Center for Disease Dynamics

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Laxminarayan R.,Princeton Environmental Institute | Laxminarayan R.,Public Health Foundation of India | Laxminarayan R.,Center for Disease Dynamics | Matsoso P.,Direc Of Health | And 5 more authors.
The Lancet | Year: 2016

Recent years have seen substantial improvements in life expectancy and access to antimicrobials, especially in low-income and lower-middle-income countries, but increasing pathogen resistance to antimicrobials threatens to roll back this progress. Resistant organisms in health-care and community settings pose a threat to survival rates from serious infections, including neonatal sepsis and health-care-associated infections, and limit the potential health benefits from surgeries, transplants, and cancer treatment. The challenge of simultaneously expanding appropriate access to antimicrobials, while restricting inappropriate access, particularly to expensive, newer generation antimicrobials, is unique in global health and requires new approaches to financing and delivering health care and a one-health perspective on the connections between pathogen transmission in animals and humans. Here, we describe the importance of effective antimicrobials. We assess the disease burden caused by limited access to antimicrobials, attributable to resistance to antimicrobials, and the potential effect of vaccines in restricting the need for antibiotics. © 2016 Elsevier Ltd.

News Article | November 17, 2016

Highly drug-resistant infections are on the rise among U.S. children, reports a new study published in the Journal of the Pediatric Infectious Diseases Society. Researchers found increasing rates of antibiotic resistance among samples of Pseudomonas aeruginosa, an important type of bacteria, collected from pediatric patients nationwide over the last decade. The findings provide more evidence that aggressive strategies to track, prevent, and treat these concerning infections in children are greatly needed. "Infections with P. aeruginosa can be serious and are associated with significant morbidity and mortality," said study author Latania K. Logan, MD, of Rush University Medical Center. In children, these infections can result in prolonged illness, require longer hospital stays, and, ultimately, increase the risk of death. "Highly drug-resistant P. aeruginosa infections leave health care providers with limited--or sometimes no--antibiotic choices available, and these antibiotics are less safe and more toxic in children," said study author Sumanth Gandra, MD, MPH, of the Center for Disease Dynamics, Economics & Policy. In the study, researchers analyzed information from a network of clinical microbiology laboratories serving approximately 300 hospitals across the country. Their analysis focused on data obtained by testing P. aeruginosa isolates for susceptibility to several different types of antibiotics. The samples were collected from patients between the ages of 1 and 17 who were in outpatient, inpatient, intensive care unit, and long-term care settings from 1999 to 2012. The proportion of P. aeruginosa isolates resistant to at least three classes of antibiotics rose from 15.4 percent in 1999 to 26.0 percent in 2012. The proportion of bacterial strains resistant to carbapenems, a class of antibiotics considered one of the treatments of last resort for highly resistant infections, increased from 9.4 percent in 1999 to 20.0 percent in 2012. Drug resistance was more common in pediatric patients in intensive care units, among those 13-17 years old, and in the Midwest (Iowa, Kansas, Minnesota, Missouri, Nebraska, and the Dakotas). An estimated 51,000 health care-associated P. aeruginosa infections occur in adults and children in the U.S. each year, according to the Centers for Disease Control and Prevention. More than 6,000 (13 percent) of these infections are resistant to multiple classes of antibiotics, leading to about 400 deaths annually. Few studies have assessed trends of resistant P. aeruginosa infection specifically in children, despite rising rates of antibiotic resistance nationally overall. The latest findings highlight the need for better tracking of antibiotic-resistant infections and for effective strategies to prevent these infections in children, in addition to antibiotic stewardship programs to address inappropriate antibiotic prescribing, the study authors concluded. Health care facilities should also consider using rapid molecular diagnostics to guide antibiotic treatment decisions. Editor's Note: For an embargoed copy of the study, please contact Terri Christene Phillips, MSA (, 703-299-9865). Published quarterly, the Journal of the Pediatric Infectious Diseases Society represents the spectrum of peer-reviewed, scientific and clinical information on perinatal, childhood, and adolescent infectious diseases. The journal is a publication of the Pediatric Infectious Diseases Society (PIDS), the world's largest professional organization of experts in the care and prevention of infectious diseases in children. PIDS membership encompasses leaders across the global scientific and public health spectrum, including clinical care, advocacy, academics, government, and the pharmaceutical industry. From fellowship training to continuing medical education, research, regulatory issues and guideline development, PIDS members are the core professionals advocating for the improved health of children with infectious diseases both nationally and around the world, participating in critical public health and medical professional advisory committees that determine the treatment and prevention of infectious diseases, immunization practices in children, and the education of pediatricians. For more information, visit http://www. .

Laxminarayan R.,Center for Disease Dynamics | Laxminarayan R.,Princeton Environmental Institute | Laxminarayan R.,Public Health Foundation of India
Science | Year: 2014

Antibiotic effectiveness is a natural societal resource that is diminished by antibiotic use. As with other such assets, keeping it available requires both conservation and innovation. Conservation encompasses making the best use of current antibiotic effectiveness by reducing demand through vaccination, infection control, diagnostics, public education, incentives for clinicians to prescribe fewer antibiotics, and restrictions on access to newer, last-resort antibiotics. Innovation includes improving the efficacy of current drugs and replenishing effectiveness by developing new drugs. In this paper, I assess the relative benefits and costs of these two approaches to maintaining our ability to treat infections.Copyright © 2014 by the American Association for the Advancement of Science; all rights reserved.

Teillant A.,Princeton University | Gandra S.,Center for Disease Dynamics | Barter D.,Center for Disease Dynamics | Morgan D.J.,Center for Disease Dynamics | And 4 more authors.
The Lancet Infectious Diseases | Year: 2015

Background: The declining efficacy of existing antibiotics potentially jeopardises outcomes in patients undergoing medical procedures. We investigated the potential consequences of increases in antibiotic resistance on the ten most common surgical procedures and immunosuppressing cancer chemotherapies that rely on antibiotic prophylaxis in the USA. Methods: We searched the published scientific literature and identified meta-analyses and reviews of randomised controlled trials or quasi-randomised controlled trials (allocation done on the basis of a pseudo-random sequence-eg, odd/even hospital number or date of birth, alternation) to estimate the efficacy of antibiotic prophylaxis in preventing infections and infection-related deaths after surgical procedures and immunosuppressing cancer chemotherapy. We varied the identified effect sizes under different scenarios of reduction in the efficacy of antibiotic prophylaxis (10%, 30%, 70%, and 100% reductions) and estimated the additional number of infections and infection-related deaths per year in the USA for each scenario. We estimated the percentage of pathogens causing infections after these procedures that are resistant to standard prophylactic antibiotics in the USA. Findings: We estimate that between 38·7% and 50·9% of pathogens causing surgical site infections and 26·8% of pathogens causing infections after chemotherapy are resistant to standard prophylactic antibiotics in the USA. A 30% reduction in the efficacy of antibiotic prophylaxis for these procedures would result in 120 000 additional surgical site infections and infections after chemotherapy per year in the USA (ranging from 40 000 for a 10% reduction in efficacy to 280 000 for a 70% reduction in efficacy), and 6300 infection-related deaths (range: 2100 for a 10% reduction in efficacy, to 15 000 for a 70% reduction). We estimated that every year, 13 120 infections (42%) after prostate biopsy are attributable to resistance to fluoroquinolones in the USA. Interpretation: Increasing antibiotic resistance potentially threatens the safety and efficacy of surgical procedures and immunosuppressing chemotherapy. More data are needed to establish how antibiotic prophylaxis recommendations should be modified in the context of increasing rates of resistance. Funding: DRIVE-AB Consortium. © 2015 Elsevier Ltd.

Van Boeckel T.P.,Princeton University | Gandra S.,Center for Disease Dynamics | Ashok A.,Center for Disease Dynamics | Caudron Q.,Princeton University | And 9 more authors.
The Lancet Infectious Diseases | Year: 2014

Background: Antibiotic drug consumption is a major driver of antibiotic resistance. Variations in antibiotic resistance across countries are attributable, in part, to different volumes and patterns for antibiotic consumption. We aimed to assess variations in consumption to assist monitoring of the rise of resistance and development of rational-use policies and to provide a baseline for future assessment. Methods: With use of sales data for retail and hospital pharmacies from the IMS Health MIDAS database, we reviewed trends for consumption of standard units of antibiotics between 2000 and 2010 for 71 countries. We used compound annual growth rates to assess temporal differences in consumption for each country and Fourier series and regression methods to assess seasonal differences in consumption in 63 of the countries. Findings: Between 2000 and 2010, consumption of antibiotic drugs increased by 36% (from 54 083 964 813 standard units to 73 620 748 816 standard units). Brazil, Russia, India, China, and South Africa accounted for 76% of this increase. In most countries, antibiotic consumption varied significantly with season. There was increased consumption of carbapenems (45%) and polymixins (13%), two last-resort classes of antibiotic drugs. Interpretation: The rise of antibiotic consumption and the increase in use of last-resort antibiotic drugs raises serious concerns for public health. Appropriate use of antibiotics in developing countries should be encouraged. However, to prevent a striking rise in resistance in low-income and middle-income countries with large populations and to preserve antibiotic efficacy worldwide, programmes that promote rational use through coordinated efforts by the international community should be a priority. Funding: US Department of Homeland Security, Bill & Melinda Gates Foundation, US National Institutes of Health, Princeton Grand Challenges Program. © 2014 Elsevier Ltd.

Laxminarayan R.,Center for Disease Dynamics
American Journal of Epidemiology | Year: 2013

Methicillin-resistant Staphylococcus aureus (MRSA) can cause major illness and death and impose serious economic costs on patients and hospitals. Community-associated MRSA (CA-MRSA) is a growing problem in US hospitals, which are already dealing with high levels of hospital-associated MRSA (HA-MRSA), but little is known about how patient age and seasonal differences in the incidence of these 2 forms of MRSA affect the epidemic. By using national data on hospitalizations and antibiotic resistance, we estimated the magnitude and trends in annual S. aureus and MRSA hospitalization rates from 2005-2009 by patient age, infection type, and resistance phenotype (CA-MRSA vs. HA-MRSA). Although no statistically significant increase in the hospitalization rate was seen over the study period, the total number of infections increased. In 2009, there were an estimated 463,017 (95% confidence interval: 441,595, 484,439) MRSA-related hospitalizations at a rate of 11.74 (95% confidence interval: 11.20, 12.28) per 1,000 hospitalizations. We observed significant differences in infection type by age, with HA-MRSA-related hospitalizations being more common in older individuals. We also noted significant seasonality in incidence, particularly in children, with CA-MRSA peaking in the late summer and HA-MRSA peaking in the winter, which may be caused by seasonal shifts in antibiotic prescribing patterns. © 2013 The Author.

Laxminarayan R.,Public Health Foundation of India | Laxminarayan R.,Princeton University | Laxminarayan R.,Center for Disease Dynamics | Ganguly N.K.,Post Graduate Institute of Medical Education and Research
Health Affairs | Year: 2011

Although India is a leading producer and exporter of vaccines, the country is home to one-third of the world's unimmunized children. Fewer than 44 percent of India's young children receive the full schedule of immunizations. India's vaccine deficit has several causes: little investment by the government; a focus on polio eradication at the expense of other immunizations; and low demand as a consequence of a poorly educated population and the presence of anti-vaccine advocates. In this article we describe India's vaccine deficit and recommend that the government move quickly to increase spending on, and otherwise strengthen, national immunization programs. © 2011 Project HOPE-The People-to-People Health Foundation, Inc.

Kouyos R.,Princeton University | Kouyos R.,University of Zürich | Klein E.,Princeton University | Klein E.,Johns Hopkins University | And 2 more authors.
PLoS Pathogens | Year: 2013

Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of morbidity and mortality in both hospitals and the community. Traditionally, MRSA was mainly hospital-associated (HA-MRSA), but in the past decade community-associated strains (CA-MRSA) have spread widely. CA-MRSA strains seem to have significantly lower biological costs of resistance, and hence it has been speculated that they may replace HA-MRSA strains in the hospital. Such a replacement could potentially have major consequences for public health, as there are differences in the resistance spectra of the two strains as well as possible differences in their clinical effects. Here we assess the impact of competition between HA- and CA-MRSA using epidemiological models which integrate realistic data on drug-usage frequencies, resistance profiles, contact, and age structures. By explicitly accounting for the differing antibiotic usage frequencies in the hospital and the community, we find that coexistence between the strains is a possible outcome, as selection favors CA-MRSA in the community, because of its lower cost of resistance, while it favors HA-MRSA in the hospital, because of its broader resistance spectrum. Incorporating realistic degrees of age- and treatment-structure into the model significantly increases the parameter ranges over which coexistence is possible. Thus, our results indicate that the large heterogeneities existing in human populations make coexistence between hospital- and community-associated strains of MRSA a likely outcome. © 2013 Kouyos et al.

News Article | August 24, 2016

First, there was the pitching and rolling in an old Jeep for eight hours. Next came the river crossing in a slender canoe. When Nathalie Strub Wourgaft finally reached her destination, a clinic in the heart of the Democratic Republic of the Congo, she was exhausted. But the real work, she discovered, had just begun. It was July 2010 and the clinic was soon to launch trials of a treatment for sleeping sickness, a deadly tropical disease. Yet it was woefully unprepared. Refrigerators, computers, generators and fuel would all have to be shipped in. Local health workers would have to be trained to collect data using unfamiliar instruments. And contingency plans would be needed in case armed conflict scattered study participants — a very real possibility in this war-weary region. This was a far cry from Wourgaft's former life as a top executive in the pharmaceutical industry, where the hospitals that she commissioned for trials were pristine, well-resourced and easy to reach. But Wourgaft, now medical director for the innovative Drugs for Neglected Diseases initiative (DNDi), was confident that the clinic could handle the work. She was right. With data from this site and others, the DNDi will next year seek approval for a sleeping-sickness tablet, fexinidazole. It would be a massive improvement on existing treatment options: an arduous regimen of intravenous injections, or a 65-year-old arsenic-based drug that can be deadly. The DNDi is an unlikely success story in the expensive, challenging field of drug development. In just over a decade, the group has earned approval for six treatments, tackling sleeping sickness, malaria, Chagas' disease and a form of leishmaniasis called kala-azar. And it has put another 26 drugs into development. It has done this with US$290 million — about one-quarter of what a typical pharmaceutical company would spend to develop just one drug. The model for its success is the product development partnership (PDP), a style of non-profit organization that became popular in the early 2000s. PDPs keep costs down through collaboration — with universities, governments and the pharmaceutical industry. And because the diseases they target typically affect the world's poorest people, and so are neglected by for-profit companies, the DNDi and groups like it face little competitive pressure. They also have lower hurdles to prove that their drugs vastly improve lives. Now, policymakers are beginning to wonder whether their methods might work more broadly. “For a long time, people thought about R&D as so complicated that it could only be done by the biggest for-profit firms in the world,” says Suerie Moon, a global-health researcher at the Harvard T.H. Chan School of Public Health in Cambridge, Massachusetts, who studied PDPs and joined the DNDi's board of directors in 2011. “I think we are at a point today where we can begin to take lessons from their experience and begin to apply to them non-neglected disease,” she says. In that vein, the DNDi has started research on alternatives to pricey drugs for hepatitis C, and is spearheading an effort to create antibiotics for drug-resistant infections, a problem that pharmaceutical companies have been slow to contend with. If successful, the work could challenge standard assumptions about drug development, and potentially rein in the runaway price of medications. “We can't match our financial figures one to one,” says executive director Bernard Pécoul. “But we believe that DNDi can demonstrate that a different model is possible for R&D.” When medical charity Médecins Sans Frontières (MSF; also known as Doctors without Borders) won the Nobel Peace Prize in 1999, its members decried the lack of lifesaving drugs for diseases of the poor, and used the Nobel prize money to kick-start the DNDi. Pécoul, a soft-spoken Frenchman who had been with MSF for 20 years, took the helm when the initiative launched in Geneva, Switzerland, in 2003. Pharmaceutical executives were sceptical. Drug development is an expensive, complex, decade-long endeavour. “In the early days, we saw DNDi as a bit amateurish,” recalls François Bompart, a medical director at the Paris-based drug company Sanofi. “We thought, they cannot be serious.” Pécoul and his team started with a safe project. In 2001, the World Health Organization had called for malaria drugs that combined ingredients to slow the spread of resistance to the single best available agent, artemisinin. But the poverty of most people who need malaria drugs meant that the private sector had little incentive to create and test such combination therapies. Pécoul contacted Sanofi, which owned two malaria treatments: one based on artemisinin, and the other on the slower-acting amodiaquine. He proposed a deal in which the DNDi would pay for and run clinical trials on a pill that combined the two drugs. In return, Sanofi would not patent the pill and would sell an adult course of treatment for no more than $1, half that for children. “To me it sounded very aggressive and not reasonable, since the two drugs separately were two to three times that,” says Bompart. But Pécoul convinced Sanofi that the move would be good for the company's public image. He also compromised, allowing Sanofi to stipulate that it could reach the low price gradually. As it turned out, by the time the pills were approved in 2007, manufacturing costs had come down far enough for the company to meet the target price right out of the gate. Hundreds of millions of pills have since been distributed in Africa. All told, the project cost the DNDi about $14 million, a tiny sum in the world of drug development. It has since replicated the process to develop other combination therapies (see 'Discount drugs'). Although they improve on existing therapies, some of these combinations remain inadequate. The DNDi's sleeping-sickness therapy NECT, for example, reduces a standard treatment from 56 intravenous infusions to 14. That is still problematic in affected countries: clean needles can be hard to come by, and long hospital stays are often impossible. People need a pill. Drug development from scratch is arduous and expensive. It begins with experiments on hundreds of thousands of chemicals in the lab, looking for one that kills a pathogen without harming the host. The DNDi does not have a laboratory, so it does this through collaborations. It searches for promising leads in compound libraries generated by biotechnology and pharmaceutical companies. Many firms are willing to share access to these precious libraries because the diseases that the DNDi targets will not result in blockbuster drugs, so it is not infringing on their turf. The DNDi then contracts high-throughput screening centres, such as those at the Institut Pasteur Korea in Seongnam and the University of Dundee, UK, to test them out. “We use the same technique that pharma does,” says Rob Don, director of discovery and preclinical research at the DNDi, “but we do it for less.” In 2007, such efforts identified fexinidazole, a compound that had shown promise against single-celled parasites but was pulled from development before reaching clinical trials. The DNDi turned it into a tablet, and passed it to its clinical-development team two years later. The DNDi approached Sanofi again and promised to take care of trials if the company could file for regulatory approval. Sanofi warned that human trials would not be easy, because sleeping sickness is not common and people who get it tend to live in remote, unstable regions. But with the existing therapies being so dreadful, Wourgaft argued that any improvements from fexinidazole would be clear. “The delta between what we bring and what exists is huge. You don't need a magnifying glass on thousands of patients to see it.” She set up multiple small trial sites in the Democratic Republic of the Congo and the Central African Republic and pooled their data. Wourgaft says that the studies were the hardest she has ever run. In addition to logistical challenges, civil war erupted in the Central African Republic shortly after the study launched, and rebel groups repeatedly robbed a clinic there and threatened the Congolese surgeon leading the trial. “I squeeze all my energy into each project,” Wourgaft says. “It's as if I'm using forceps to deliver a baby — and the baby is an elephant.” The final trials on fexinidazole conclude this year, and Wourgaft is hopeful that the data will earn regulators' stamp of approval. The project has so far cost the DNDi about $45 million — and it stands to help 21 million people at risk of the disease in Africa. In a few months, Wourgaft will launch another trial, on a completely new oral drug — SCYX-7158 — that may cure people with sleeping sickness in a few days. The DNDi estimates that its development up to approval will cost around $50 million. For more than three decades, economists at the Tufts Center for the Study of Drug Development in Boston, Massachusetts, have collected proprietary data from pharmaceutical companies, and used it to calculate the average cost of developing a new drug. The most recent estimate is $1.4 billion. This is used to justify exorbitant drug prices — companies must recoup their investments. But many don't think it has to cost that much. Even the chief executive of London-based pharmaceutical giant GlaxoSmithKline, Andrew Witty, has called billion-dollar estimates “one of the great myths of the industry”. He attributed the huge sums to spending too much time on failures. Drug candidates can be killed as a result of safety concerns, poor efficacy or profitability worries, and he argued that companies could save money by dropping bad leads sooner. Others say that the figure is inflated by large and excessive trials done to prove that a new drug works just slightly better than an existing one. By averaging the cost of projects in its portfolio, the DNDi says that it can develop a new drug for between $110 million and $170 million. Like the Tufts estimate, these prices include a theoretical cost of failed projects. The DNDi admits to enjoying perks that pharma does not have. It keeps overhead costs low because its organization is virtual. The research organizations that it contracts probably charge the group less than they would a for-profit company. The DNDi also relies on scientific consultants who work for low pay because they relish the chance to make lifesaving drugs without considering competitors, investors and marketing. “DNDi gets a lot for free,” says Richard Bergström, director-general of the European Federation of Pharmaceutical Industries and Associations in Brussels. “My companies do a lot of pro bono work, and so do universities.” Still, the organization reckons that such in-kind contributions account for just 10–20% of its expenditure. It saves much more through efficient collaboration (avoiding duplicated effort by screening pooled libraries, for example) and a focus on desperately needed drugs. Clinical trials can be smaller, faster and cheaper when the people who run them don't have to struggle to show barely perceptible improvements. And the DNDi kills candidate compounds only if they fail on safety or efficacy — it doesn't have to worry about marketability. By contrast, a few for-profit companies froze candidate drugs for hepatitis C after Gilead Sciences of Foster City, California, brought powerful drugs to the market. “A lot of R&D failures in pharma are commercial rather than scientific,” says Don. “We keep going until it gets to market or scientifically fails.” The DNDi has earned respect from the industry, even though its founding organization has been antagonistic to big pharma. “Although DNDi came out of MSF, they don't let ideological viewpoints get in the way of making progress,” says Jon Pender, vice-president of government affairs at GlaxoSmithKline. He and others praise Pécoul's skills at negotiation, and the DNDi's pragmatic approach to development challenges. Policymakers have taken notice, too. Last year, the World Health Organization asked the DNDi to consider antibiotics for drug-resistant infections in the developing world; in May, the initiative announced that it would start the GARD (Global Antibiotic Research and Development) partnership with $2.2 million in seed funding. GARD will start by repurposing and combining existing antibiotics to treat a few diseases, including gonorrhoea and infections in newborn babies. Marja Esveld, a research adviser at the Netherlands ministry of health, is watching it closely. “We are worried about the rising costs of pharmaceuticals,” she says, “and so for us, GARD is also a kind of experiment to see if the DNDi model can work for the development of drugs in the Western world.” Not everyone is convinced. Economist Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy in Washington DC, says that pharmaceutical companies have an incentive to make antibiotics for multidrug-resistant infections because patients in the United States and Europe will pay to get them — and non-profit organizations cannot hope to compete. Once the drugs exist, he says, subsidies could ensure that they are affordable. Pécoul disagrees: he doesn't think that subsidies, donations or tiered pricing can ensure accessibility. “We need appropriate products and a sustainable market for those products,” he says. That environment has not materialized for other conditions: Gilead's hepatitis C drugs, for example, are listed at more than $74,000 for a course. And their potency against some strains of the virus is questionable, says Pécoul. When he and his team learned about other hepatitis drug candidates being frozen, he launched a project to turn them into treatments that more people could use and afford. They're also attempting to combine existing drugs. If the group succeeds with this and with antibiotics, it will have shown that its model can be applied to diseases that affect developed countries. “I hope we provide lessons that can be used by others,” says Pécoul. But companies won't simply adopt the DNDi's methods, because they do not generate profit. The investors who keep firms alive are concerned with the bottom line. Pécoul says that a transformation would require government involvement and a reorganization of the development process. It would need a system to prioritize what treatments are needed and which companies and organizations could collaborate; and it would require forethought about how the final products would reach those in need. It means shifting away from profit-based incentives to things such as prizes and government funding. Today's profit-driven approach is not only expensive, Pécoul says, it fails huge swathes of the population. When Wourgaft reflects on the differences between her career in pharma and her work at the DNDi, she thinks not about the cost of research and development, but about the value of a human life. She recalls one trip to a Congolese sleeping-sickness trial site. She sat on a cot beside a woman in the middle of a psychotic episode, and spoke to her desperate husband. Later, she learned that the woman survived because of the DNDi's treatment. “When you see that, you know the value of what you're doing,” she tells me. “We are trying to fix diseases that are lethal — this is really serious medicine.”

While the incidence of antibiotic-resistant MRSA bacteria, seen here, is down, the news isn't so good with other bugs(Credit: iLexx/ Depositphotos ) According to the Centers for Disease Control and Prevention (CDC) in the US, every year about two million people become infected with bacteria that are resistant to anything we can throw at them and of those, at least 23,000 die. Now the European equivalent to the CDC, the European Centre for Disease Prevention and Control (ECDC) has just reported on how well the EU is doing in the battle to keep deadly bugs at bay. And the news isn't great. The announcement was released to coincide with today's marking of the 9th annual European Antibiotic Awareness Day, an effort to bring awareness to the fact that overprescribing antibiotics can create superbugs that we are powerless to fight. While the report found an overall increase of antibiotic-resistant bacteria, the ECDC says that of particular concern was the fact that the average percentage of carbapenem resistance in Klebsiella pneumoniae increased from 6.2 percent in 2012 to 8.1 percent in 2015. K. pneumoniae is an opportunistic infection that often attacks people hospitalized for other conditions and "can cause different types of healthcare-associated infections, including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis, according to the CDC. Carbapenems are a class of antibiotics used to attack bacteria that have become resistant to other more common antibiotics. The fact that they are now failing in greater number is a cause for concern. "Antibiotic resistance is one of the most pressing public health issues of our time," said Vytenis Andriukaitis, European Commissioner for Health and Food Safety. "If we don't tackle it, we can go back to a time when even the simplest medical operations were not possible, and organ transplants, cancer chemotherapy or intensive care even less so." Not all of the news was dire, however. ECDC Acting Director, Dr. Andrea Ammon said that antibiotic consumption was down in six countries. Also, the percentage of Staphylococcus aureus (MRSA) that was resistant to the antibiotic meticillin decreased significantly between 2012 and 2015, says the agency, which is taking new initiatives to spread the word about antibiotic resistance. "The European Commission will launch a new action plan next year so that we can, together with our partners in the EU Member States and internationally, continue to ensure that the prevention and control of antibiotic resistance is strengthened within a one-health approach," said Andriukaitis. In addition to that initiative, the ECDC is hosting a global Twitter conversation today using the hashtags #AntibioticResistance and #EAAD2016. It also has posted today's presentation entitled "European Antibiotic Awareness Day: The future is now," on its YouTube channel. If you'd like to add even more worry to your day, you can also get a look at antibiotic resistance across the globe by germ and drug on the Center for Disease Dynamics, Economics & Policy's interactive map.

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