Receive Updates
ResistanceMap: Key Findings
GLOBAL HIGHLIGHTS
Although it ranks in the middle of our Resistance Overview, the United States compares unfavorably with European nations in terms of resistance against clinically important Gram-positive bacteria. Some of these “superbugs,” like vancomycin-resistant Enterococcus (VRE), are more common in hospital settings and affect the critically ill. Others, such as methicillin-resistant Staphylococcus aurea (MRSA) and drug-resistant S. pneumonia, are frequently encountered in the community.
Fortunately, a reliable treatment arsenal is still available against Gram-positive infections, and certain drugs released in the past decade, such as Tigecycline and Quinupristin-Dalfopristin, target these bacteria. Nevertheless, infection control lessons – from the Netherlands, or from individual health care facilities in the U.S. – should be applied on a broader scale to curtail the nosocomial spread of infections before current treatment options succumb to resistant strains.
NOTABLE TRENDS IN UNITED STATES REGIONS
Resistance among staphylococci, including both MRSA and CoNS species, is trending downwards. Reasons for the decline are not fully understood, but may be at least in part the result of raised awareness and targeted infection control efforts since the late 1990s. Also of note, the evolution of MRSA was characterized by a striking increase in the prevalence of community-associated strains, which are now showing up in hospitals. Consequently, although MRSA is becoming more treatable, it may be affecting more people than ever.
Still more alarmingly, we are seeing the rapid spread of resistance to broad-spectrum drugs among common Gram-negative species , including simultaneous resistance to multiple antibiotic classes. Some of these species are associated with community infections (Escherichia coli), others strike mostly hospital populations (Klebsiella pneumonia, Acinetobacter baumannii). Though still rare, a growing number of Gram-negative infections are becoming untreatable even with the strongest, last-resort antibiotics, pointing to the urgent need to develop new drugs.
OUTPATIENT ANTIBIOTIC USE IN THE UNITED STATES
From 1999-2007, overall rates of antibiotic dispensing in the United States decreased by about 12%, from 0.96 to 0.86 prescriptions per capita. While this trend is encouraging, mapping consumption also shows alarming geographic disparities: for example, residents of West Virginia and Kentucky consume about twice as many antibiotics per capita as people living in Oregon and Alaska. In addition, the overall reduction in use comes from older classes, but use of broad-spectrum drugs like fluoroquinolones or newer macrolides is on the rise.
High per capita antibiotic use rates in certain regions could be due to a variety of cultural, socio-economic and epidemiological causes. Additional research must be done to better understand the driving factors behind antibiotic overuse and tailor information campaigns according to local needs.
CONCLUDING REMARKS
The findings in ResistanceMap indicate that many important bacterial infections may be getting costlier and more difficult to treat both in and out of hospitals. Not all options have been exhausted, but many of the remaining treatments are new antibiotics that can cost several thousand dollars per course or combinations of older drugs once shelved for their high toxicity. Nevertheless, the time when even the most powerful antibiotics fail may not be far off.
To ensure the sustainability of our antibiotic use, public health officials, doctors and healthcare workers need to take urgent action before it is too late. A list of policy recommendations, by no means exclusive, may include the following:
Public health officials should invest in large-scale improvements to the existing surveillance infrastructure to track established and emerging threats on a local, national and global scale. Surveillance is needed to track changes at the population, as well as the microbiological level.
Hospital administrators should evaluate widespread adoption of proven infection control measures such, as the active detection, reporting and isolation of resistant infections, in addition to the implementation and improvement of existing education and stewardship programs that promote judicious antibiotic use.
Legislators and regulators must create incentives for the rapid development of new antibiotics by realigning the financial interests of the pharmaceutical industry with the public health goals of antibiotic conservation. In addition to streamlined FDA approval procedures, the federal government can make headway in the race against resistance by expanding NIH funding for new drug development.
