Within the last week, not one but TWO major national antibiotic resistance reports were released. One was produced by the Centers for Disease Control and Prevention (CDC), and covers the burden of antibiotic resistance in the US. The other was commissioned by the Government of Canada and written by a panel of independent, multidisciplinary experts to give an outlook on this burden in Canada.
Read the reports here:
Great examples of clear writing and data visualization
This post is not meant to summarize the entire contents of the reports; they are both choc-full of fascinating data and beautiful visuals, and are extremely clearly written and easy to read. I’ve only scratched the surface with this article, and highly recommend you have a look through the actual reports, take time to understand the findings, and refer back to them over time as references. (And of course, use them as a rich new source of figures to borrow for your intro powerpoint slides…).
At a glance: what’s in the reports?
Both reports tally deaths attributed to antibiotic resistance, and provide detailed breakdowns of what kinds of infections and syndromes are causing the problems. The Canadian report gets more into estimating how much antibiotic resistance is costing Canadians (and how much it is predicted to cost in the future). The CDC report talks more about kinds of bacteria causing the most risk, and which ones they’ve been able to curb. Both reports emphasize that antibiotic resistance is a global public health crisis second only to climate change. And yet, the reports do include positive stories of the progress that’s been made in recent years.
When was the last time reports like these were released?
The CDC’s last report was released in 2013. The Canadian report is the first of its kind in Canada. The UK released a similar report in 2016, which has been widely referenced around the world (most of us have probably heard the estimate that by 2050, AMR will cause 10 million deaths per year (more than cancer); this estimate came from that report).
Resistance-attributed deaths per year
According to the CDC report, the current rate for resistance-attributed deaths in the US is 35,000 deaths/year. The CDC report also, separately, counts deaths from C. difficile infections (around 12,800/year). The Canadian report shows a rate of 14,000 resistance-attributed deaths/year (with 5,400/year, or about 15/day, directly attributed to resistance).
CDC reports a reduction in deaths since 2013 (though the numbers don’t look that way at first)
Of note, the 2013 CDC report showed 23,000 deaths/year, which makes it look like death rates have gone up since then. However, they state in their report that they had access to more data sources this year, so they recalculated the 2013 values using these sources. They found that they underestimated the numbers in 2013 by around two-fold.
The revised 2013 estimate is 44,000 deaths/year, showing a decrease from then to now (down to 35,000/year). This is of course good news, but this number is still too high. Plus, resistance burden is about more than number of deaths (e.g. costs of care, decreased quality of life, loss of limbs, adverse drug events, etc. all contribute to the burden of resistance).
Overall, the CDC report states that the burden of antibiotic resistance threats in the US is actually greater than initially understood, even though they’ve seen a reduction in deaths.
Costs of antibiotic resistance
The Canadian report showed results of modeling based on “micro-costing” to estimate direct costs of antibiotic resistance.
For example, in 2018, antibiotic resistance led to:
- $2 billion reduction in Canada’s GDP
- $1.4 billion in costs to the Canadian healthcare system
- Average cost of resistance per patient: $18,000
And by 2050:
- Canada’s GDP is estimated to be reduced by $13-21 billion per year
- Canada’s animal farming industry is estimated to lose $26-37 billion per year
The CDC report provided costs per pathogen for many pathogens, but did not provide total resistance costs on a national scale. However, the numbers are staggering even for individual pathogens (for example, Candida species alone cause $3 billion in direct medical costs per year in the US, already dwarfing the costs for all of Canada’s resistant infections combined).
Predominant pathogens and syndromes
The CDC report provides in-depth analysis, pathogen by pathogen, of cases over time, types of infection, methods of treatment, and more. It divides them into urgent, serious, and concerning threats, and has a new “watch list” for pathogens newly classified as important to watch.
Urgent threats (highest threat level), according to CDC:
- Carbapenem-resistant Acinetobacter
- Candida auris
- Clostridioides difficile
- Carbapenem-resistant Enterobacteriaciae
- Drug-resistant Neisseria gonorrhoeae
By contrast, the Canadian report stated it lacked the surveillance data to examine resistant infections on a pathogen by pathogen basis, so it instead focused more on 10 bacteria-induced clinical syndromes.
These syndromes accounted for 91% of hospital costs associated with resistance in Canada:
- Skin and soft tissue infections
- Urinary tract infections
- Pneumonia
- Intra-abdominal infections
Proposed solutions
Both reports mentioned that surveillance, prevention (e.g. antibiotic stewardship and hygiene) and new therapeutics (vaccines, phages, etc) are paramount. Both reports emphasize that antibiotic resistance is a One Health problem that needs to be addressed by making changes in human, animal and environmental health. They also both emphasize that antibiotic resistance is a global problem, as bacteria cross borders easily, so it’s important to see this as a constantly-evolving problem (even if it’s solved here, resistant bugs from other regions will keep coming in since people are always traveling).
Is phage therapy discussed in the reports?
Yes, both reports described phage therapy as a possible antibiotic alternative. Each report used the word “phage” 12 times in the main text. By comparison, the reports used the word “vaccine” (or variations of the word) 45-50 times. While considered somewhat cautiously in both reports, phage therapy was far from being an afterthought, and seemed to be portrayed as a serious option by both.
Any good news?
It’s of course good news that these reports are coming out at all. As well, the CDC report showed evidence for how surveillance, prevention, stewardship, and interventions can work, and showed a number of areas where the US made progress since 2013. For example, children’s outpatient antibiotic prescriptions have come down by 16%, and vancomycin-resistant Staphylococcus aureus has been removed as a threat. There’s a nice table in the CDC report showing all the bacterial pathogens that have increased or decreased in prevalence in patients since the 2013 report was published, and several have actually shown a decrease.
The Canadian report also highlights infection prevention and control programs that have made a difference thus far, and points to a nation-wide action plan that will come out next year, which will be informed in part by the results of the Canadian report.
Read the reports here:
