Dan Murphy: The Resistance is Real

antibiotic needle ( iStock )

CDC’s latest assessment of the threat posed by antibiotic-resistant pathogens has good news and bad news: Good, that incidence levels are declining; bad because thousands are still dying.

A new report from the Centers for Disease Control and Prevention paints a sobering picture of the threat from antibiotic-resistant microbial pathogens.

But before jumping into the disturbing statistics — although CDC’s “estimates” of the scale of what its official classify as foodborne illness outbreaks casts some doubt on the numbers — I want to share upfront what the agency buried fairly deep in its report.

To quote: “Overall, there has been significant progress preventing infections and deaths from resistant germs typically associated with hospitals,” according to the report. Titled “Antibiotic Resistance Threats in the United States, the report also noted that “deaths from antibiotic-resistant infections in hospitals went down 28% from 2012 to 2017.”  

That’s highly significant. Any time medical outcomes improve by 28%, there should be hosannas all around, because such a significant change is decidedly not the case with most healthcare challenges. 

CDC attributed the decline to a series of strategic initiatives, including stricter hospital protocols on treating infections, tighter controls on outpatient antibiotic usage and greater use of rapid detection tests.  

However, you know there’s a qualifier coming, because 28% fewer resistant infection-related deaths doesn’t represent the optimal situation by any means. Indeed, the agency noted that antibiotic-resistant bacteria remain a significant threat, especially the infamous MRSA, or methicillin-resistant Staphylococcus aureus, which caused a large percentage of the 2.8 million infections and more than 85% of the 35,000 deaths annually attributed to resistant infections as calculated in the report.

Worse, when Clostridioides difficile, a common pathogen that’s not typically resistant but which can cause severe, even life-threatening diarrhea — not my preferred way to exit this world, I’d like to point out. And when that unenviable condition is associated with antibiotic treatment, the annual toll of resistant cases “exceeds 3 million infections and 48,000 deaths,” according to the report.

The food-related risk

But wait. There’s more bad news, and it involves the very statistics that CDC’s critics have questioned.

As the report explained, “Using data sources not previously available, there were nearly twice as many annual deaths from antibiotic-resistant infections as CDC originally reported in 2013.”

That is horrific. Double the number of deaths? Even if those data are estimated, it still represents a serious healthcare crisis, one that previous policies and protocols have only worsened.

For example: CDC identified Carbapenem-Resistant Enterobacteriaceae, so-called CRE pathogens. Enterobacteriaceae are bacteria, such as E. coli, that live in the gut and although most aren’t pathogenic, they’re considered “indicator organisms” in food processing that should signal operators that sanitation efforts are not what they should be.

Carbapenem, on the other hand, is a powerful class of antibiotics reserved for treating severe or high-risk bacterial infections, particularly in suspected multidrug-resistant infections. So when common bacteria, like enterobacteriaceae, develop resistance to the class of antibiotics considered most effective against resistant infections, something’s wrong.

To its credit, CDC’s overall strategy, the “Antibiotic Resistance Solutions Initiative,” takes a measured approach to the challenge. Its public-facing information does target food animals as a source of resistant bacteria, which develop when livestock are given antibiotics, and makes clear that those resistant bacteria can end up on meat, poultry and produce — ie, food sold uncooked — and cause infections that exacerbate the threat of combatting resistant pathogens.

But its control strategy is focused more so on detection and prevention, including:

  • Increasing state laboratory capacities to more rapidly detect foodborne drug-resistant bacteria, such as Campylobacter and Salmonella
  • Improving surveillance ant tracking of foodborne outbreaks
  • Promoting responsible use of antibiotics in foods animals, mainly be equipping veterinarians with proper tools and training

It’s a strategic game plan that could have been written by an industry trade group, and likely was based on input from such sources. Given the seriousness of the antibiotic resistance problem, I’d be inclined to support a more rigorous approach to managing growth promotants in animal agriculture, since therapeutic administration of antibiotics to treat frank occurrences of animal disease is a non-factor in the etiology of drug-resistant microbial pathogens.

We don’t have to “ramp up” either the clinical training or the on-the-ground experience of the nation’s veterinarians to ensure “responsible” drug use when animals get sick.

What we do need are ways to minimize routine use of sub-therapeutic drugs used solely as preventive agents and/or to stimulate growth in livestock. That’s where the problems start. That’s how bacteria eventually develop resistant strains: after endless exposure to dosages that don’t wipe out bacterial colonies but do accelerate mutations that no longer succumb to the drugs.

Credit CDC for a reasoned, comprehensive approach to dealing with what is undeniably a serious public health threat.

Now industry needs to step up and direct its resources less toward justifying widespread application of sub-therapeutic antibiotics and more toward implementing measures that minimize their use.

There was a time not so long ago when the meat industry’s leadership argued the improbability of everything from improving beef quality to embracing animal ID to deploying antimicrobial interventions at packing plants, and one by one they all got done.

Now it’s time to figure out how to maintain animal health and support robust growth without restoring to current levels of antibiotics use.

No more woulda, coulda, shoulda. It can — and must — get done.

The opinions in this commentary are those of Dan Murphy, an award-winning journalist and commentator.