A new report from the CDC has underscored the continued threat of antibiotic resistance in the United States, including 18 antibiotic-resistant bacteria and fungi split into 3 categories based on level of concern—urgent, serious, and concerning. The report also includes a watch list with 3 threats that could become common without ongoing aggressive treatment.1

More than 2.8 million antibiotic-resistant infections occur in the United States each year according to the report, and more than 35,000 people die as a result of these infections, according to the report.1

"Stop referring to a coming post-antibiotic era—it's already here," said CDC Director Robert Redfield, MD, in a statement. "You and I are living in a time when some miracle drugs no longer perform miracles and families are being ripped apart by a microscopic enemy. The time for action is now and we can be part of the solution."

According to the report, urgent threats include Cabapenem-resistant Acinetobacter, Candida auris, Clostridioides difficile, Carbapenem-resistant Enterobacteriaceae, and drug-resistant Neisseria gonorrhoeae.1

C. auris has been of particular concern in recent years, after being reported for the first time in the United States in 2016. Since then, more than 2000 patients have been infected or colonized by the highly transmittable pathogen.2 The CDC has estimated in previous reports that infections with C. auris are associated with a mortality rate of up to 60% and that some strains are resistant to all 3 major classes of antifungal drugs.2

Biotechnology company SCYNEXIS Inc has been developing ibrexafungerp, an investigational agent, for the treatment of the pathogen. According to a statement from the company, a phase 3 study of the drug initiated in 2018 has shown successful outcomes in patients with C. auris infections.2

In the new report, serious threats included drug-resistant Campulobacter; drug-resistant Candida; extended-spectrum beta-lactamases-producing Enterbacteriaceae; vancomycin-resistant Enterococci; multidrug-resistant Pseudomonas aeruginosa; drug-resistant nontyphoidal Salmonella; drug-resistant Salmonella serotype typhi; drug-resistant Shigella; methicillin-resistant Staphylococcus aereus (MRSA); drug-resistant Streptococcus pneumoniae; and drug-resistant tuberculosis.1

In total, these 11 serious threats resulted in more than 1.4 million infections or hospitalizations each year, and more than 33,000 deaths.1

The report also listed 2 concerning threats: Erythromycin-resistant Group A Streptococcus and Clindamycin-resistant Group B Streptococcus.1 The former resulted in an estimated 5400 drug-resistant infections in 2017 and 450 deaths, whereas the latter caused an estimated 13,000 infections in 2016 and 720 deaths.1

Finally, the report listed 3 drugs on its watch list: Azole-resistant Aspergillus fumigatus, drug-resistant Mycoplasma genitalium, and drug-resistant Bordetella pertussis. These threats have not spread widely in the United States, but the report emphasized that without aggressive prevention measures, they could become more widespread.1

The report included 5 areas in which to fight these increasing threats.1
  • First, by using data to detect and track resistance, the CDC aims to improve tools for health care providers and facilities.
  • Second, using national alert systems can rapidly identify and improve response times for resistance outbreaks.
  • Third, working with partners to implement strategic antibiotic use can improve health outcomes for patients while minimizing unnecessary antibiotic prescriptions.
  • Fourth, collaborating to identify gaps in environment-related resistance can promote better sanitation and access to safe water globally, which the report said is a key risk factor in antibiotic resistance.
  • Finally, investing in drug, diagnostic, and vaccine development can have vital impacts for patient health.

The threat of antibiotic resistance has dangerous consequences for health care and expectancy, but the report emphasized that taking appropriate precautions and maintaining aggressive responses can lessen the threat, especially for vulnerable populations.


REFERENCES
  1. Centers for Disease Control and Prevention, Antibiotic Resistance Threats in the United States: 2019, CDC website. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf. Accessed Nov. 14, 2019.
  2. SCYNEXIS Commends the CDC for the Recognition of Candida auris as a New “Urgent Threat” in it Updated Report on Antibiotic Resistance Threats in the United States [news release]. Jersey City, NJ; Nov 14, 2019. PR Newswire. https://prnmedia.prnewswire.com/news-releases/scynexis-commends-the-cdc-for-the-recognition-of-candida-auris-as-a-new-urgent-threat-in-its-updated-report-on-antibiotic-resistance-threats-in-the-united-states-300958049.html. Accessed Nov 14, 2019.