CDC Superbug Report: Pushing Back on a Losing Battle

The U.S. Centers for Disease Control and Prevention (CDC) issued a new report, “Antibiotic Resistance Threats in the United States, 2019,” the first in six years. The agency found that more than 2.8 million antibiotic-resistant infections occurred in the U.S. each year, killing more than 35,000 people. In 2017, the agency found that there were 223,900 cases of Clostridioides difficile (C. diff) infections, resulting in at least 12,800 deaths.

One positive finding was that in 2017, drug-resistant infections killed a bout 36,000 people in the U.S., but it was down 18% from the estimated 2013 figure of 44,000. The report attributes the decline to considerable efforts on hospitals and health systems to prevent and control the spread of especially dangerous infections.

“We are pushing back in a battle we were losing,” Michael Kirsch, a pharmacist with AdventHealth Tampa, in Florida, told the Los Angeles Times. “I would not by any means declare success.”

The report analyzed electronic health records and other data. The report cited five “urgent threats,” including C. diff and drug-resistant Neisseria gonorrhoeae. C. diff is a common infection in nursing homes and extended care facilities, and the other causes the sexually transmitted disease, gonorrhea.

The report notes 11 “serious threats,” including drug-resistant nontyphoidal Salmonella, methicillin-resistant Staphylococcus aureaus (MRSA) and drug-resistant Tuberculosis. Two “concerning threats” include erythromycin-resistant Group A Streptococcus and Clindamycin-resistant Group B Streptococcus, and a “watch list” of three infections, including a fungal infection and a drug-resistant Bordetella pertussis.

CDC Director Robert Redfield wrote a letter accompanying the report, urging the public to “stop referring to a coming post-antibiotic era—it’s already here. You and I are living in a time when some miracle drugs no longer perform miracles and families are being ripped apart by a microscopic enemy.”

It is likely that the report underestimates the role of resistant infections in patient deaths. Greg Frank, director of Infectious Disease Policy at the Biotechnology Innovation Organization (BIO), told USA Today that medical records are useful for creating more accurate data than the agency’s 2013 report, but notes a hypothetical case of a cancer patient dying after acquiring a drug-resistant infection, but the cause of death being listed as cancer. And researchers from the Washington University School of Medicine project that drug-resistant infections could kill as many as 162,000 people in the U.S. each year.

One of the differences in the 2019 report is the sourcing. Some of the earlier research reports leveraged data from approximately 180 hospitals. For the most recent report, the CDC drew on the electronic health records of about 700 hospitals in the U.S. It also recalculated the 2013 estimate using the new data, which created a new baseline.

“This data is exciting because it shows that we are not powerless against antibiotic resistance,” Hilary Babcock, president of the Society for Healthcare Epidemiology of America, told USA Today. “We must continue to fund and support effective infection prevention and antibiotic stewardship programs in every healthcare setting and use every tool we have to prevent the spread of antibiotic resistance.”

There were some positive notes in the report, such as fewer cases of drug-resistant tuberculosis and MRSA in the hospital setting and an apparent plateau of the so-called “nightmare bacteria” carbapenem-resistant Enterobacteriaceae (CRE), few experts are rejoicing.

“There are still way too many people dying,” Michael Craig, senior advisor for the CDC’s Antibiotic Resistance, Antibiotic Resistance Coordination and Strategy Unit, told the Los Angeles Times. “We have a long way to go before we can feel we can even get ahead of this.”