CDC chief: Antibiotic resistance 'scary' threat to modern medicine

Tom Frieden, CDC
Tom Frieden, CDC

Tom Frieden, MD, MPH, CDC director., CDC / Kathryn Foti

The head of the Centers for Disease Control and Prevention (CDC) kicked off the plenary session at IDWeek2016 with a warning that modern medicine could be undermined if we don't act quickly to reduce antibiotic resistance.

"Truly we face a scary situation," CDC Director Tom Frieden, MD, MPH, told the audience of clinicians and infectious disease researchers in New Orleans. "We need to act now, because we cannot know with certainty that we will have new or better drugs in the future."

Frieden's warning on antibiotic resistance comes a month after the United Nations issued a declaration that committed world leaders to fighting antimicrobial-resistant (AMR) pathogens and ensuring continued access to life-saving antibiotics.

An estimated 700,000 people around the world die each year from drug-resistant strains of common bacterial infections, HIV, tuberculosis, and malaria. And a 2014 report from the UK's Review on Antimicrobial Resistance projected that if rising AMR is not addressed, the annual death toll could reach 10 million by the year 2050.

Frieden said that antibiotic resistance threatens to turn back the clock to a pre-antibiotic era in which pneumonia and urinary tract infections are potentially fatal conditions. But beyond that, it also endangers the more than 600,000 cancer patients who get chemotherapy each year and rely on antibiotics to protect them from potentially deadly infections. "We presume that we can treat them, but that may not always be the case," Frieden said.

Creative thinking, better cooperation

Turning the tide against antimicrobial resistance, Frieden argued, will require work in four areas: Better surveillance and monitoring to find resistant bacteria faster wherever it emerges, better antibiotic stewardship to prevent the emergence of drug-resistant pathogens, better system-wide infection control and treatment, and better outbreak control. "Urgent actions can save both lives and money," he said.

But for Frieden, who battled drug-resistant tuberculosis infections as a CDC officer working with the New York City Health Department in the 1990s, addressing the growing threat of antibiotic resistance also lies in part in the infectious disease community thinking outside the box. One element of that, he explained, is understanding that resistance is not solely an issue for individual hospitals.

The role of hospitals as incubators of increasingly antibiotic-resistant infections has been well-established. Frieden cited statistics showing that one in six central line-associated infections are caused by serious antibiotic-resistant infections, and that nearly nine in 10 Clostridium difficile infections are associated with healthcare treatment.

But, he noted, "healthcare facilities are not islands." For example, older patients move between acute-care and long-term care facilities frequently, and when they move, the bacteria and infections move with them. So even if a hospital has great infection control and antibiotic stewardship programs, it is "at the mercy" of the nursing home or long-term care facility down the block. That's why hospitals need to think about what other healthcare facilities in their community are doing, and how they can coordinate with them, he said.

"By working together, coordinating within a community, facilities can make an enormous difference," Frieden said, citing a CDC analysis that showed that carbapenem-resistant Enterobacteriaceae infections within a community could be drastically reduced with better coordination. "It's not just what one hospital can do. It's about the coordination between facilities."

Looking beyond individual bacteria, borders

Frieden took the "thinking outside the box" metaphor further, suggesting that the infectious disease community also needs to think beyond the individual bacterium by understanding the ecology of bacteria, what role the human microbiome plays in maintaining health and controlling infections, and how the use of antibiotics affects the microbial environment.

"There are many more friendly bacteria around than there are unfriendly ones, and we disrupt them at our peril," he said.

Finally, Frieden explained, clinicians and researchers need to think outside of what they are seeing in their own countries. He cited his own experience treating an Indian patient in New York City with drug-resistant tuberculosis 25 years ago and then going to India years later to establish a program to prevent such infections. "We are all connected by the trends around the world," Frieden said.

To that end, Frieden touted the Global Health Security Agenda, a partnership of more than 70 nations, international organizations, and non-governmental stakeholders that aims to strengthen the capacity of each country to identify, prevent, and respond to infectious disease threats when they emerge.

The CDC chief also urged the audience to look beyond the numbers and focus on the lives affected by antibiotic resistance. "This is important, putting a human face on the problems we see every day… so that the public and policy makers use that kind of motivation to change what we do."

IDWeek is a joint meeting of the Infectious Disease Society of America, the Society for Healthcare Epidemiology of America, the HIV Medical Association, and the Pediatric Infectious Diseases Society.

See also:

Sep 21 CIDRAP News story "UN leaders pledge to fight antimicrobial resistance"

May 19 CIDRAP News story "UK group calls for $40 billion to tackle antibiotic resistance"

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