Why aren’t healthcare organizations and the government doing more?
According to the Centers for Disease Control (CDC), each year in the United States, at least 2 million people become infected with bacteria resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections. In September, President Obama called antibiotic-resistant infections “a serious threat to public health and the economy,” and outlined a new national initiative to address the issue.
Since 1945, scientists have known that antibiotic resistance could be a serious danger. Alexander Fleming, credited with the discovery of penicillin, warned of this fact during his Nobel Prize speech, predicting “there may be a danger, though, in underdosage (of penicillin). It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself, and by exposing his microbes to nonlethal quantities of the drug, make them resistant.”
Misuse and Abuse
Since that time many factors have contributed to the misuse and abuse of antibiotics. Patients are consistently asking for antibiotic prescriptions when they are not needed, and oftentimes, clinicians fall victim to these requests. As many as half of all antibiotic prescriptions are either not needed or are not effective. According to the CDC, almost one in five emergency room visits resulting from adverse drug events that are caused by antibiotics. Children are the most likely victims. Despite the fact antibiotics generally are safe, they can cause allergic reactions and interact with other drugs, harming patients who are vulnerable because they already suffer from other medical conditions.
Another major contributing factor to the crisis of antibiotic resistance is the use of antibiotics in livestock. This isa practice the CDC says is “not necessary” and “should be phased out.” Additionally, the FDA similarly states that “in light of the risk that antimicrobial resistance poses to public health, the use of medically important antimicrobial drugs in food-producing animals for production purposes does not represent a judicious use of these drugs.” For now, though, the FDA’s approach to curbing this threat has been limited to issuing voluntary guidelines.
The Need to Do More
If antibiotic resistance is a topic of such national significance and poses such a significant threat to global public safety, why aren’t hospitals and healthcare organizations doing more to review their use of antibiotics to get a better understanding of which are most likely to be effective in their particular settings? Antibiograms have proven successful in aiding healthcare practitioners in prescribing antibiotics in local populations, such as hospitals, nursing homes or in the community. This information is invaluable in the fight against antibiotic resistance. The Clinical and Laboratory Standards Institute published guidelines that recommended compiling antibiograms at least annually. Currently, most hospitals use antibiograms, which are only updated once a year, despite the fact resistance can shift significantly from month-to-month.
Currently, there are no national guidelines for antibiogram review on a monthly basis, which is only complicating this pressing issue. Antibiotic resistance is a constantly evolving situation, and without constant analysis, clinicians will run out of options in their medicinal repertoire that work for certain infections. Recent research conducted at Oregon State University and published in Infection Control and Hospital Epidemiology pointed out 85% of antibiotic prescriptions in the skilled nursing facility residents who were studied were made without culture data to help determine what drug, if any, would be effective. This has serious implications, as the antibiotics being prescribed often will fail to effectively treat the infection and could lead to further complications within the patient population.
Researchers predict the next major global pandemic might involve an antibiotic-resistant superbug. In June of this year, Reuters reported the risks posed by pandemic threats such as deadly strains of flu and drug-resistant superbugs have shot up the agenda of global security issues at this year’s World Economic Forum in Davos, Switzerland, as politicians and scientists grapple with the lessons from an Ebola outbreak that has killed more than 8,600 people.
Antibiotic resistance is a major threat to public safety and action needs to be taken immediately to start correcting this issue. Until there are set national guidelines regarding antibiogram review, hospitals and healthcare organizations need to do as much as they can to review their local data and make sure the antibiotics being prescribed are appropriate and useful for the infections being presented.