People in the United States contend with more than 2.8 million antibiotic-resistant infections a year—and more than 35,000 die as a result, according to new data from the Centers for Disease Control and Prevention. The agency’s “Antibiotic Threats in the United States, 2019” —an update of its first analysis in 2013 of antibiotic resistance in the U.S.—outlines the top 18 resistant pathogens and evaluates progress in the fight against superbugs.
The report shows important advances made over the past six years—particularly in the decline of six types of resistant infections—but it also highlights the continued severity of the superbug threat and the urgent need to preserve the effectiveness of the antibiotic stockpile and spur innovation of new types of antibiotics.
Here are five priorities for combating antibiotic resistance in 2020:
In 2020, hospital administrators, accrediting organizations, and policymakers should focus on enhancing the quality of hospital antibiotic stewardship programs, which aim to ensure appropriate antibiotic use and patient safety. Thanks to a September 2019 federal rule change, all hospitals participating in Medicare and Medicaid must implement stewardship programs as of March 2020. Because over half of patients receive antibiotics during their stays, this change represents a major step forward in slowing the emergence of antibiotic-resistant bacteria.
Improved antibiotic prescribing is also needed in outpatient health care settings, such as doctors’ offices, emergency rooms, retail health clinics, and urgent care centers. The Joint Commission, a nonprofit accrediting organization, recently finalized its stewardship requirement for outpatient facilities, an important step in the right direction. Though encouraging, this requirement applies only to the relatively small portion of outpatient clinics the organization accredits.
Wider implementation of meaningful stewardship programs is critical, but that will require concerted action by health insurance plans, health systems, and state and local health agencies. For example, these health care stakeholders can support stewardship efforts by providing antibiotic prescribing feedback to physicians, a method that has proved successful in improving prescribing practices.
Success in the fight against antibiotic resistance also requires steps to ensure that these drugs are used judiciously in food animals. There are several ways that stewardship can and should be improved this year in the agricultural sector.
First, all medically important antibiotics used in animals need to be brought under veterinary oversight. Although most of these drugs now require a prescription to be administered to food-producing animals under a federal policy change that took effect in 2017, some can still be purchased over the counter. In October, the Food and Drug Administration released draft guidance that would address this gap; the agency should finalize this guidance as soon as possible.
Second, all antibiotics approved for use in animals should have defined duration limits, specifying the length of time they should be used to address a given condition. Many antibiotic labels currently allow for very long or undefined durations of use, meaning that they can be given to animals for weeks, months, or even indefinitely. Additionally, some limits are tied to subjective or poorly defined external factors, such as when an animal experiences “times of stress.”
FDA has funded research to help determine duration limits for certain types of drugs, but these efforts only scratch the surface. There is more the agency can and should do in 2020 to establish defined duration limits using existing data.
These are just a couple of the important actions outlined in FDA’s five-year plan to improve antibiotic use in food animals, all of which need to be implemented as swiftly as possible.
In 2020, the U.S. must do more to stimulate the innovation of urgently needed new antibiotics. Even with the appropriate use of antibiotics, bacteria will continue to develop resistance, and new drugs will be needed to treat infections. Unfortunately, there are not enough antibiotics in development to keep pace with evolving bacteria. To make matters worse, many major pharmaceutical companies are limiting or stopping their investments in antibiotic innovation because of low returns on investment.
Consistent with recommendations from numerous studies and commissions, Pew sees economic incentives as essential to help catalyze development of antibiotics that can treat the increasingly resistant strains of bacteria. Congress should pass the Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act of 2019, which would change the way Medicare reimburses hospitals for treating patients with bacterial infections by removing financial disincentives that discourage hospitals from using new antibiotics even when they are better able to treat a resistant infection. The federal government should create incentives to help drug companies recoup the costs of bringing to market novel antibiotics that address unmet needs.
Additionally, to accelerate the science behind antibiotic discovery, Pew urges academic institutions, nonprofits, and drug companies to continue to contribute data from their antibiotic research programs to our open-access Shared Platform for Antibiotic Research and Knowledge (SPARK).
The fight against antibiotic resistance requires adequate support of federal programs. This includes ensuring that key agencies such as CDC, FDA, the National Institutes of Health, the Biomedical Advanced Research and Development Authority, and the Department of Agriculture have sufficient funding to perform essential functions such as collecting data to track resistant bacteria and improve antibiotic use and to fund antibiotic research. In February, Pew’s Stand Up to Superbugs ambassadors will come to Washington to urge their representatives to keep antibiotic resistance a national priority.
International efforts are needed to combat this ever-growing threat to public health. Governments, private companies, and nongovernmental organizations from around the world made formal commitments to combat antibiotic-resistant bacteria through the U.S. Antimicrobial Resistance (AMR) Challenge and should continue building on these efforts in 2020.
Although CDC’s report is a grim reminder of the human toll exacted by antibiotic-resistant bacteria, it also demonstrates the power of data-based interventions to slow the spread of resistance. Stakeholders in the U.S. and around the world must heed the clear call to action in 2020 and beyond.
Kathy Talkington directs The Pew Charitable Trusts’ antibiotic resistance project.