Generated Summary
This document is a report by the CDC (Centers for Disease Control and Prevention) titled “Antibiotic Resistance Threats in the United States, 2013.” It provides a snapshot of the complex problem of antibiotic resistance, the consequences of inaction, and how to address the threat. The report covers bacteria causing severe human infections and the antibiotics used to treat those infections. It also includes information on Candida, a fungus that commonly causes serious illness. The report is designed to be accessible to many audiences and serves as a reference for information about antibiotic resistance. The report is structured to increase awareness of the threat posed by antibiotic resistance and to encourage immediate action to address this threat. The document is structured into three sections. Section 1 focuses on the threat of antibiotic resistance, including an introduction, national summary data, and assessments of antibiotic-resistant threats. Section 2 discusses how to combat antibiotic resistance, including actions like preventing infections, tracking resistance patterns, improving antibiotic use, and developing new antibiotics. Finally, section 3 includes current antibiotic resistance threats in the United States, organized by the specific microorganisms and their respective threat levels (urgent, serious, and concerning).
Key Findings & Statistics
- In the United States, at least 2 million people acquire serious infections with antibiotic-resistant bacteria each year.
- At least 23,000 people die each year as a direct result of these antibiotic-resistant infections.
- 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.
- The total economic cost of antibiotic resistance to the U.S. economy has been estimated to be 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).
- The number of illnesses and deaths caused by antibiotic resistance are: At least 2,049,442 illnesses and 23,000 deaths.
- The estimated minimum number of illnesses and deaths due to Clostridium difficile (C. difficile) are: At least 250,000 illnesses and 14,000 deaths.
- 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.
- The estimates are based on conservative assumptions and are likely minimum estimates.
- Healthcare-associated infections (HAIs) caused by Klebsiella and E. coli (CRE) have an estimated annual number of cases of 9,300, with 610 deaths.
- Drug-resistant Neisseria gonorrhoeae has an estimated annual number of cases of 246,000, with less than 5 deaths.
- Multidrug-resistant Acinetobacter has an estimated annual number of cases of 7,300, with 500 deaths.
- Drug-resistant Campylobacter has an estimated annual number of cases of 310,000, with 28 deaths.
- Drug-resistant Candida (fluconazole) has an estimated annual number of cases of 3,400, with 220 deaths.
- Extended-spectrum ß-lactamase producing Enterobacteriaceae (ESBLs) has an estimated annual number of cases of 26,000, with 1,700 deaths.
- Vancomycin-resistant Enterococcus (VRE) has an estimated annual number of cases of 20,000, with 1,300 deaths.
- Multidrug-resistant Pseudomonas aeruginosa has an estimated annual number of cases of 6,700, with 440 deaths.
- Drug-resistant non-typhoidal Salmonella has an estimated annual number of cases of 100,000, with 38 deaths.
- Drug-resistant Salmonella Typhi has an estimated annual number of cases of 3,800, with less than 5 deaths.
- Drug-resistant Shigella has an estimated annual number of cases of 27,000, with less than 5 deaths.
- Methicillin-resistant Staphylococcus aureus (MRSA) has an estimated annual number of cases of 80,000, with 11,000 deaths.
- Drug-resistant Streptococcus pneumoniae has an estimated annual number of cases of 1,200,000, with 7,000 deaths.
- Drug-resistant tuberculosis has an estimated annual number of cases of 1,042, with 50 deaths.
- Vancomycin-resistant Staphylococcus aureus (VRSA) has an estimated annual number of cases of less than 5, with less than 5 deaths.
- Erythromycin-resistant Group A Streptococcus has an estimated annual number of cases of 1,300, with 160 deaths.
- Clindamycin-resistant Group B Streptococcus has an estimated annual number of cases of 7,600, with 440 deaths.
- It is estimated that more than 800,000 gonococcal infections occur annually in the United States.
- In 2011, 321,849 cases of gonorrhea were reported to CDC.
- Carbapenem-resistant Enterobacteriaceae (CRE) have become resistant to all or nearly all available antibiotics. Approximately 7,900 infections are caused by carbapenem-resistant Klebsiella spp. and 1,400 by carbapenem-resistant E. coli each year.
- 63% of Acinetobacter infections are multidrug-resistant, and no longer curable by existing antibiotics.
- Drug-resistant Campylobacter infections are estimated to cause 310,000 infections per year.
- An estimated 46,000 healthcare-associated Candida infections occur among hospitalized patients each year.
- 7% of Candida bloodstream isolates test as resistant to fluconazole.
- Approximately 26,000 healthcare-associated Enterobacteriaceae infections, and 1,700 deaths are attributable to ESBLs.
- About 20,000 (or 30%) of Enterococcus healthcare-associated infections are vancomycin resistant.
- Approximately 6,700 multidrug-resistant Pseudomonas aeruginosa infections occur in the U.S. each year, resulting in 440 deaths.
- Approximately 1.2 million illnesses caused by drug-resistant Salmonella infections occur each year.
- In the U.S., drug-resistant Salmonella causes about 365 million dollars in medical costs each year.
- Approximately 3,800 drug-resistant Salmonella Typhi infections occur per year.
- Approximately 27,000 drug-resistant Shigella infections occur per year.
- In 2011, 80,461 severe MRSA infections occurred.
- Drug-resistant Streptococcus pneumoniae causes 1,200,000 infections per year, and there are 7,000 deaths per year.
Other Important Findings
- The loss of effective antibiotics will undermine our ability to fight infectious diseases.
- Patients with resistant infections are often much more likely to die, and survivors have significantly longer hospital stays, delayed recuperation, and long-term disability.
- Antibiotic resistance is spreading at a remarkable speed.
- 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.
- CDC has prioritized bacteria in this report into three categories: urgent, serious, and concerning.
- 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.
- CDC has four core actions to combat this growing threat: 1) preventing infections from occurring and preventing resistant bacteria from spreading, 2) tracking resistant bacteria, 3) improving the use of antibiotics, and 4) promoting the development of new antibiotics and new diagnostic tests for resistant bacteria.
- Among the most serious gram-negative infections are healthcare-associated, and the most common pathogens are Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter.
- Antibiotics are responsible for almost 1 out of 5 emergency department visits for adverse drug events.
- Antibiotics are the most common cause of emergency department visits for adverse drug events in children under 18 years of age.
- Each year, there are more than 140,000 emergency department visits for reactions to antibiotics. Almost four out of five (79%) emergency department visits for antibiotic-related adverse drug events are due to an allergic reaction.
- C. difficile causes diarrhea linked to at least 14,000 American deaths each year.
- CDC manages the Get Smart program, a national campaign to improve antibiotic prescribing and use in both outpatient and inpatient settings.
- The program supports a variety of state-based programs modeled on the national effort.
- Each November, CDC publicizes its annual Get Smart About Antibiotics Week to raise awareness among patients, healthcare providers, hospital administrators, and policy makers about the threat of antibiotic resistance and the need to decrease inappropriate antibiotic use.
- Preventing infections negates the need for antibiotic use in the first place, and scientific evidence shows that reducing antibiotic use in a single facility can reduce resistance in that facility.
- In the United States, there are 3,800 drug-resistant Salmonella Typhi infections per year.
- Gonorrhea is the second most commonly reported notifiable infection in the United States.
- Drug-resistant Shigella causes approximately 27,000 infections per year.
- The proportion of infections that occur with a vancomycin-resistant strain differs by the species of Enterococcus; overall 20,000 vancomycin-resistant infections occurred among hospitalized patients each year, with approximately 1,300 deaths attributed to these infections.
- Patients who undergo dialysis treatment have an increased risk for getting a bloodstream infection.
- Invasive pneumococcal disease means that bacteria invade parts of the body that are normally sterile, and when this happens, disease is usually severe, causing hospitalization or even death.
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.
- 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.
- This report does not provide a specific estimate for the financial cost of antibiotic-resistant infections.
Conclusion
The report emphasizes the critical importance of addressing antibiotic resistance, a significant public health threat that undermines the ability to fight infectious diseases and manage infectious complications. The loss of effective antibiotics will cripple efforts to treat infections. The report stresses the need for concerted commitment and action to reduce this threat. The report highlights the magnitude of the problem, with millions of infections and tens of thousands of deaths annually. The total economic cost of antibiotic resistance is substantial, adding considerable and avoidable costs to the already overburdened U.S. healthcare system. The main drivers of antibiotic resistance include the overuse and misuse of antibiotics in human medicine, and food animals. The report underscores the need to use antibiotics judiciously and to improve antibiotic stewardship practices. It stresses that the development and spread of resistance is driven by inappropriate antibiotic use. The report also outlines four core actions to combat this growing threat. The report calls for action from individuals, healthcare providers, and communities. It encourages the use of appropriate antibiotic use, infection prevention and control measures, and support for the development of new antibiotics. The report also highlights the role of vaccination in preventing infections and reducing the spread of antibiotic resistance. It emphasizes the importance of tracking and monitoring resistance patterns to implement targeted interventions. It underscores the importance of safe practices and the role of the public in preventing the spread of antibiotic-resistant infections. The report concludes by underscoring the need for collaboration and widespread engagement to address antibiotic resistance effectively.