Superbugs: An epidemic your hospital cannot afford to ignore

CONTRIBUTOR

Oscar Guzman, Pharm D, BCPS

Clinical Director
Infectious Disease and Clinical Care
Innovative Delivery Solutions
Cardinal Health

Kate Shea, PharmD, BCPS-AQ-ID

Director, Clinical Specialty, Innovative Delivery Solutions

As evidenced in recent media reports, antibiotic resistant bacteria, also called “superbugs,” are a growing concern. As we learn of more superbugs cases each day, with perhaps the most notable being their presence in the waterways of Rio de Janiero during the 2016 Olympic competition, it is undeniable that this epidemic demands our attention and requires immediate action.

Defining antibiotic resistance

Antibiotic resistance affects all types of pathogens: bacteria, fungus and viruses. Resistance from appropriate antimicrobial drug use in general is not preventable, but resistance from inappropriate use is definitely preventable. Antibiotic use in the food and farming industries holds the title for the most antibiotic drug use by volume, and inappropriate prescribing in the inpatient and outpatient settings contribute heavily to the epidemic.

Why is antibiotic resistance a threat?

$20 billion

Excess healthcare costs each year due to antibiotic resistance

According to the Centers for Disease Control and Prevention (CDC), at least 2 million people in the United States each year become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections.1 The Worldwide Health Organization (WHO) has said antibiotic resistance “is an increasingly serious threat to global public health that requires action across all government sectors and society.”2

This summer, the U.S. government announced the formation of a trans-Atlantic public-private partnership to combat antibiotic resistant bacteria. The objective of this global partnership, called Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator, or CARB-X, is to support the advancement of innovative products including antimicrobial therapy and preventives such as vaccines, diagnostics and devices. The first initiative identified by CARB-X will focus on antimicrobial therapy to treat Gram-negative bacteria on the Serious or Urgent Threat List prepared by the CDC.3

One specific pathogen of concern is Carbapenem-Resistant Enterobacteriaceae (CRE). Traditionally, CRE has been a problem outside of the U.S. Now, however, CRE is spreading through U.S. hospitals, particularly in long term acute care facilities. Infections associated with these organisms are linked to high rates of morbidity and mortality, and unfortunately current treatment options are limited.4

Another more recent threat identified in the U.S. is a colistin-resistant strain of the E. coli bacteria. Colistin is an older antibiotic that has resurfaced in this new era of resistance and is often considered a last resort antibiotic.5

The high price of resistance

According to the Antimicrobial (Drug) Resistance Quick Facts published by the U.S. Department of Health and Human Services and the National Institutes of Health, antibiotic resistance results in an estimated $20 billion a year in excess healthcare costs, $35 billion in other societal costs, including loss of productivity due to work and school absences, and more than 8 million additional days spent in U.S. hospitals.6

Managing the epidemic

The Centers for Disease Control and Prevention (CDC) positions antibiotic resistance as a public health threat and details the core actions needed to combat this threat, namely infection prevention, resistance tracking, antimicrobial stewardship and development of novel antimicrobials.7 Available evidence suggests that antimicrobial stewardship is associated with improved antimicrobial utilization, with corresponding improvements in antimicrobial resistance and adverse events, all without compromising clinical outcomes. Developing new drugs takes longer, however there are several initiatives in place to improve drug development, such as the 10x’20 initiative, whose aim is to create a sustainable global antibacterial drug R&D enterprise with the power in the short-term to develop 10 new, safe, and effective antibiotics by 2020.8,9,10 Of course, key elements in preventing infections from occurring in the first place include patient education around risks, providing vaccinations, practicing infection prevention and establishing infection control departments.

Stay tuned for our next article, where we’ll expand on the new antimicrobial stewardship requirements coming in 2017 and discuss resources that will help you reach compliance.