Drug-Resistant Infections A Threat to Our Economic Future
Drug-resistant infections occur when pathogens change in ways that
render antimicrobial drugs ineffective. As a result, the pathogens
survive and continue to spread. When infections are treatable with
antimicrobials, people can be cured and further spread within the
population can be readily contained. This has saved hundreds of millions
of lives since wide use of these “miracle drugs” started over 70 years
ago. Loss of drug-effectiveness because of antimicrobial resistance
(AMR) is increasing in both developing and developed countries. If this
trend continues unchecked, the world will confront a reality where many
infectious diseases have “no cure and no vaccine.”
This report provides insights into the extent and broad patterns of the economic impacts of AMR and their implications for poverty, should AMR continue to increase because of inadequate collective actions. Echoing other recent studies, this report underscores that the likely direct and indirect economic damage would be substantial. The annual costs could be as large as those of the global financial crisis that started in 2008.
The costly impacts of AMR on GDP would be worse in two respects, however: they would be felt during the entire simulation period (which extends to 2050) and inequality between countries would increase because low-income countries would experience the largest shortfalls in economic growth.
A new review of surveillance data reveals that rates of highly
drug-resistant infections are on the increase among children in the
United States. The findings reinforce the need for better ways to track,
prevent, and treat these serious infections in children and for
bolstering stewardship programs.
The researchers say as highly drug-resistant infections rise, they leave healthcare providers with limited choices in effective antibiotics to treat them, and these antibiotics are less safe and more toxic in children.
The researchers came to this conclusion after analyzing a large
reference-laboratory database of samples collected from pediatric
patients all over the U.S. between 1999-2012. The samples were of an
important infection-causing bacteria called Pseudomonas aeruginosa.
P. aeruginosa is a common cause of healthcare-associated infections that can result in prolonged illness, require longer hospital stays, and, ultimately, raise the risk of death.
The researchers report their findings in the Journal of the Pediatric Infectious Diseases Society.
First and corresponding author Latania K. Logan, assistant professor at Rush University Medical Center in Chicago, IL, says:
"Infections with P. aeruginosa can be serious and are associated with significant morbidity and mortality."
Antibiotics have transformed medicine - they have made it possible to treat once deadly infections and paved the way for advances like transplant surgery and chemotherapy for cancer. They have reduced disease and saved lives.
However, misuse of the drugs has also contributed to the increasing problem of antibiotic resistance, now a serious and growing threat to public health.
The CDC class multi-drug resistant P. aeruginosa as a serious threat - that is, "not considered urgent" but the threat "will worsen and may become urgent without ongoing public health monitoring and prevention activities."
Their estimates show 51,000 healthcare-associated P. aeruginosa infections in adults and children occur in the U.S. each year. This includes 6,700 cases where the bacterium is resistant to multiple types of antibiotic, resulting in 440 deaths a year.
The CDC suggest hospital antibiotic stewardship programs should contain the following core elements:
They looked at data from a surveillance network of laboratories serving around 300 hospitals across the U.S. The laboratories analyze patient samples of P. aeruginosa for resistance to several types of drugs.
For their analysis, the researchers included data on children aged 1-17 who were in outpatient, inpatient, intensive care unit, and long-term care settings from January 1999 - July 2012. They excluded children under 1 year old and patients with cystic fibrosis.
The researchers found the proportion of P. aeruginosa samples that were resistant to at least three classes of antibiotics - that is, multi-drug resistant - increased from 15.5 percent in 1999 to 26 percent in 2012.
The proportion that were resistant to carbapenems rose from 9.4 percent to 20 percent over the same period. Carbapenems are a class of antibiotic that is considered a treatment of last resort for highly resistant infections.
The researchers found both multi-drug resistant and carbapenem-resistant P. aeruginosa were more common in patients in intensive care units, in children aged 13-17, in respiratory samples, and among patients in the Midwest states (Iowa, Kansas, Minnesota, Missouri, Nebraska, and the Dakotas).
They conclude their findings highlight the need for "aggressive
prevention strategies, including instituting antimicrobial stewardship
programs in pediatric settings, are essential for combating
antimicrobial resistance."
They suggest healthcare facilities should also consider using rapid molecular diagnostics to help make decisions about use of antibiotics.
This report provides insights into the extent and broad patterns of the economic impacts of AMR and their implications for poverty, should AMR continue to increase because of inadequate collective actions. Echoing other recent studies, this report underscores that the likely direct and indirect economic damage would be substantial. The annual costs could be as large as those of the global financial crisis that started in 2008.
The costly impacts of AMR on GDP would be worse in two respects, however: they would be felt during the entire simulation period (which extends to 2050) and inequality between countries would increase because low-income countries would experience the largest shortfalls in economic growth.
The researchers say as highly drug-resistant infections rise, they leave healthcare providers with limited choices in effective antibiotics to treat them, and these antibiotics are less safe and more toxic in children.
P. aeruginosa is a common cause of healthcare-associated infections that can result in prolonged illness, require longer hospital stays, and, ultimately, raise the risk of death.
The researchers report their findings in the Journal of the Pediatric Infectious Diseases Society.
First and corresponding author Latania K. Logan, assistant professor at Rush University Medical Center in Chicago, IL, says:
"Infections with P. aeruginosa can be serious and are associated with significant morbidity and mortality."
Antibiotics have transformed medicine - they have made it possible to treat once deadly infections and paved the way for advances like transplant surgery and chemotherapy for cancer. They have reduced disease and saved lives.
However, misuse of the drugs has also contributed to the increasing problem of antibiotic resistance, now a serious and growing threat to public health.
Multi-drug resistant P. aeruginosa a 'serious threat'
The Centers for Disease Control and Prevention (CDC) include antibiotic-resistant P. aeruginosa among the top 18 drug-resistant threats to Americans.The CDC class multi-drug resistant P. aeruginosa as a serious threat - that is, "not considered urgent" but the threat "will worsen and may become urgent without ongoing public health monitoring and prevention activities."
Their estimates show 51,000 healthcare-associated P. aeruginosa infections in adults and children occur in the U.S. each year. This includes 6,700 cases where the bacterium is resistant to multiple types of antibiotic, resulting in 440 deaths a year.
The CDC suggest hospital antibiotic stewardship programs should contain the following core elements:
- Commitment from leaders: dedicate the human, financial, and information technology resources necessary to implement the program
- Accountability: appoint a single leader responsible for getting results - evidence from successful programs shows this works
- Drug expertise: appoint a single pharmacist leader who works to improve antibiotic use
- Action: implement at least one recommended action - such as evaluate the need for continuing treatment after a set period (for example, "antibiotic time-out" after 48 hours)
- Monitoring: track patterns of drug prescribing and resistance
- Informing: keep doctors, nurses, and relevant staff up-to-date about antibiotic use and resistance
- Education: educate clinicians about resistance and optimal prescribing.
Highly resistant P. aeruginosa infections rising in children
However, the researchers behind the new study note that - despite many papers warning about rising national rates of antibiotic resistance - few investigate the trends of drug-resistant P. aeruginosa in children specifically.They looked at data from a surveillance network of laboratories serving around 300 hospitals across the U.S. The laboratories analyze patient samples of P. aeruginosa for resistance to several types of drugs.
For their analysis, the researchers included data on children aged 1-17 who were in outpatient, inpatient, intensive care unit, and long-term care settings from January 1999 - July 2012. They excluded children under 1 year old and patients with cystic fibrosis.
The researchers found the proportion of P. aeruginosa samples that were resistant to at least three classes of antibiotics - that is, multi-drug resistant - increased from 15.5 percent in 1999 to 26 percent in 2012.
The proportion that were resistant to carbapenems rose from 9.4 percent to 20 percent over the same period. Carbapenems are a class of antibiotic that is considered a treatment of last resort for highly resistant infections.
The researchers found both multi-drug resistant and carbapenem-resistant P. aeruginosa were more common in patients in intensive care units, in children aged 13-17, in respiratory samples, and among patients in the Midwest states (Iowa, Kansas, Minnesota, Missouri, Nebraska, and the Dakotas).
They suggest healthcare facilities should also consider using rapid molecular diagnostics to help make decisions about use of antibiotics.
"Highly drug-resistant P. aeruginosa infections leave healthcare providers with limited - or sometimes no - antibiotic choices available, and these antibiotics are less safe and more toxic in children."Learn how scientists are developing a new class of antibiotics for fighting drug-resistant bacterial infections.
Co-author Sumanth Gandra, Center for Disease Dynamics, Economics & Policy
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