In the last decade, national governments and health agencies around the world have published reports outlining the rise of antibiotic resistance globally. But what does that mean?
It means we may be very rapidly approaching a post-antibiotic world. In February, researchers identified multiple organisms with resistance to the antibiotic Colistin (polymyxin E). The organism had plasmid-mediated resistance--and they showed up in 20% of animals tested, 15% of raw meat sampled and in 16 patients tested in China. An author of the study, published in Lancet Infectious Diseases Journal, said that the development means that “all the key players are now in place to make the post-antibiotic world a reality.”1,2
A post-antibiotic world could be one in which cancer would have to go untreated because chemotherapy and radiotherapy, which destroy the immune system, would be too dangerous to use. Many surgeries would be too risky to perform and organ transplants would be a thing of the past.
How did we get here? Antibiotic resistance is a natural, perhaps inevitable process. The gene for resistance to penicillin was identified three years before the first antibiotic even reached the general public. Inappropriate use of antimicrobials such as prescribing them for viral infections, cutting short a course of therapy, using them prophylactically when unnecessary, putting them in consumer products or using them to promote growth in farm animals can increase the development of resistance.
Now a number of pathogens cannot be treated with any known antimicrobial. Antibiotic resistance is rapidly escalating among Gram-negative bacteria such Klebsiella and gonorrhea, which already have few effective therapies. The emergence of pan-resistant Gram-negative Enterobacteriaceae in China “is likely to emulate other global resistance mechanisms,” spreading both to other countries and to other organisms, noted the study’s authors.
Combatting resistant organisms with new antibiotics is not an available option. Few new antibiotics are in the pharmaceutical development pipeline. In the last decade, just four new antibiotics have been released, and no new class of antibiotics has been developed since the 1980s. The last new treatment for Gram-negative bacilli was introduced four decades ago.
Antibiotic resistance is creating increasingly serious challenges for patients and hospitals:
- In the United States, multidrug resistant organisms (MDROs) infect two million people each year, resulting in about eight million hospital days and causing 23,000 deaths, according to the Centers for Disease Control and Prevention. 3
- Antibiotic resistance costs U.S. hospitals between $20 billion and $35 billion each year. Because healthcare-associated infections (HAIs) account for 70% of infections caused by resistant organisms, most of that money remains unreimbursed by Medicare or commercial insurers.4
- According to a December 2014 report, within 35 years, 317,000 people in North America and 10 million people worldwide could die each year from just six common MDROs.5
What is your hospital doing to address antibiotic resistance?
Liu YY, Wang Y, Walsh TR, Yi LX, Zhang R, Spencer J, Doi Y, Tian G, Dong B,
Huang X, Yu LF, Gu D, Ren H, Chen X, Lv L, He D, Zhou H, Liang Z, Liu JH, Shen J.
Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and
human beings in China: a microbiological and molecular biological study. Lancet
Infect Dis. 2016 Feb;16(2):161-8.
Sainato M. The End of the Antibiotic Era: What You Need to Know About Bacterial Resistance. Observer News & Politics. November 24, 2015.
Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Atlanta, GA: CDC;2013.
Fishman N. Antimicrobial Stewardship 2014: National and regional trends. University of Pennsylvania Perelman School of Medicine. September 30, 2014.
O’Neill J, Chair. Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations. The Review on Antimicrobial Resistance. December 2014.