4) promoting the development of new antibiotics and new diagnostic tests for resistant bacteria Antibiotic Resistance Threats in the United States, 2013 Executive Summary by Centers for Disease Control

The other unfortunate reality is that many of even the most severe antibiotics have already been rendered ineffective. In order to clean up the existing strains of resistant bacteria, new medicines will have to be rushed, requiring billions of dollars of research, tens of years of work, and the distinct possibility of failure, especially if step 3 is ignored.

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3) improving the use of antibiotics Antibiotic Resistance Threats in the United States, 2013 Executive Summary by Centers for Disease Control

Unfortunately, the problem is already so bad that the primary solution is relegated to the third slot, after cleanup efforts. Simply by radically shifting antibiotic prescription rates, evolutionary processes can be altered and resistance can be minimized. Currently, even with a large-scale awareness of the hazards of antibiotic abuse, the medicines are still misused: a startling 801 prescriptions for every 1,000 patients, on average in the US, were written in 2010. In many cases, the culprit was likely not even a bacteria, making the antibiotics superfluous.

Again, that figure is on average — it is not unheard of for some doctors to prescribe low-level antibiotics more often.

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Is a snapshot of the complex problem of antibiotic resistance today and the potentially catastrophic consequences of inaction Antibiotic Resistance Threats in the United States, 2013 Executive Summary by Centers for Disease Control

Evolution lesson:

How do bacteria “become” drug resistant?
When an antibiotic is used, the goal is to wipe out a large percentage of the population, leaving only a few bacteria behind that the body can naturally handle. Up until recently, it was normal practice to prescribe antibiotics as a precaution, even when bacteria were not the agent at hand.

As it turns out, natural mutations in some bacteria make them resistant to certain antibiotics. Since these are the only bacteria to survive the antibiotic use, they also are the only bacteria to split and “reproduce,” meaning that, through basic genetics, each “offspring” bacteria likely also carries that mutation. You see where this is going — eventually, entire bacteria groups are nearly or entirely resistant to the most commonly used antibiotics, and even to more rarely used kinds.

Interestingly, the very existence of “drug-resistant bacteria” is evidence for evolution, and even indirect natural selection!

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Antibiotic Resistance Threats in the United States, 2013 Antibiotic Resistance Threats in the United States, 2013 Executive Summary by Centers for Disease Control

View the full report here.

Note that, for the first time, the CDC has created categories of bacteria, grouped by severity and risk.

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Regarding level of concern, CDC has — for the first time — prioritized bacteria in this report into one of three categories: urgent, serious, and concerning Antibiotic Resistance Threats in the United States, 2013 Executive Summary by Centers for Disease Control

The subtext here is monumental: the CDC is no fear monger, usually criticized for how slowly it reacts to disease. Qualifying, for the first time, categories of danger, each of which are “threats,” suggests that the problem at hand has reached near epidemic status. Without immediate, and lasting, steps, global health is at risk.

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This report covers bacteria causing severe human infections and the antibiotics used to treat those infections Antibiotic Resistance Threats in the United States, 2013 Executive Summary by Centers for Disease Control

Note that death is not the qualifier on this list. While some bacteria can kill if untreated, the most common side effects are severe pain, a complete decrease in quality of life, and symptom-related death. All of these issues are as severe as mortality, as they challenge the ability for the human body to function.

CREs in particular carry, however, a 50% mortality rate.

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Drug resistance related to viruses such as HIV and influenza is not included, nor is drug resistance among parasites such as those that cause malaria. These are important problems but are beyond the scope of this report Antibiotic Resistance Threats in the United States, 2013 Executive Summary by Centers for Disease Control

The report focuses specifically on bacteria, which are treated most often with antibiotics. While the realm of microbiology may seem fairly…small, entire careers can be dedicated to studying a single variation of a family of bacteria. Thus, cramming every form of drug resistance into one paper would be a monumental, and wasteful, task.

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Drug-resistant Neisseria gonorrhoeae Antibiotic Resistance Threats in the United States, 2013 Executive Summary by Centers for Disease Control

Good old gonorrhea!

Due to rampant antibiotic abuse in treating STIs and even gonorrhea, many variations of the bacteria now show signs of full drug resistance. While rarely fatal, and not directly a cause of death, gonorrhea untreated can lead to infertility and infant blindness, among several other nasty concerns. As of the report, drug-resistance gonorrhea has be identified.

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Carbapenem-resistant Enterobacteriaceae (CRE) Antibiotic Resistance Threats in the United States, 2013 Executive Summary by Centers for Disease Control

CREs get their name from the antibiotics that they are capable of resisting: the “last resort” carbapenem. As a result, these strains are at times the closest to reaching full drug-resistant status. Unlike the relatively docile Clostridium difficile, CRE blood infections carry a 50% mortality rate. This latent risk, coupled with growing drug resistance, makes CREs actually the most urgent concern on the list in terms of fatalities.

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Clostridium difficile Antibiotic Resistance Threats in the United States, 2013 Executive Summary by Centers for Disease Control

Not itself life-threatening, Clostridium difficile is a natural feature of the human colon. Normally, it exists, simply carrying out its symbiotic relationship without incident. However, some hypotheses suggest that the wide overuse of antibiotics can, at times, eliminate all competition in the colon, leaving only drug-resistant Clostridium difficile bacteria. Flourishing, the bacteria can lead to diarrhea, severe pain, and even toxic shock and death. Because Clostridium difficile is well known to survive antibiotic abuse, it is an urgent threat and forerunner for drug resistance.

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