While deaths from antibiotic resistant infections have declined in the U.S. since 2013, these infections very much remain a public health threat, CDC researchers said.
New data from the agency's "Antibiotic Resistance Threats in the United States" report found that antibiotic-resistant bacteria and fungi cause at least 35,000 deaths and 2.8 million infections in this country -- and that's not even including Clostridioides difficile, which brings the total to 48,000 deaths and more than 3 million infections.
But since 2013, deaths from antibiotic-resistant infections have declined 18% due to prevention efforts, driven mainly by a 28% decline in deaths from hospitals, the CDC noted in a statement.
"Antibiotic resistance remains a significant enemy," said Robert Redfield, MD, CDC director, on a press call with reporters. "[Our] success is undoubtedly due to public health and healthcare professionals who stand up to this threat every day, as well as every state public health department ... and other federal agencies committed to take action against it."
The declines in deaths from antibiotic-resistant infections were measured against revised data from the first "AR Threat Report" in 2013, which Michael Craig, MPP, of the CDC Antibiotic Resistance Coordination and Strategy Unit in Atlanta, described as a "conservative" estimate.
"We likely underestimated the true burden of antibiotic resistance [in 2013] and we were right," he said, adding that the revised methodology shows that the burden was nearly twice as high than what was reported 6 years ago. Craig noted that the agency used data from 700 hospitals, from electronic health records.
There are five "urgent threats" listed in the new report -- the three from the previous report (carbapenem-resistant Enterobacteriaceae, or CRE, Neisseria gonorrhoeae, and C difficile) and two newcomers -- the deadly multi-drug resistant fungus, Candida auris, as well as carbapenem-resistant Acinetobacter.
In the report, the CDC identified 18 pathogens, and noted that resistance to essential antibiotics is rising in seven of these pathogens. They also added a "watch list" of three pathogens that have yet to spread resistance widely or are not well understood in the U.S., but should be monitored closely:
- Azole-resistant Aspergillus Fumigatus, a fungus that can cause infections in patients with weakened immune systems
- Drug-resistant Mycoplasma Genitalium, which can cause sexually transmitted infections
- Drug-resistant Bordetella Pertussis, which is rarely reported in the U.S., but has been documented in other countries
While pathogens found in healthcare, such as CRE and methicillin-resistant Staphylococcus aureus (MRSA), were responsible for more than 85% of the deaths listed in the report, it also detailed community-acquired antibiotic-resistant infections, notably drug-resistant strains of Neisseria gonorrhoeae (rising from an estimated 246,000 infections and <5 deaths in the 2013 report to 550,000 infections in the 2019 report).
The CDC also highlighted extended-spectrum beta lactamase-producing Enterobacteriaceae, which has been seen in urinary tract infections (UTI).
"Normal UTIs that would resolve in a couple days are now harder to treat and you potentially have to be hospitalized," Craig said.
Still, Redfield touted "significant progress" against antibiotic resistance, in part due to CDC investments in public health infrastructure, and working closely with partners like the Centers for Medicare & Medicaid Services (CMS), data analysts, and healthcare professionals to improve use of antibiotics.
Other organizations, such as the Society for Healthcare Epidemiology of America (SHEA), applauded the progress made since 2013.
"The evidence base for preventing infections was primarily developed in hospitals," said Hilary Babcock, MD, SHEA president, in a statement. "Targeted investments are needed for research to increase our understanding of effective strategies to prevent and contain infections in other settings, and for studies of the best ways to maximize implementation of those strategies once identified."
"It shows we are not powerless against antibiotic resistance," she noted.