Drug-resistant bacteria: 23,000 deaths a year in US and getting worse

A lack of new antibiotics, coupled with the over-prescription of existing ones, is making many formerly routine diseases untreatable, according to a new report published by the US Centers for Disease Control and Prevention (CDC).

At least two million people in the US are infected each year - and 23,000 of those die - from bacteria that does not respond to treatment by usual or any antibiotics, claims the Antibiotic Resistance Threats in the United States 2013 report.

“We are approaching a cliff. If we don’t take steps to slow or stop drug resistance, we will fall back to a time when simple infections killed people,” said Michael Bell, Deputy Director of CDC’s Division of Healthcare Quality Promotion, and one of the report’s authors.

Among the diseases the report labeled an ‘Urgent threat’ are C.difficile, a form of severe diarrhea that kills 14,000 people per year, and gonorrhea, as nearly a third of the 800,000 estimated annual infections are with strains that do not respond to at least some antibiotics.

The most terrifying perhaps is Carbapenem-resistant Enterobacteriaceae (CRE), a relatively new and rare but deadly infection that cannot be tackled by “drugs of last resort” (medicines that are purposely reserved for treatment courses when all else has failed).

Out of an estimated 9,000 cases of CRE each year, 600 people die.

The report says that by far the most important reason for the proliferation of drug-resistant bacteria is the incorrect prescription of antibiotics by doctors and improper use by patients.

Half of all antibiotic prescriptions in the US are unnecessary – a precaution, or a result of misdiagnosis or ignorance about the ability of the drug to treat a certain disease. A course of a drug weeds out certain types of bacteria, but leaves a minority untouched. The surviving bacteria then multiply, creating a new strain of the disease that is no longer susceptible to that medicine. The problem is made worse when patients stop their antibiotics course too early – often as soon as they feel better – as the remaining microorganisms then have a better chance of escaping.

“Every time antibiotics are used in any setting, bacteria evolve by developing resistance and that process can happen with alarming speed.  These drugs are a precious, limited resource—the more we use antibiotics today, the less likely we are to have effective antibiotics tomorrow,” said Steve Solomon, Director of the CDC’s Office of Antimicrobial Resistance.

Another breeding ground for superbugs is livestock farms – the destination of up to 80 percent of all antibiotics - where animals are routinely prescribed drugs, mostly as a preventative measure and to make sure they grow as large as possible. The strains produced in those circumstances are then passed on to humans, creating additional danger.

Estimating the exact number of people who have been infected and died from a drug-resistant bacteria is by nature an imprecise activity.

But the authors say they are not scaremongering.

“This is a bare minimum, a very conservative estimate,” said CDC Director Thomas R. Friedman, noting that the authors have tried to separate cases when the drug-resistant infection was directly responsible for death, as opposed to a contributing factor.

“The actual number of infections and the actual number of deaths are certainly higher,” states the report.

One of the problems of drug-resistance is the relative scarcity of new antibiotics. Until the current ones stop working in sufficient numbers, pharmaceutical companies have little incentive to develop them for currently curable diseases. The report urges the government to invest more money in antibiotics as a matter of national importance, though several programs are already in place.

But even if US doctors and companies take every measure available, there is only so much they can do in a globalized world.

In countries such as China and Russia, where antibiotics are freely available over-the-counter and are consumed by an order of magnitude more often than in the United States, drug-resistant strains are emerging at a much faster rate (and involve diseases like tuberculosis that are already more deadly). And these strains are sure to spread throughout the globe.

"We're facing a catastrophe," said Helen Boucher, a Tufts University expert and spokeswoman for the Infectious Diseases Society of America.