Our Growing Resistance to Antibiotics [Infographic]

The dangers of antibiotic-resistant bacteria are growing. As the CDC notes, "Without urgent action, many modern medicines could become obsolete, turning even common infections into deadly threats."

Antibiotic resistance occurs when bacteria evolve to create resistant strains, either through genetic mutation or by bacteria achieving resistance from another type of bacteria, according to the Alliance for the Prudent Use of Antibiotics. The result is an antibiotic's "inability to effectively control or kill bacterial growth," according to the group. Although bacterial adaptation and evolution is common, the growing number of antibiotic-resistant bacteria strains is caused by the systematic overuse of antibiotic drugs.

This phenomenon isn't unique to the United States. It's happening around the world.

At a recent Georgetown University Medical Center event, "Antibiotic Resistance: A Global Health Concern," experts discussed the challenges and risks of antibiotic overuse, how to empower patients to ask questions about prescriptions, and the importance of preventing resistance to ensure that antibiotics remain effective. In this piece, we'll discuss sources of exposure, trends in resistance, and what primary care providers can do to support proper and effective antibiotic use.

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Sources of Antibiotic Exposure

The consumption of antibiotics serves as the primary source of exposure, according to the Centers for Disease Control and Prevention, and overuse and misuse are the leading culprits that contribute to resistance. This occurs for a variety of reasons, including health care providers who prescribe antibiotics without demonstrated need, patients who overestimate their benefits and request them, and patients who don't take them as instructed. Antibiotics should only be prescribed for treating bacterial illnesses, but patients often request them for viral conditions, such as a cold or the flu, due to a lack of understanding.

In addition to prescribed antibiotics, there are a variety of unintentional means of exposure. These include environmental and agricultural sources, such as through soil, water, and plants; eating animal products treated with antibiotics; and over-the-counter topical drug products that contain antibiotics, such as acne treatments. In addition to serving as a source of antibiotic drug exposure, agricultural and animal products can also spread antibiotic-resistant bacteria to humans. This happens when drug-resistant bacteria remain on meat that is not handled or cooked properly, and when fertilizer or water containing animal waste and drug-resistant bacteria is used on food crops that are subsequently ingested.

Trends Related to Antibiotic Resistance

According to the CDC, approximately 2 million people are diagnosed with antibiotic-resistant bacterial infections annually around the country, and at least 23,000 die due to these infections. These figures are cited as conservative estimates. The numbers are even higher for those who die from other conditions exacerbated by an antibiotic-resistant infection. Although data indicates that most of these infections occur in the patients' homes and communities, deaths largely take place in health care settings. Additional CDC statistics in recent reports include:

  • Antibiotic resistance costs the U.S. economy approximately $20 billion in health care costs (2008 data).
  • Additional costs to society from productivity loss due to illness from antibiotic-resistant bacteria amounts to roughly $35 billion per year (2008 data).
  • Approximately 30 percent of all antibiotics use is unnecessary (2016 data).
  • Since the first antibiotic-resistant bacterium was identified in the 1940s, the CDC’s list has grown to include 18 antibiotic-resistant organisms with health hazard levels ranging from “concerning” to “urgent.”

Fortunately, there are new efforts to stop the spread of antibiotic resistance, such as the U.S. Antibiotic Resistance Solutions Initiative. This $160 million effort is part of the Obama administration’s 2015 National Action Plan for Combating Antibiotic-Resistant Bacteria, which outlines steps for implementing the 2014 National Strategy for Combating Antibiotic-Resistant Bacteria.

The Role of Primary Care Providers

Primary care providers such as Family Nurse Practitioners play a key role in helping to curb this crisis. As the gatekeepers for prescription antibiotics, providers have a significant responsibility in both practicing and promoting antibiotic stewardship. In its "Preserve the Power of Antibiotics" factsheet, the CDC lists the following recommendations for health care providers:

  • Prescribe correctly. Avoid treating viral syndromes with antibiotics, even when patients ask for them; pay attention to dose and duration to ensure that the right antibiotic is prescribed for the right duration; be aware of antibiotic-resistance patterns in your area so that you can always choose the right antibiotic; and hospital and nursing home providers should reassess within 48 hours of starting the antibiotic when the patient's culture results come back.
  • Collaborate with other health care providers and with patients. Talk to your patients about appropriate use of antibiotics; include microbiology cultures, when possible, when ordering antibiotics; and work with pharmacists to ensure appropriate antibiotic use and prevent resistance and adverse events.
  • Stop the spread. Follow hand hygiene and other infection control measures with every patient.
  • Embrace antibiotic stewardship. Improve antibiotic use in all facilities, regardless of size, through stewardship interventions and programs, which will improve individual patient outcomes, reduce the overall burden of antibiotic resistance, and save health care dollars.

The growth of antibiotic-resistant bacteria is a significant public challenge that costs millions of dollars and thousands of lives, but there are steps consumers and health care providers can take to prevent misuse of antibiotics and minimize unintentional exposure. Keys to the fight against antibiotic resistance are patient education, correct prescribing and microbial testing practices, sanitation procedures in health care facilities, and responsible food consumption.

Please note that this post is for informational purposes only. Individuals should consult their health care professionals before following any of the information provided.

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