Consequences of Antimicrobial Misuse
According to the World Health Organization (WHO), there are no global data on the number of cases or fatalities due to highly resistant pathogens. These gaps in knowledge regarding the economic and human cost of resistant bacterial infections are due to the lack of any coordinated global surveillance system.
In the U.S. alone, superbugs affect more than 2 million individuals and contribute to 99,000 deaths each year.1 In the European Union, at least 25,000 patients die every year from multidrug-resistant pathogens2; two-thirds of these are due to gram-negatives. Once confined almost exclusively to the hospital environment, superbugs such as MRSA and Clostridium difficile are now emerging in the community setting.
More people now die each year of hospital acquired infections than of AIDS, traffics accidents and the flu combined.
- Center for Disease Dynamics, Economics and Policy (CDDEP)1
The Rise of the Superbug
As of 2011, the estimated annual sales of antimicrobials was ~36 million pounds (lbs.) in the US alone (28.9 million sold for animals and 7.3 million for treating sick people), 70% of which is not utilized for disease treatment, but rather for purposes of growth promotion and prophylaxis in farm food animals.3
This use, in conjunction with the major driving force of overuse and misuse in humans has given rise to an era of "superbugs" – organisms that are resistant not only to multiple drugs, but in some cases, to every, or all but one, "last resort" antibiotic (Fig. 1). Life-threatening, antibiotic-resistant infections have even forced a reversion to the use of older drugs that were largely abandoned because they were considered too toxic for regular use.
Fig. 1 Emergence of resistance in hospital and community acquired pathogens
MRSA: methicillin-resistant Staphylococcus aureus; VRSA: vancomycin-resistant S. aureus; ESBL+: extended-spectrum beta-lactamase producers; CRE: carbapenem-resistant Enterobacteriaceae; VRE: vancomycin-resistant enterococcus; MDR-TB: multi-drug resistant M. tuberculosis; XDR-TB: extensively drug-resistant M. tuberculosis; CA-MRSA: community-acquired methicillin-resistant S. aureus.
Source: adapted from Cohen, M. et al. (1992) Epidemiology of drug resistance: implications for a post-antimicrobial era. Science 257:1050-1055.
At What Cost?
In the U.S. alone, superbugs affect more than 2 million individuals and contribute to 99,000 deaths each year.1 In the European Union, at least 25,000 patients die every year from multidrug-resistant pathogens4; two-thirds of these are due to gram-negatives.
The total medical and societal costs of treating these resistant infections have escalated dramatically and are now estimated at $16.6-26 billion in the U.S.3 and at least €9 billion in the EU.5 For Clostridium difficile infection alone, the annual excess hospital healthcare cost is estimated at $1.1 billion in the U.S. and €3 billion in the EU.6
- Center for Disease Dynamics, Economics & Policy (CDDEP) (2013) Unstoppable Superbugs: Closer than We Think? [Video] Date accessed: 06/21/2013 http://youtu.be/rIfvLp1YHmE
- World Health Organization (WHO) (2011) Race Against Time to Develop New Antibiotics Bulletin. Date accessed: 06/21/2013 http://www.who.int/bulletin/volumes/89/2/11-030211/en/
- The Pew Charitable Trusts. Record-High Antibiotic Sales for Meat and Poultry Production. [Online] Date accessed: 08/14/2013
- Nugent, R. et al. (2010) The race against drug resistance: A report of the Center for Global Development's Drug Resistance Working Group. Date accessed: 06/21/2013 http://www.cgdev.org/files/1424207_file_CGD_DRWG_FINAL.pdf [pdf 1.8MB]
- World Health Organization (WHO) (2010) Medicines: rational use of medicines. Fact sheet No. 338. Date accessed: 06/21/2013 http://www.wiredhealthresources.net/resources/NA/WHO-FS_MedicinesRationalUse.pdf
- Kuijper, E.J. et al. (2006) Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect 12 (Suppl 6):2-18.
The Health Provider’s Role in Antibiotic Stewardship: Confronting Global Antibiotic Resistance
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