A landmark report from the US Centers for Disease Control and Prevention (CDC) gives the first snapshot of the toll and threat antibiotic-resistance poses to US health. The report ranks each threat and proposes four core actions to tackle the growing problem.

Antibiotic-resistance occurs when an infection does not respond to the drug developed to treat it because the germs have since changed in ways that make them immune to it.

Every year, more than two million Americans get infections that are resistant to antibiotics and more than 23,000 die as a result.

As well as taking a considerable toll on health and life, antibiotic resistance is a huge economic burden for a health system that is already strained.

Studies suggest antibiotic resistance is responsible for some $20 billion direct health care costs and another $35 billion a year in lost productivity.

Community prevalence of drug-resistant bacteria

Once rare outside of hospitals, antibiotic-resistant infections are now increasingly arising in the community.

CDC Director Tom Frieden said in a news conference on Monday:

"Antibiotic resistance is rising for many different pathogens that are threats to health. If we don't act now, our medicine cabinet will be empty and we won't have the antibiotics we need to save lives."

Steve Solomon, director of the Office of Antimicrobial Resistance at the CDC adds:

"These drugs are a precious, limited resource - the more we use antibiotics today, the less likely we are to have effective antibiotics tomorrow."

The public health agency says the single biggest cause of antibiotic resistance is use of antibiotics, and up to half of all antibiotics prescribed for patients are either unnecessary or prescribed inappropriately.

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Overuse of antibiotics in both humans and livestock can allow bacteria to evolve by developing resistance, which will have serious impacts on patients who acquire infections.

Another heavy user of antibiotics is farming, where animals are given antibiotics to prevent, control and treat disease, and also to promote growth. The CDC says it is just as important to use antibiotics judiciously here as with humans.

The US Food and Drug Administration (FDA) recently issued guidance on how to use antibiotics responsibly in animal farming. The agency has also banned the use of certain antibiotics in food-producing animals.

"Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed," says Solomon.

Loss of effective antibiotics will have a serious impact on patients with other diseases who then acquire infections. Also, people who undergo hip replacements, receive organ transplants, have cancer therapy, and other treatments, all depend on antibiotics to help them deal with any infections that might arise.

Without effective antibiotics, the ability to offer potentially life-saving and life-transforming procedures disappears.

CDC classifications and actions for infections

In compiling the report, the CDC assessed threats posed by antibiotic-resistant infections according to seven factors: impact on health, impact on economy, how common the infection is, how common it could be in 10 years' time, how easily it spreads, availability of effective antibiotics and how difficult it is to prevent.

From the results of this assessment, they then classed antibiotic-resistant infections as "urgent," "serious," or "concerning."

Infections classed as urgent include those caused by:

  • Carbapenem-resistant Enterobacteriaceae (CRE). Carbapenem antibiotics are used as a last line of defense against many bacteria, but increased resistance has made them less useful.
  • Drug-resistant gonorrhea, a sexually transmitted infection.
  • Clostridium difficile, a serious diarrheal infection often linked with antibiotic use, which every year puts around a quarter of a million Americans in the hospital and kills over 14,000.

The CDC urges four core actions to focus on in the fight against antibiotic-resistance:

  1. Prevention: if you prevent infections, you do not need to use antibiotics in the first place. This in turn prevents spread of resistance. Actions include hand washing, safe food handling, infection prevention in hospitals and immunization.
  2. Surveillance: the CDC already tracks antibiotic-resistant infections and their causes, and analyzes underlying risk factors. This helps experts develop new approaches to prevention.
  3. Stewardship: probably the single action that could most effectively reduce the problem - there needs to be a shift toward more sparing and judicious use of antibiotics to vastly reduce the nearly 50% of misuse that goes on.
  4. Development: of new drugs and diagnostics. Antibiotic resistance is a natural step in the evolution of bacteria, so we will always need new drugs and new tests to keep one step ahead.

For more information on drug resistance, visit the CDC information hub Antibiotic/Antimicrobial Resistance.