Antibiotic-resistant bacteria have been the subject of recent news items designed to bring the issue to the world’s attention, and with the threat of widespread incurable infections, that attention may well be overdue. The story that triggered the media flurry aired on NPR’s All Things Considered, and reported on the increased incidence of carbapenem-resistant Enterobacteriaceae (CRE). CRE are resistant to nearly all antibiotics (including carbapenems, often the drugs of last resort), can transfer their resistance to other bacteria, and cause often fatal infections. The UK’s chief medical officer, Dame Sally Davies, reported to the Parliament’s Commons committee on Science and Technology that unless improvements are made, society may face an apocalyptic scenario in which routine infections are untreatable due to the lack of effective antibiotics. She also compared that risk to a catastrophic terrorist attack, a pandemic flu or massive flooding.

Here are some reasons none of us can be complacent about infection prevention:

• According to the Centers for Disease Control (CDC) report that was the source for the NPR story, the proportion of bacteria that are antibiotic-resistant has quadrupled in the last 10 years.
• Research by a team of doctors in Israel found that CRE infections were still present in patients a year after they were first identified, which gives rise to concern about community transmission of the bacteria once patients who had CRE are released from the hospital.
• The development pipeline for new antibiotics is running dry.  While a new infectious disease has been discovered in each of the past 30 years, very few new antibiotics have been developed in that time. A commonly cited reason for that situation is the high cost of development and the focus of pharmaceutical companies on more profitable drugs to treat chronic conditions.

Many efforts are underway to prevent or control the growth of antibiotic resistance. The CDC and Professor Davies’ Annual Report both provide guidelines and recommendations for approaching the problem. Those recommendations include:

• Careful antibiotic management, sometimes referred to as “antibiotic stewardship,” to avoid overuse, misuse or abuse, and to prevent antibiotic resistance at the patient and community levels.
• Government investment in and incentives for new antibiotic research and development.
• Infection control and prevention directed at multiple bacteria and all—healthy and infected—patients.

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