November 15, 2019

The number of deaths due to drug-resistant infections in the United States have declined, but the number of these infections are on the rise, indicating that so-called superbugs present a greater risk to public health than previously thought, according to a CDC report released Wednesday.

Where to start with antibiotic stewardship

Report details

For the report, CDC analyzed data from the EHRs of about 700 hospitals in the United States. CDC used the new data to calculate the number of deaths and infections due to 18 drug-resistant bacterial and fungal infections in 2017. CDC also recalculated estimates from a 2013 CDC report.

CDC found that about 36,000 people in the United States died from drug-resistant infections in 2017, down 18% from 44,000 such deaths in 2013. According to the Wall Street Journal, that 18% decline excludes deaths from Clostridioides difficile (C. diff) bacteria that while not drug-resistant themselves are caused by the same factors that spur antibiotic resistance. Overall, Staph infections ESBL-producing enterobacteriaceae, enterococcus, and streptococcus pneumoniae—which are some of the top infections in the country—led, respectively, to 10,600 deaths; 9,100 deaths; 5,400 deaths; and 3,600 deaths in 2019.

However, despite a decline in the number of superbug-related fatalities, the report also revealed that the overall number of non-fatal superbug infections increased from 2.6 million in 2013 to 2.8 million in 2017. In addition, according to the CDC report, C. diff infections in 2017 led to 223,900 hospitalizations and 12,800 fatalities—totals that when added to the overall numbers brings "the annual U.S. toll of all these pathogens" to "more than 3 million infections and 48,000 deaths," the Washington Post reports.

Behind the data

The researchers concluded that the decline in superbug deaths is likely due to efforts by U.S. hospitals to decrease the spread of the infections by isolating patients with superbug infections and using antibiotics more judiciously. Currently, 84% of hospitals have a program in place to track antibiotic use, according to CDC.

The increase in infections, on the other hand, could be related to the emergence of new superbugs as well as the increase in drug-resistant infections that appear outside the hospital, such as drug-resistant gonorrhea and urinary tract infections.

Implications

Public health experts say the report findings demonstrate that drug-resistant infections are a bigger threat to public health than researchers previously estimated.

For instance, CDC's 2013 report on superbugs considered only 17 bacteria and fungi and identified that 23,000 U.S. deaths and 2 million infections were caused by super bugs. However, the agency's updated 2013 estimate found that superbugs were connected to more than 40,000 deaths and more than 2 million infections.

Other research indicates that the "superbug problem" might be even larger than CDC estimates, according to the Associated Press.

The results of one 2018 paper suggested that 153,000 people in the United States die each year with superbug infections. Usually, the difference in these estimates depends on what infections are included in the analysis. "There's not universal agreement on what constitutes a drug-resistant infection," according to Jason Burnham from Washington University in St. Louis.

Overall, CDC's latest report and other research further demonstrate that the "post-antibiotic era…[is] already here," and that researchers and drug companies need to look into developing new antibiotics to combat these superbugs, according to CDC Director Robert Redfield.

"There are still way too many people dying," said Michael Craig, an author of the CDC report. "We have a long way to go before we can feel we can even get ahead of this" (AP/Los Angeles Times, 11/13; McKay, Wall Street Journal, 11/13; Sun, Washington Post, 11/13).

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