Antibiotics Resistance an 'Urgent' Global Public Health Threat

Because many of us have grown up in the “Age of Antibiotics,” we might be excused if we take their amazing ability to save lives for granted. Indeed, antibiotics have extended the average human lifespan by 23 years, and many of the now-routine surgeries performed today—cancer treatment, organ transplants and open-heart surgery to name just a few—would be impossible without them.

Since the mid 20^th century, however, a gradual decline in antibiotic discovery and development and the evolution of drug resistance in many human pathogens, or germs, has led to what the U.S. Centers for Disease Control and Prevention (CDC) now calls an “antimicrobial resistance crisis” and “an urgent global public health threat.”

Antibiotics’ effectiveness in treating potentially lethal infections is rapidly being diminished by antimicrobial resistance, experts say, and the widespread use of antibiotics—both appropriate and inappropriate—pressures bacteria to become more resistant to our antibiotic drugs.

According to the CDC, in 2019, the most recent year for which data is available, antimicrobial resistance was directly responsible for killing at least 1.27 million people worldwide and was associated with as many as 5 million deaths.

In the U.S. alone, more than 2.8 million antimicrobial-resistant infections occur each year and nearly 36,000 people die as a result. In many cases, the CDC notes, those who develop such infections “require extended hospital stays, additional follow-up doctor visits and the use of treatments that may be costly and potentially toxic.”

A naturally occurring process

The CDC says antimicrobial resistance happens when infectious germs like bacteria and fungi develop the ability to defeat the drugs—called antibiotics or antifungals—designed to kill them. Such infections can be difficult and sometimes impossible to treat.

“Antimicrobial resistance is a naturally occurring process and it has been found in every U.S. state and in every country across the globe,” the CDC explains. However, it says, increases in antimicrobial resistance are being driven by “a combination of germs exposed to antibiotics and antifungals, and the spread of those germs and their resistance mechanisms.”

Raising awareness of the threat

The CDC instituted U.S. Antibiotic Awareness Week, an annual observance from Nov. 18-24, to raise awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic use.

In advance of Antibiotic Awareness Week, Resource editors spoke with two specialists with Baptist Health about the threat posed by antimicrobial resistance—not just for individuals but also for hospitals and health care providers everywhere.

Timothy Gauthier, PharmD, BCPS, BCIDP, is the Antimicrobial Stewardship Clinical Program Manager for Baptist Health, and Corey Frederick, PharmD, BCPS, BCIDP is the organization’s Ambulatory Care Infectious Diseases Clinical Coordinator. As pharmacists with advanced training in infectious diseases, pharmacotherapy and antimicrobial stewardship program management, Dr. Gauthier and Dr. Frederick are on the front lines of antimicrobial resistance and eager to help find immediate and long-term solutions.

Timothy Gauthier, PharmD, BCPS, BCIDP, Antimicrobial Stewardship Clinical Program Manager for Baptist Health

RESOURCE: What’s new with antibiotics resistance since we spoke about this last year?

TG/CF: Honestly and unfortunately, not much has changed. Antibiotic resistance remains a major threat to human health worldwide. Tremendous efforts are being made around the globe but it is slow moving and complicated by many factors. 

One thing that gives us hope is the push from governmental agencies and accrediting bodies to encourage healthcare organizations’ engagement in antimicrobial stewardship. For example, the Centers for Medicaid and Medicare Services (CMS) now has active standards on antimicrobial stewardship.

Additionally, the U.S. Centers for Diseases Control and Prevention (CDC) is coming out with Core Elements on Antimicrobial Stewardship for Departments of Health. Policy work like this is critical towards getting the resources for fighting back against the progression of antimicrobial resistance. It also helps align core partners such as infection prevention and control as well as quality assurance and performance improvement. We believe an all-hands-on-deck approach is key to finding success in what is rightly considered to be a global threat.

RESOURCE: Are supply chain issues and “Big Pharma’s” reluctance to invest in next-generation antibiotics aggravating the situation we find ourselves in now?

TG/CF: Absolutely. From natural disasters to manufacturing issues, we have seen the supply of antibiotics affected and shortages occur. Oral amoxicillin and intramuscular penicillin G are two recent shortages that have been particularly troubling. These supply chain issues can force prescribers to use alternative treatment options, which often are not as safe, effective, convenient or affordable. 

We have seen a few new antimicrobial treatments come to market in the last couple years, but all too often they are reserved for very specialized clinical scenarios and are very similar to existing products. We need new—and convenient—antibiotics with new mechanisms of actions to fight antibiotic-resistant pathogens in new ways. 

The problem of antibiotic-resistant organisms—sometimes called “super bugs” in the media—has also been exacerbated by the lack of new antibiotics coming to the market, and the outlook for new, more effective antibiotics is not very encouraging. Unfortunately, the antibiotic pipeline is broken. Because antibiotics can actually cure diseases, unlike many other types of medicines,

there is less opportunity for pharmaceutical companies to recoup their huge investments in research and development and marketing.

RESOURCE: What are the biggest dangers of failing to curb the transmission of antibiotic-resistant organisms?

TG/CF: Aside from our work with Baptist Health, both of us are parents of young children and we worry that if antimicrobial resistance continues to worsen, our kids may not have effective antibiotics when they need them as adults. One report estimates that drug-resistant diseases could be responsible for 10 million deaths a year by 2050. This would cause tremendous damage to the economy and force up to 24 million people into extreme poverty. As citizens of the world, this is very concerning.

Also, quite frankly, antibiotic resistance is bad for patient outcomes. For example, if our antibiotics are not effective in preventing surgery-related infections, even routine surgeries may not be safe to perform or they may soon carry a significant risk. Antibiotic resistance is important for everyone—even if you do not have an active infection today. However, it can be a challenge for individuals to acknowledge how their own actions with antibiotics can have impacts on the societal utility of these drugs. 

RESOURCE: What steps is Baptist Health taking to address antibiotics resistance?

TG/CF: The future is bright for antimicrobial stewardship at Baptist Health, where our stewardship programs focus on both the inpatient and outpatient healthcare settings. We have aligned our efforts with governmental bodies and regulatory agencies, using the CDC Core Elements of Antibiotic Stewardship as our fundamental lodestar. Those core elements include a commitment by hospital leadership, accountability, pharmacy expertise, action, tracking, reporting and education. 

Baptist Health actively supports antimicrobial stewardship across the continuum of care, engaging interdisciplinary collaboratives to identify, assess and develop ways to improve antibiotic use processes. We are successful because our work is supported by physicians, pharmacists, nurses, microbiology lab staff, infection preventionists, healthcare quality staff, information technology staff, organizational leadership and more. This is a team sport.

In addition to elevating the care of patients with infectious diseases, we are proud to share what we have learned with the global medical community so that others may benefit from our work. We have presented our findings at some of the most prestigious infectious diseases conferences in the U.S. and around the globe.

Corey Frederick, PharmD, BCPS, BCIDP, ambulatory care infectious diseases clinical coordinator for Baptist Health's Antimicrobial Stewardship Clinical Program

RESOURCE: What steps can our readers take in their own lives to limit the impact of antibiotics resistance?

TG/CF: This is an important question because most antibiotic use occurs outside of the hospital and we have no control over what the patient does or does not do with their medication once they leave with a prescription. That said, here are some specific steps people can take to help curb the persistent threat of antibiotics resistance:

• Avoid taking antibiotics unless you are under the care of a licensed medical professional. You may otherwise get the wrong tool for the job, and that can cause harm without any chance for benefit. Get the right diagnosis, let the diagnosis guide finding the right tool for the job.
  
  
• Do not demand antibiotics from your doctor. Let the doctor make the diagnosis and use that to determine if antibiotics are warranted. 
  
  
• Do not share antibiotics or keep old antibiotics “just in case” because antibiotics (like all drugs) become less effective over time and expired drugs have compromised efficacy.
  
  
• Do not take antibiotics without asking why you need them. Antibiotics pose risks. We should always make sure the benefit is understood before taking a risk. Protect yourself by only taking medications that are indicated. Any pharmacist will tell you, to limit the risk for adverse effects, take the lowest effective dose for the shortest necessary duration. 
  
  
• Promote rational antibiotic use with your friends, family and peers. Endorse letting the doctor’s diagnosis guide if antibiotics are needed. If you show that you care, people in your circles are more likely to care. As a society we need to encourage good antimicrobial stewardship and infection control as standard practice.

• Use reliable resources like what is provided by CDC to stay informed. And beware of misinformation—especially on social media.
  
  
• Sometimes antibiotics are indicated. When that is the case, make sure to take your medication as instructed by your licensed healthcare provider. If you need an antibiotic or other medication, Baptist Health has numerous community pharmacies which may be able to support your needs.

RESOURCE: How can vaccines help prevent bacteria and viruses from spreading?

TG/CF: Vaccines are often thought of as protecting us against viruses such as influenza or COVID-19 but they can also help prevent infections like pneumonia due to bacteria like Streptococcus pneumoniae. Vaccinations can also reduce the risk for secondary bacterial infection if a viral infection is avoided or mitigated. 

Baptist Health Pharmacy also offers a wide selection of immunizations, including for pneumococcal, influenza and RSV. Find a Baptist Health Pharmacy near you at BaptistHealth.net/Pharmacy to learn more about scheduling the right vaccinations to keep you and your family healthy.