Generated Summary
This document is a report by the CDC (Centers for Disease Control and Prevention) on the threats posed by antibiotic resistance in the United States. It provides a snapshot of the complex problem of antibiotic resistance, the potentially catastrophic consequences of inaction, and encourages immediate action to address the threat. The report covers bacteria causing severe human infections and the antibiotics used to treat those infections, also including Candida, a fungus that is showing increasing resistance to the drugs used for treatment. It gives a national assessment of the most dangerous antibiotic resistance threats, summarizes the burden of illness, level of concern, and available antibiotics. The document categorizes the threats as urgent, serious, and concerning, and also discusses what can be done to combat the growing threat, including information on current CDC initiatives and four core actions that fight the spread of antibiotic resistance.
Key Findings & Statistics
- In the United States, at least 2 million people are sickened every year with antibiotic-resistant infections, with at least 23,000 dying as a result.
- CDC estimates that in the United States, more than two million people are sickened every year with antibiotic-resistant infections, with at least 23,000 dying as a result.
- Almost 250,000 people each year require hospital care for Clostridium difficile (C. difficile) infections. At least 14,000 people die each year in the United States from C. difficile infections.
- Estimates of minimum illnesses and deaths caused by antibiotic resistance: At least 2,049,442 illnesses, 23,000 deaths
- Estimated minimum number of illnesses and death due to Clostridium difficile (C. difficile): At least 250,000 illnesses, 14,000 deaths.
- Carbapenem-resistant Enterobacteriaceae (CRE) Estimated annual number of cases 9,300, Estimated Annual Number of Deaths 610
- Drug-resistant Neisseria gonorrhoeae (any drug) Estimated annual number of cases 246,000, Estimated Annual Number of Deaths <5
- Multidrug-resistant Acinetobacter (three or more drug classes) Estimated annual number of cases 7,300, Estimated Annual Number of Deaths 500
- Drug-resistant Campylobacter (azithromycin or ciprofloxacin) Estimated annual number of cases 310,000, Estimated Annual Number of Deaths 28
- Drug-resistant Candida (fluconazole) Estimated annual number of cases 3,400, Estimated Annual Number of Deaths 220
- Extended-spectrum ẞ-lactamase producing Enterobacteriaceae (ESBLs) Estimated annual number of cases 26,000, Estimated Annual Number of Deaths 1,700
- Vancomycin-resistant Enterococcus (VRE) Estimated annual number of cases 20,000, Estimated Annual Number of Deaths 1,300
- Multidrug-resistant Pseudomonas aeruginosa (three or more drug classes) Estimated annual number of cases 6,700, Estimated Annual Number of Deaths 440
- Drug-resistant non-typhoidal Salmonella Estimated annual number of cases 100,000, Estimated Annual Number of Deaths 38
- Drug-resistant Salmonella Typhi Estimated annual number of cases 3,800, Estimated Annual Number of Deaths <5
- Drug-resistant Shigella Estimated annual number of cases 27,000, Estimated Annual Number of Deaths <5
- Methicillin-resistant Staphylococcus aureus (MRSA) Estimated annual number of cases 80,000, Estimated Annual Number of Deaths 11,000
- Drug-resistant Streptococcus pneumoniae Estimated annual number of cases 1,200,000, Estimated Annual Number of Deaths 7,000
- Drug-resistant tuberculosis (any clinically relevant drug) Estimated annual number of cases 1,042, Estimated Annual Number of Deaths 50
- Vancomycin-resistant Staphylococcus aureus (VRSA) Estimated annual number of cases <5, Estimated Annual Number of Deaths <5
- Erythromycin-resistant Group A Streptococcus Estimated annual number of cases 1,300, Estimated Annual Number of Deaths 160
- Clindamycin-resistant Group B Streptococcus Estimated annual number of cases 7,600, Estimated Annual Number of Deaths 440
- The total economic cost of antibiotic resistance to the U.S. economy has been difficult to calculate. Estimates vary but have ranged as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars).
- Drug-resistant infections add considerable and avoidable costs to the already overburdened U.S. healthcare system.
- Each year in the United States, at least 2 million people acquire serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections.
- At least 23,000 people die each year as a direct result of these antibiotic-resistant infections.
- In addition, almost 250,000 people each year require hospital care for Clostridium difficile (C. difficile) infections.
- At least 14,000 people die each year in the United States from C. difficile infections.
Other Important Findings
- The single most important factor leading to antibiotic resistance around the world is the use of antibiotics. Antibiotics are among the most commonly prescribed drugs used in human medicine. However, up to 50% of all the antibiotics prescribed for people are not needed or are not optimally effective as prescribed. Antibiotics are also commonly used in food animals to prevent, control, and treat disease, and to promote the growth of food-producing animals.
- Antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U.S. healthcare system. In most cases, antibiotic-resistant infections require prolonged and/or costlier treatments, extend hospital stays, necessitate additional doctor visits and healthcare use, and result in greater disability and death compared with infections that are easily treatable with antibiotics.
- The other major factor in the growth of antibiotic resistance is spread of the resistant strains of bacteria from person to person, or from the non-human sources in the environment, including food.
- The report consists of multiple one or two page summaries of cross-cutting and bacteria- specific antibiotic resistance topics. The first section provides context and an overview of antibiotic resistance in the United States. In addition to giving a national assessment of the most dangerous antibiotic resistance threats, it summarizes what is known about the burden of illness, level of concern, and antibiotics left to defend against these infections. This first section also includes some basic background information, such as fact sheets about antibiotic safety and the harmful impact that resistance can have on high-risk groups, including those with chronic illnesses such as cancer.
- Antibiotic resistance is a worldwide problem. New forms of antibiotic resistance can cross international boundaries and spread between continents with ease. Many forms of resistance spread with remarkable speed.
- The four core actions to prevent antibiotic resistance are: preventing infections and preventing the spread of resistance, tracking resistant bacteria, improving the use of today’s antibiotics, and promoting the development of new antibiotics and developing new diagnostic tests for resistant bacteria.
- Regarding level of concern, CDC has — for the first time — prioritized bacteria in this report into one of three categories: urgent, serious, and concerning.
Limitations Noted in the Document
- The data presented in this report are approximations, and totals, as provided in the national summary tables, can provide only a rough estimate of the true burden of illness. Greater precision is not possible at this time for a number of reasons.
- Precise criteria exist for determining the resistance of a particular species of bacteria to a specific antibiotic. However, for many species of bacteria, there are no standard definitions that allow for neatly dividing most species into only two categories-resistant vs. susceptible without regard to a specific antibiotic.
- There are very specific criteria and algorithms for the attribution of deaths to specific causes that are used for reporting vital statistics data. In general, there are no similar criteria for making clinical determinations of when someone’s death is primarily attributable to infection with antibiotic-resistant bacteria, as opposed to other co-existing illnesses that may have contributed to or caused death.
- Many studies attempting to determine attributable mortality rely on the judgment of chart reviewers, as is the case for many surveillance systems.
- The methodology employed in this report likely underestimates, at least for some pathogens, the impact of antibiotic resistance on mortality.
- For several pathogens, complete data from all types of infections are not available since tracking is limited to the more severe types of infections. For some pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA), only cases due to invasive disease are counted. For other pathogens, where resistance is predominately limited to healthcare settings, only disease occurring in acute care hospitals, or requiring hospitalization, are counted.
Conclusion
The report emphasizes the urgent need for action to combat antibiotic resistance, a growing threat to global health. The main message is that the increasing prevalence of antibiotic-resistant bacteria and fungi poses a significant risk to the ability to treat infections, leading to increased morbidity, mortality, and healthcare costs. The report highlights the factors contributing to resistance, including the overuse and misuse of antibiotics in both human medicine and animal agriculture, and the spread of resistant strains. The CDC’s report emphasizes the urgency of the situation, categorized antibiotic resistance threats into urgent, serious, and concerning levels, highlighting the most dangerous pathogens like Clostridium difficile, Carbapenem-resistant Enterobacteriaceae, and drug-resistant Neisseria gonorrhoeae. The report outlines four core actions to tackle this challenge: preventing infections and their spread, tracking resistance patterns, improving antibiotic prescribing practices, and developing new drugs and diagnostic tests. The CDC’s efforts in surveillance, infection control, and promoting responsible antibiotic use are key components of the strategy. The report also details specific actions that healthcare providers, patients, and communities can take to contribute to the fight against antibiotic resistance. The core message stresses the importance of a multi-faceted approach and the need for immediate, concerted efforts from various stakeholders, including healthcare providers, patients, and policymakers. The report is a call to action, highlighting that without significant changes, the world risks losing the ability to effectively treat common infections, which could jeopardize modern medical advancements, increase healthcare costs, and endanger public health globally. The report emphasizes that only through commitment and sustained action can the nation succeed in reducing this threat, and the information is presented in a manner designed to be accessible to a wide audience, with a goal of raising awareness and encouraging immediate action to address the growing problem of antibiotic resistance. In summary, the report underlines that antibiotic resistance is a critical and evolving public health issue that requires a comprehensive and collaborative approach. Prevention, prudent antibiotic use, and development of new treatments are key strategies to mitigate the threats and protect public health. The report concludes with a strong sense of urgency and emphasizes the need for sustained, global action to address antibiotic resistance.