers can keep their food safe.
• FDA Draft Guidance on Reducing Use of Medically Important Antimicrobial Drugs in Animals
  The Food and Drug Administration issued guidance requiring medically necessary antibiotics be used on animals under the supervision of a veterinarian. This is aimed at reduce overuse of antibiotics in agriculture.
• Critical Antibiotics Still Used on U.S. Farms Despite Superbug Crisis
  June 2018 investigative report on how U.S. farm animals still are being doused with “critically important” antibiotics despite an FDA ban on the practice in 2017.
• Reducing Antimicrobial Use in Food Animals
  A 2017 report by infectious disease experts on how to reduce antibiotic usage in U.S. farming.

Antibiotic research and development pipeline

• Antibiotics Currently in Global Clinical Development
  A Pew Charitable Trusts’ Antibiotic Project’s September 2019 tracking the number of antibiotics in the pipeline.
• Antimicrobials Working Group
  A group of antibiotic and diagnostics companies working together to improve the regulatory, investment and commercial opportunities for new drugs.
• 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 May Soon Become Useless, Now What?
  Report in October 2018 on how few antibiotics are in the research and development pipeline.
• Antibiotics – The Perfect Storm
  A former drug executive writes up-to-date posts on the ins and outs of antibiotics R&D.

Government agencies

• The Obama administration created 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 50 leading infectious disease experts is prioritizing public health clinical research on antibiotic resistance.
• Department of Agriculture One Health Collaborative: An inter-governmental agency effort to work with the human health, 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 on its work and strategy to stem growing antibiotic resistance.
• Food and Drug Administration’s Foodborne Pathogen’s page: Division that oversees the safety of domestic and imported food.
• Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response: This office handles pandemic preparedness as well as the health threat from antibiotic resistance.
• National Antimicrobial Resistance Monitoring System: A CDC, Food and Drug Administration and USDA effort to track antibiotic resistance cases in the U.S.
• World Health Organization’s Collaborating Centres:  The WHO’s hub for halting antibiotic resistance worldwide.

Hospitals

• 2018 National and State Healthcare-Associated Infections Progress Report:

  Updated in November 2019, 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: 2019: The CDC, in November 2019, updated its 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.
• 2018 Antibiotic Stewardship Report: The CDC’s report on hospital progress toward antibiotic stewardship.
• Acute Care Hospital Toolkit
  The Agency for Healthcare Research and Quality has released this resource to support implementation of the “Four Moments of Antibiotic Decision Making” and improve antibiotic prescribing.
• Strategies for Superbugs: Antibiotic Stewardship for Rural Hospitals: The Rural Health Information Hub in this 2017 report describes strategies being used by rural hospitals to protect patients from antibiotic resistant bugs.

Recent coverage

• Deadly Germs, Lost Cures: Ongoing New York Times 2019 series on antimicrobial resistance, its causes, its impact on patients and possible solutions.
• Center for Infectious Disease Research and Policy’s Antimicrobial Stewardship Project: This website provides ongoing and updated information about efforts to curb inappropriate usage of antimicrobials.
• New York Identifies Hospitals and Nursing Homes with Deadly Fungus: Policy change comes as the CDC reports more people are dying of antibiotic resistant microbes. (11/13/19)
• The Post Antibiotic Era is Here: (11/19/19) In the U.S., one person dies every 15 minutes because of drug resistance.
• How Best to Use The Few New Drugs To Treat Antibiotic Resistance Germs: (11/13/19): A story looking at how to best utilize new antibiotics.
• How a Journalist Overcame Challenges of Covering Antibiotic Resistance: (8/5/19) A “How I Did It” with the New York Times’s Matt Richtel who has been co-authoring a series on antibiotoic resistance in US hospitals.
• Data Note: Public Awareness Around Antibiotic Resistance (6/21/19): The Kaiser Family Foundation’s polling experts take a look at what the public understands about antibiotic resistance. It showed there is a lot of misunderstanding about antibiotics.
• Scientists Look for new Antimicrobials and urge government incentives: (5/8/19) Scientist and business leaders discuss the state of antibiotic research and the need for government policy changes at the Association of Health Care Journalists’ conference in Baltimore.
• Sustainable Discovery and Development of Antibiotics – Is A Nonprofit Approach the Future? (June 2019) A group of physicians write about shifting to a nonprofit-driven model for development of antibiotics in the New England Journal of Medicine.
• SuperBug Threat: Will Antibiotics Continue to Work? (6/15/18): In-depth report on the global state of antibiotic resistance written by AHCJ core topic leader Bara Vaida.