The threat of antibiotic resistance has been recognized as the largest risk to global health facing us today. In a rare move by the United Nations General Assembly, all 193 member countries came together in September for a high-level meeting to sign a declaration on antibiotic resistance in a global, coordinated manner. This marks only the fourth time that a health care issue has brought the General Assembly together for a meeting of this magnitude. This meeting elevates antibiotic resistance to the same level of urgency and threat as HIV/AIDS, non-communicable diseases like obesity and diabetes, and Ebola.
By signing the declaration, all 193 countries committed to reducing antibiotic resistance in the human health, veterinary, and agriculture fields. Specifically, countries committed to:
- monitoring and collecting data on the spread of antibiotic resistant infections and the volume of antibiotics used in humans, animals, and crops; and
- encouraging innovation and prevention awareness among health care professionals and the public.
The General Assembly reaffirmed their commitment to fighting antibiotic resistance—first made in 2015 as part of the 2030 Agenda for Sustainable Development, which provides a framework to ensure all people can live healthy lives. The General Assembly also confirmed that countries should be using the World Health Organization’s (WHO’s) Global Action Plan on Antimicrobial Resistance as a guidepost for their own antibiotic resistance plans.
The U.S. Response
Recognizing the domestic and global threat, the U.S. government has taken action in recent years to address antibiotic resistance. The Centers for Disease Control and Prevention (CDC) and Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria—along with WHO— have released calls to action focused on stemming inappropriate antibiotic use, incentivizing research and development, and collecting data. CDC Director Thomas Frieden noted at the White House Forum on Antibiotic Stewardship that antibiotic resistance “affects every community and potentially every patient.”
In response, the United States has established a module in the National Healthcare Safety Network (NHSN) to track antibiotic use and resistant infections. CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) recommended that antibiotics should only be prescribed when necessary and at the lowest doses possible, based on effectiveness studies. HICPAC also recommended that diagnostic tests should be avoided without appropriate clinical indicators. In addition, the Centers for Medicare & Medicaid Services recently proposed requiring antibiotic stewardship programs in hospitals and long-term care facilities participating in Medicare and Medicaid. The United Nations can build on these efforts to provide resources to member countries struggling to create and implement a plan.
Essential Hospitals Take Action
Essential hospitals are on the front lines combatting antibiotic resistance to ensure that patients continue to have access to critical treatments needed to fight infection.
As outlined in a recent report by the Pew Charitable Trusts, the University of Alabama at Birmingham’s (UAB’s) Antimicrobial Stewardship Program is making a big difference. The program uses computerized physician order entry and automated dispensing cabinets to facilitate easy and accurate tracking and dispensing of antibiotics. UAB also uses bedside bar coding to automatically document and verify when medications are administered. Additionally, UAB Hospital provides infectious disease or pharmacy consultation for prescribing providers and requires advanced authorization for certain antibiotics. Following an earlier intervention to educate providers on proper prescription patterns for ciprofloxacin, UAB Hospital saw a 77 percent decrease in ciprofloxacin use and several pathogens showed an increased sensitivity to the drug.
Meanwhile, the University of Chicago Medical Center has taken the fight against antibiotic resistance beyond the four walls of the hospital. Like UAB, the medical center’s antibiotic stewardship program includes collection and tracking of data, but it goes a step further by also focusing on education. The medical center plays an active role in educating the public about antibiotic stewardship through social media, maintaining an active presence on Facebook and Twitter. As Jennifer Pisano, MD, the associate medical director of the Antimicrobial Stewardship Program, said in a Feb. 2016 interview with Becker’s Hospital Review, “Stewardship at specific hospital institutions is just one place to start, but over time we need to look more broadly to control the spread of resistant organisms.”
America’s Essential Hospitals also is a partner organization in the U.S. Stakeholder Forum on Antimicrobial Resistance. The Infectious Diseases Society of America convenes this group to support the principle that antimicrobial resistance is an urgent problem and to help inform policy and create awareness across industries.
We Have Work Left to Do
While the United States is an example to the world on how to coordinate and plan a response to antibiotic resistance, we still have work to do when it comes to putting antibiotic stewardship plans into action.
A recent review of outpatient prescription rates found that nearly 30 percent of the 154 million antibiotics prescribed annually in an outpatient setting in the United States are medically unnecessary. Despite having the NHSN module to track antibiotic use and resistance, not all providers use the module. The National Action Plan for Combating Antibiotic-Resistant Bacteria aims to reduce inappropriate prescriptions in outpatient settings by 50 percent, while increasing acute-care hospitals’ use of the NHSN module by 95 percent by 2020.
An Inter-Connected World
While the United States has set goals and begun to regulate antibiotic stewardship, many nations lack the resources to collect and report data in a meaningful way. Health professionals already have identified patients across the world with bacterial infections that are resistant to drugs of last resort. Infections do not adhere to modern concepts of national boundaries, so with our increasingly globalized world, international preparedness is crucial to ensure the efficacy of our drugs and the safety of patients everywhere.
Analysis by the World Bank also shows that if antibiotic resistance goes unchecked, the United Nations will fail to achieve its sustainable development goals, which aim to eradicate extreme poverty by 2030. United Nations Secretary General Ban Ki Moon said failing to tackle antibiotic resistance “quickly and comprehensively…will make providing high-quality universal health care coverage more difficult if not impossible,” adding, “It will undermine sustainable food production. And it will put the sustainable development goals in jeopardy.”