The world is continuing to lose ground against antibiotic resistance, according to a new report out last week from the US Centers for Disease Control and Prevention (CDC). And among other things, the number of superbugs that pose a dire threat to people's health has only gotten larger in the past half decade, at least in America.
In 2013, the CDC issued a first of its kind report on antibiotic resistant infections in the US. It provided a conservative estimate of how often these infections sicken and kill Americans every year, as well as listed off a rogues gallery’s of resistant fungi and bacteria that were becoming common problems. These microbes were ranked by threat level, from concerning to urgent. Back then, the CDC estimated that more than 2 million people in the US contracted these infections annually, while at least 23,000 died as a result.
By 2019, the situation has only gotten worse. The CDC’s latest estimates are that nearly 3 million people get infected by superbugs annually, while 35,900 die. And not only is the overall health impact of these infections growing, so are the dangerous pathogens that cause them.
“This report should raise the alarm for everyone concerned about protecting and improving health against infectious diseases. While its focus is on the United States, the findings will echo around the world,” Tim Jinks, head of the Wellcome Trust’s Drug-Resistant Infections Program, said in a statement provided to Gizmodo.
Indeed, the CDC report comes on the heels of a similarly depressing report from Canadian experts also released last week. It found that 26 per cent of infections suffered by Canadians every year resist the front-line antibiotics used to treat them – and that number may rise to 40 per cent by 2050.
Two new infections have been added to the CDC’s urgent list of resistant infections since 2013: a hardy type of fungi called Candida auris (C. auris) and Carbapenem-resistant Acinetobacter, a gram negative bacteria that’s often harmless to healthy people but dangerous to hospital patients. These infections join Clostridioides difficile (C. difficile), a group of bacteria called Carbapenem-resistant Enterobacteriaceae (CRE), and drug-resistant Neisseria gonorrhoeae, the bug that causes the sexually transmitted disease gonorrhoea.
Of these urgent infections, C. difficile is thought to cause the lion’s share of harm, with 223,900 estimated cases in hospitalised patients along with 12,800 deaths annually (the CDC report is even dedicated to the families of people killed by C. difficile). But there’s also CRE, given the charming nickname of “nightmare bacteria” because many infections already resist nearly every available antibiotic used against it. Gonorrhoea, too, is on the short list of bacteria that may soon become resistant to all of the front-line drugs we have for it.
Along with the categories of risk included in the 2013 report, the 2019 version has also now added a “Watch List” of potential threats. These include strains of the fungus Aspergillus fumigatus resistant to the azole class of antifungals, resistant Mycoplasma genitalium, another sexually transmitted disease, and resistant Bordetella pertussis, the bacteria that causes pertussis, or whooping cough (unlike most of the bugs on the list, there’s an effective childhood vaccine for the disease, but people might lose their immunity to it quicker than we thought).
“The report reiterates that this is not a stagnant problem – that we have to be ever vigilant because it does change,” Kathy Talkington, project director of the Antibiotic Resistance Project at Pew Charitable Trusts, told Gizmodo by phone.
Talkington noted that the US has made some small progress in combating the risk factors that promote antibiotic resistance.
In 2017, for instance, the country's Food and Drug Administration instituted restrictions on the use of antibiotics for livestock, such as mandating that any use is first signed off by a veterinarian. Following the new rules, sales of livestock antibiotics have seemingly declined, though the latest data won’t be available until the end of this year. The vast majority of hospitals in the US have also implemented stewardship programs meant to reduce the overprescription of antibiotics to outpatients and children, and there’s evidence that prescription rates have decreased among both groups in recent years, according to the CDC.
But the sombre truth is that these minor victories are just that. Rampant antibiotic overuse continues unimpeded in many areas of the world. And the development pipeline of new antibiotics and other therapies that can treat resistant infections has slowed to a crawl, as many pharmaceutical companies have decided to abandon antibiotic research altogether due to a lack of profitability. And while governments and private organisations have created new funding models that are starting to convince some companies to pursue antibiotic research, it’s unclear whether these efforts will be timely or large enough as things stand.
“We’ve succeeded in the past. In the early 1980s, we had the heyday of antibiotic development and we were able to stay ahead of this issue,” Talkington said. “We still have the capacity and the ability to do it today, but we need the political will and adequate resources – because currently, we are losing the battle.”
There’s no immediate future where antibiotics stop working for all infections. But our lives and those of our loved ones will change for the worse long before we reach that point. Everything from giving birth to receiving a life-saving transplant depends on antibiotics to keep people safe. Without any significant advances against antibiotic resistance in the years to come, more of us will needlessly suffer and die.
Featured image: Illustration: Jennifer Oosthuizen (CDC/Antibiotic Resistance Coordination and Strategy Unit)