THURSDAY, NOVEMBER 14 , 2019. THE WASHINGTON POST EZ RE A23
tant germs, and deaths from
superbug infections there have
decreased by nearly 30 percent
since 2013. Experts say everyone
can help control many of these
pathogens by practicing basic
prevention: good hand hygiene,
vaccination, safe food handling
and safe sex.
In addition to germs that have
evolved drug resistance, the
report included a dangerous
infection that is linked to
antibiotic use: Clostridioides
difficile (C. diff.). It can cause
deadly diarrhea when antibiotics
kill beneficial bacteria in the
digestive system that normally
keep it under control. When the C.
diff. illnesses and deaths are
added, the annual U.S. toll of all
these pathogens is more than
3 million infections and 48,000
deaths.
The CDC had previously
estimated about 2 million
antibiotic resistant infections and
23,000 deaths in a 2013 report.
The new report used previously
unavailable data, including
electronic health databases from
more than 700 acute-care
hospitals. By applying the new
methods retrospectively, the CDC
calculated that the 2013 estimate
missed about half of the cases and
deaths.
“A lot of progress has been
made, but the bottom line is that
antibiotic resistance is worse than
we previously thought,” said
Michael Craig, the CDC’s senior
adviser on antibiotic resistance.
The new numbers, though still
conservative, underscore the
magnitude of the problem,
establish a new national baseline
of infections and deaths, and will
help prioritize resources to
address the most pressing threats,
SUPERBUGS FROM A1 infectious diseases experts said.
These germs spread through
people, animals and the
environment.
The report details the toll that
18 pathogens are taking on
humans, ranking the threat of
each as “urgent,” “serious” or
“concerning.”
Five germs account for the
most urgent threats. Three are
long-recognized dangers: C. diff.,
drug-resistant gonorrhea and
carbapenem-resistant
enterobacteriaceae (CRE), also
known as “nightmare bacteria”
because they pose a triple threat.
They are resistant to all or nearly
all antibiotics, they kill up to half
of patients who get bloodstream
infections from them, and the
bacteria can transfer their
antibiotic resistance to related
bacteria.
Two new germs were added to
the urgent category since the
CDC’s 2013 report: a deadly
superbug yeast called Candida
auris that has alarmed health
officials around the world and a
family of bacteria, carbapenem-
resistant Acinetobacter, that has
developed resistance to nearly all
antibiotics.
The CDC also added a new
category in addition to the ones
used to classify the 18 pathogens:
a watch list of three germs that
officials are monitoring because
they have the potential to spread
resistance widely or are not well
understood in the United States.
They are a life-threatening
fungus, azole-resistant
Aspergillus fumigatus; a sexually
transmitted infection called drug-
resistant Mycoplasma
genitalium; and drug-resistant
Bordetella pertussis, commonly
known as whooping cough, which
can be prevented with a vaccine.
The report cites two worrisome
trends: the increasing numbers of
resistant infections outside
hospitals, including highly drug-
resistant gonorrhea; and the
increasing ability of drug-
resistant microbes to share their
dangerous resistance genes with
other kinds of bacteria, making
those other germs untreatable, as
well.
Antibiotic resistance is
particularly deadly for patients in
hospitals and nursing homes, and
those with weak immune systems.
But these hard-to-treat infections
now threaten people undergoing
common modern surgeries and
therapies, such as knee
replacements, organ transplants
and cancer treatments.
“We see people from everydaylife, who are young and otherwise
healthy, who get a MRSA
[methicillin-resistant
Staphylococcus aureus] infection
on their skin,” said Helen
Boucher, chief of infectious
diseases at Tufts Medical Center,
who cares for many transplant
patients who are vulnerable to
these infections, which the CDC
lists as a serious threat.
If someone gets a urinary tract
infection from another type of
bacteria listed as a serious threat,
ESBL-producing
enterobacteriaceae, “all we can
offer is an intravenous antibiotic
for 10 to 14 days” because
clinicians no longer have other
effective treatments, Boucher
said. The intravenous antibiotic
requires a catheter, a procedurethat also poses an infection risk,
she said.
“We want to have diagnostic
tools and medical treatments for
problems we know we’re going to
have,” she said. “But we also need
to prepare for the kind of
resistance that we could never
predict. We know from history
that bacteria and Mother Nature
are smarter than we are.”
It’s difficult to estimate the
number of drug-resistant
infections, because no
comprehensive surveillance
system or database exists.
Antibiotic resistance also isn’t a
single disease.
Other estimates find the true
burden of these infections could
be much higher. Jason Burnham,an infectious diseases expert at
Washington University, said he
and his colleagues included more
pathogens and a broader
definition of drug resistance in
their analysis than the CDC did in
its new report. Burnham’s team
estimated the death toll at about
153,000 annually.
Bacteria are constantly
evolving to fend off the drugs used
to kill them. As they mutate, some
develop the ability to fight off
different antibiotics and survive
to multiply and spread resistance.
The more antibiotics are used in
health care and agriculture, the
less effective they become.
Overuse of antibiotics is a likely
reason for the dramatic rise in
resistant infections, the report
said. Nearly a third of antibioticsprescribed in doctors’ offices,
emergency rooms and hospital-
based clinics in the United States
are not needed, according to a
2016 study. Most of them were
prescribed for conditions that
don’t respond to antibiotics, such
as colds, sore throats, flu and
other viral illnesses.
“The fact that we’re seeing
some of the greatest increases
among resistant infections that
are acquired outside of the
hospital — combined with data
we already have showing that
approximately 1 in 3 outpatient
prescriptions are completely
unnecessary — underscores the
need for improved antibiotic use
in doctor’s offices and other non-
hospital settings,” said David
Hyun, who researches and
develops strategies for the
Antibiotic Resistance Project at
the Pew Charitable Trusts.
The report found that drug-
resistant gonorrhea infections
have surged. More than half a
million such infections occur
each year, twice as many as
reported in 2013. Their increase
could be an unintended
consequence of the success of
PrEP, the once-a-day pill that
protects users against HIV
infection, which may make people
less vigilant about using
condoms.
“People may feel very confident
that they’re not going to get HIV
using PrEP, but that is not going to
protect you from bacterial
illnesses,” said Craig, the CDC
senior adviser.
Gonorrhea has quickly
developed resistance to all but
one class of antibiotics; half of all
infections are resistant to at least
one antibiotic. Untreated
gonorrhea can cause serious and
permanent health problems,
including ectopic pregnancy andinfertility.
ESBL-producing
enterobacteriaceae are one of the
leading causes of death from
resistant germs. They often cause
infections in otherwise healthy
people. The CDC estimates there
were 197,400 cases in hospitalized
patients in 2017, including 9,100
deaths.
Erythromycin-resistant group
A streptococcus infections have
quadrupled since the 2013 report.
Currently, strep throat is not
resistant to common first-line
antibiotics such as penicillin or
amoxicillin. But doctors often use
erythromycin and azithromycin
to treat the condition, especially
for people allergic to penicillin.
More than 1 in 5 invasive strep
infections are caused by resistant
strains, limiting treatment
options for patients.
One of the two new urgent
threats is carbapenem-resistant
Acinetobacter. The bacteria,
which can cause pneumonia,
bloodstream and urinary tract
infections, are already resistant to
many antibiotics, and frequently
contaminate health-care facility
surfaces and medical equipment.
They also carry mobile genetic
elements that can spread
resistance to other germs.
The other new urgent threat, C.
auris, is a fungus that can cause
life-threatening infections if it
gets into the bloodstream. It
spreads easily among
hospitalized patients and nursing
home residents. It is often
resistant to all the major
antifungal drugs.
Health authorities in New York,
which has been hard hit by the
deadly fungus, released a report
Wednesday identifying more than
100 facilities that treated patients
with C. auris.
[email protected]Deadly superbugs pose greater threat than previously understood, CDC says
“A lot of progress has been made, but... antibiotic
resistance is worse than we previously thought.”
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