Hospitals, not farms, "most acute problem" in antibiotic resistance
— Improved stewardship needed on all fronts
In a move that disappointed anti-animal ag groups, a new report by the Center for Disease Control (CDC) pointed the finger at hospitals and human misuse as forefront of the antibiotic resistance issue. Though the report did include antibiotic use in livestock as a source of concern, the fact it did not take center stage was a welcome change.
Last week, CDC released “Antibiotic Resistance Threats in the United States, 2013.” For the first time the report ranked various bacteria by their threat level. Most notable, however, was it pointed to misuse in the human side of antibiotics over use in animal agriculture.
“The use of antibiotics is the single most important factor leading to antibiotic resistance around the world. Antibiotics are among the most commonly prescribed drugs used in human medicine. However, up to 50 percent of all the antibiotics prescribed for people are not needed or are not optimally effective as prescribed,” read the report’s introduction.
This portion was quickly followed by information on antibiotic use in food animals and the CDC’s position that non-therapeutic uses of antibiotics be phased out. But the fact this was second to the superfluous use of antibiotics in humans was a change from the popular mindset on the topic.
The report estimated that, at minimum, over 2 million people contract an antibiotic-resistant infection annually. Of that number, at minimum, over 23,000 people die of an antibiotic-resistant infection annually. It also noted that, while antibiotic-resistant infections can happen anywhere, the data shows “most deaths related to antibiotic resistance happen in healthcare settings, such as hospitals and nursing homes.”
“Right now, the most acute problem is in hospitals,” said Tom Frieden, CDC’s director. “The most resistant organisms in hospitals are emerging in those settings because of poor antimicrobial stewardship among humans.”
Frieden, and the report, did stress however that simply using antibiotics can contribute to resistance.
“Perhaps the single most important action needed to greatly slow down the development and spread of antibiotic-resistant infections is to change the way antibiotics are used. Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe. Stopping even some of the inappropriate and unnecessary use of antibiotics in people and animals would help greatly in slowing down the spread of resistant bacteria,” read the report.
On the human side of the equation, the report pointed to poor prescription practices among doctors and patient behavior as contributing to the problem.
“Prescribing antibiotics when they are not needed or prescribing the wrong antibiotic in outpatient settings such as doctors’ offices is common. In some cases, doctors might not order laboratory tests to confirm that bacteria are causing the infection, and therefore the antibiotic might be unnecessarily prescribed.
“In other cases, patients demand treatment for conditions such as a cold when antibiotics are not needed and will not help. Likewise, healthcare providers can be too willing to satisfy a patient’s expectation for an antibiotic prescription.”
Interestingly, the report did not highlight what many physicians have stated publicly is problem regarding antibiotic use: patients regularly not taking the full prescription, which allows hardier bacteria to survive.
On the animal side of the equation, the report repeated the CDC’s position against non-therapeutic uses of antibiotics in food animals and stressed the need for judicious use.
“Resistant bacteria in food-producing animals are of particular concern because these animals serve as carriers. Resistant bacteria can contaminate the foods that come from those animals, and people who consume these foods can develop antibiotic-resistant infections. Antibiotics must be used judiciously in humans and animals because both uses contribute to not only the emergence, but also the persistence and spread of antibiotic-resistant bacteria.”
Entertainingly, many media outlets and organizations with anti-agriculture track records seemed disappointed or focused solely on the report’s comments on antibiotic use in food animals.
“CDC missed an opportunity to advise veterinarians and federal and state agencies on reducing the quantity of antibiotics used in animal production,” said Center for Science in the Public Interest (CSPI), a group opposed to meat consumption and often derided as “food cops” by watchdog group Center for Consumer Freedom.
CSPI further criticized the CDC report for offering recommendations to human health care practitioners without offering the same attention to “the food industry” and USDA and FDA.
However, the report frequently voiced support for, and provided links to, existing USDA and FDA efforts at reducing non-therapeutic uses of antibiotics in its discussion of the topic. — Kerry Halladay, WLJ Editor