November 13, 2017
By: Christopher M. Jones, PharmD, MPH
Summary:
Antibiotic resistance is a significant threat
to our nation’s public health, and one that is spreading and evolving rapidly.
Antibiotic resistance is a significant threat to
our nation’s public health, and one that is spreading and evolving rapidly. It
was only a couple of years ago that scientists discovered the emergence in
China of mcr-1, a gene that makes bacterial infections resistant to
colistin, an antibiotic that is increasingly used as a “last resort” treatment
when others don’t work. Americans are already dying of untreatable infections.
This discovery and the
robust multi-agency and international response illustrates the constantly
evolving threat of bacteria that are resistant to antibiotics and the
importance of widespread surveillance to detect new resistance types, quick
response to prevent spread and development of new treatments.
As soon as the mcr-1 gene
was discovered in China, the U.S. government began conducting surveillance for
it here. Less than six months later, the gene was found in a patient in
Pennsylvania. Given the mcr-1 gene’s ability to move to other
bacteria and make them resistant, the federal government implemented an urgent
public health response to contain and slow any potential spread, coordinating
across multiple agencies and surveillance systems, and relying on collaboration
and innovation. The CDC, FDA, USDA, DOD and state agencies all got involved to
swiftly respond and prevent further spread of resistance.
The mcr-1 gene is just
one example of the broad challenge of antibiotic resistance. Every year, more
than 2 million people in the U.S. get infections that are resistant to one or
more antibiotics, and at least 23,000 people die as a result. Another
15,000 or more deaths each year in the U.S. are caused byClostridium
difficile, a bacterium often associated with unnecessary antibiotic use and
advanced age and can cause serious complications.
The increasing
resistance to antibiotics puts at risk our ability to effectively treat sepsis
or to provide effective care to cancer patients, organ transplant recipients, and
burn victims, who are at higher risk of complications and infections.
Drug-resistant infections can complicate the U.S. medical response to chemical,
biological, radiological or nuclear emergencies. We’re also seeing more common
infections, like urinary tract infections, becoming increasingly difficult to
treat because of antibiotic resistance.
This is why the federal
government developed the National Action Plan on Combating
Antibiotic-Resistant Bacteria (CARB), to coordinate and enhance
the public health response to the threat of antibiotic resistance in humans and
animals, domestically and internationally. The Plan provides a five-year roadmap
to guide the nation in reducing the prevalence of antibiotic-resistant bacteria
by:
·
Slowing the emergence of resistant bacteria and preventing the
spread of resistant infections.
·
Strengthening national surveillance efforts to combat resistance.
·
Advancing development and use of rapid and innovative diagnostic
tests for identification of resistant bacteria.
·
Accelerating research and development for new antibiotics, other
therapeutics, and preventive strategies, including vaccines.
·
Improving international collaboration and capacities for
antibiotic-resistance prevention, surveillance, control and antibiotic research
and development.
The federal government
has been working diligently to implement the Plan since its release in 2015. As
part of U.S. Antibiotic Awareness Week, November
13-19, 2017, HHS, on behalf of the Interagency CARB Task Force, has released
a Progress Report to detail the significant
progress made during the first two years of implementation of the National
Action Plan. Highlights include:
·
The percentage of U.S. hospitals reporting antibiotic stewardship programs using
CDC’s Core Elements for Stewardship rose to 64 percent in 2016, up from 46
percent in 2015. The goal is to reach 100 percent by 2020.
·
Methicillin-resistant Staphylococcus aureus (MRSA) in acute care
hospitals declined by 13 percent between 2011 and 2014, and by a further 5
percent by 2016. C. difficile infections declined in acute care hospitals by 8
percent between 2011 and 2014, and by a further 7 percent by 2016.
·
CDC established the Antibiotic Resistance Laboratory Network,
enhancing lab capacity to better detect, respond and contain resistance and
resistant infections. CDC has invested in all 50 states, five large cities and
Puerto Rico to detect and respond to CRE, “the nightmare bacteria.” CDC has
also established seven regional labs to detect and support response to
resistant organisms recovered from human samples.
·
Since the National Action Plan was released in March 2015, NIH has
provided support to investigators through multiple funding opportunities and
access to a wide array of preclinical resources designed to facilitate new drug
development. These efforts are greatly expanding the pipeline of new drug
candidates, at various stages of development, to treat antibiotic-resistant
infections. In particular, the NIH-supported Antibacterial Resistance
Leadership Group is pioneering an innovative clinical research agenda on
antibacterial resistance.
·
As of April 2017, USDA’s Animal and Plant Health Inspection
Service for the first time has begun conducting antibiotic use monitoring,
resistance surveillance, and antimicrobial use surveys of beef feedlots and
swine farms. These data are critical to understanding the relationships between
antibiotic use and resistance in animals and humans.
·
In the past two years, FDA approved, cleared or granted marketing
authorization for marketing several new diagnostic devices that may
significantly enhance detection or prevention of antibiotic resistance.
·
Last year, NIH and the Biomedical Advanced Research and
Development Authority (BARDA) launched the Antimicrobial
Resistance Diagnostic Challenge, which seeks tests that identify
antibiotic-resistant bacteria or that distinguish between viral and bacterial
infections to reduce unnecessary use of antibiotics.
·
The Multidrug-Resistant Organism Repository and Surveillance
Network at the Walter Reed Army Institute of Research offers an
almost unprecedented 48-hour turn-around time to all DOD hospitals for next
generation sequencing to support outbreak investigations and has similar
services available to non-DOD institutions.
·
In July of 2016, BARDA launched CARB-X, a
five-year, $450 million public-private partnership between BARDA, NIH, and the
Wellcome Trust aimed at bolstering innovation in antibacterial product
development. As of November 2017, CARB-X had granted awards to 23 biotech
companies and research teams for drug discovery and development projects to
tackle antibiotic resistance.
The U.S. Government has
also worked with international partners, including the World Health
Organization, the Food and Agriculture Organization, and the World Organization
for Animal Health, to combat antimicrobial resistance. Through the Global
Health Security Agenda, U.S. agencies have enhanced efforts to combat
antibiotic resistance in over 30 countries.
The progress report of
the CARB National Action Plan shows that each
of us has a role in the fight against antibiotic resistance, and we
can make a difference at the personal, community, state, national and international
levels. From individuals working with their doctors to determine if
an antibiotic is the right treatment for them, to enhanced surveillance, response
and increased international cooperation, we can continue to make progress in
our efforts to stop the spread of resistant infections and to ensure that
antibiotics will be available for us and future generations.
Christopher Jones is the
acting associate deputy assistant secretary for science and data policy, HHS
Office of the Assistant Secretary for Planning and Evaluation.
https://www.hhs.gov/blog/2017/11/13/plan-drives-progress-against-antibiotic-resistant-bacteria.html
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