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National Action Plan Drives Progress in Fight Against Antibiotic-Resistant Bacteria

Summary: 
Antibiotic resistance is a significant threat to our nation’s public health, and one that is spreading and evolving rapidly.

Antibiotic resistance is a significant threat to our nation’s public health, and one that is spreading and evolving rapidly. It was only a couple of years ago that scientists discovered the emergence in China of mcr-1, a gene that makes bacterial infections resistant to colistin, an antibiotic that is increasingly used as a “last resort” treatment when others don’t work. Americans are already dying of untreatable infections.

This discovery and the robust multi-agency and international response illustrates the constantly evolving threat of bacteria that are resistant to antibiotics and the importance of widespread surveillance to detect new resistance types, quick response to prevent spread and development of new treatments.

As soon as the mcr-1 gene was discovered in China, the U.S. government began conducting surveillance for it here.  Less than six months later, the gene was found in a patient in Pennsylvania. Given the mcr-1 gene’s ability to move to other bacteria and make them resistant, the federal government implemented an urgent public health response to contain and slow any potential spread, coordinating across multiple agencies and surveillance systems, and relying on collaboration and innovation. The CDC, FDA, USDA, DOD and state agencies all got involved to swiftly respond and prevent further spread of resistance.

The mcr-1 gene is just one example of the broad challenge of antibiotic resistance. Every year, more than 2 million people in the U.S. get infections that are resistant to one or more antibiotics, and at least 23,000 people die as a result.  Another 15,000 or more deaths each year in the U.S. are caused by Clostridium difficile, a bacterium often associated with unnecessary antibiotic use and advanced age and can cause serious complications.

The increasing resistance to antibiotics puts at risk our ability to effectively treat sepsis or to provide effective care to cancer patients, organ transplant recipients, and burn victims, who are at higher risk of complications and infections. Drug-resistant infections can complicate the U.S. medical response to chemical, biological, radiological or nuclear emergencies. We’re also seeing more common infections, like urinary tract infections, becoming increasingly difficult to treat because of antibiotic resistance.

This is why the federal government developed the National Action Plan on Combating Antibiotic-Resistant Bacteria (CARB), to coordinate and enhance the public health response to the threat of antibiotic resistance in humans and animals, domestically and internationally. The Plan provides a five-year roadmap to guide the nation in reducing the prevalence of antibiotic-resistant bacteria by: 

  • Slowing the emergence of resistant bacteria and preventing the spread of resistant infections.
  • Strengthening national surveillance efforts to combat resistance.
  • Advancing development and use of rapid and innovative diagnostic tests for identification of resistant bacteria.
  • Accelerating research and development for new antibiotics, other therapeutics, and preventive strategies, including vaccines.
  • Improving international collaboration and capacities for antibiotic-resistance prevention, surveillance, control and antibiotic research and development.

Antibiotics

The federal government has been working diligently to implement the Plan since its release in 2015. As part of U.S. Antibiotic Awareness Week, November 13-19, 2017, HHS, on behalf of the Interagency CARB Task Force, has released a Progress Report to detail the significant progress made during the first two years of implementation of the National Action Plan. Highlights include:

  • The percentage of U.S. hospitals reporting antibiotic stewardship programs using CDC’s Core Elements for Stewardship rose to 64 percent in 2016, up from 46 percent in 2015. The goal is to reach 100 percent by 2020.
  • Methicillin-resistant Staphylococcus aureus (MRSA) in acute care hospitals declined by 13 percent between 2011 and 2014, and by a further 5 percent by 2016. C. difficile infections declined in acute care hospitals by 8 percent between 2011 and 2014, and by a further 7 percent by 2016.
  • CDC established the Antibiotic Resistance Laboratory Network, enhancing lab capacity to better detect, respond and contain resistance and resistant infections. CDC has invested in all 50 states, five large cities and Puerto Rico to detect and respond to CRE, “the nightmare bacteria.” CDC has also established seven regional labs to detect and support response to resistant organisms recovered from human samples. 
  • Since the National Action Plan was released in March 2015, NIH has provided support to investigators through multiple funding opportunities and access to a wide array of preclinical resources designed to facilitate new drug development. These efforts are greatly expanding the pipeline of new drug candidates, at various stages of development, to treat antibiotic-resistant infections. In particular, the NIH-supported Antibacterial Resistance Leadership Group is pioneering an innovative clinical research agenda on antibacterial resistance.
  • As of April 2017, USDA’s Animal and Plant Health Inspection Service for the first time has begun conducting antibiotic use monitoring, resistance surveillance, and antimicrobial use surveys of beef feedlots and swine farms. These data are critical to understanding the relationships between antibiotic use and resistance in animals and humans.
  • In the past two years, FDA approved, cleared or granted marketing authorization for marketing several new diagnostic devices that may significantly enhance detection or prevention of antibiotic resistance.
  • Last year, NIH and the Biomedical Advanced Research and Development Authority (BARDA) launched the Antimicrobial Resistance Diagnostic Challenge, which seeks tests that identify antibiotic-resistant bacteria or that distinguish between viral and bacterial infections to reduce unnecessary use of antibiotics.
  • The Multidrug-Resistant Organism Repository and Surveillance Network at the Walter Reed Army Institute of Research offers an almost unprecedented 48-hour turn-around time to all DOD hospitals for next generation sequencing to support outbreak investigations and has similar services available to non-DOD institutions.
  • In July of 2016, BARDA launched CARB-X, a five-year, $450 million public-private partnership between BARDA, NIH, and the Wellcome Trust aimed at bolstering innovation in antibacterial product development. As of November 2017, CARB-X had granted awards to 23 biotech companies and research teams for drug discovery and development projects to tackle antibiotic resistance.

The U.S. Government has also worked with international partners, including the World Health Organization, the Food and Agriculture Organization, and the World Organization for Animal Health, to combat antimicrobial resistance. Through the Global Health Security Agenda, U.S. agencies have enhanced efforts to combat antibiotic resistance in over 30 countries.

The progress report of the CARB National Action Plan shows that each of us has a role in the fight against antibiotic resistance, and we can make a difference at the personal, community, state, national and international levels. From individuals working with their doctors to determine if an antibiotic is the right treatment for them, to enhanced surveillance, response and increased international cooperation, we can continue to make progress in our efforts to stop the spread of resistant infections and to ensure that antibiotics will be available for us and future generations.

Christopher Jones is the acting associate deputy assistant secretary for science and data policy, HHS Office of the Assistant Secretary for Planning and Evaluation.

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