The Global Toll

Drug-resistant organisms take an astonishing toll world-wide. In the United States one of these organisms, Staphylococcus aureus (MRSA), kills more Americans every year than emphysema, HIV/AIDS, Parkinson’s disease and homicide combined. Almost 2 million Americans a year develop hospital-acquired infections (HAIs), resulting in 99,000 deaths. The vast majority of the mortalities are due to antibacterial (antibiotic)-resistant pathogens. Sepsis and pneumonia alone, two common HAIs, killed nearly 50,000 Americans and cost the US health care system more than $8 billion in 2006. A 2009 survey showed approximately half of the patients in more than 1,000 intensive care units in 75 countries suffered from an infection and the infected patients were twice as likely to die in the hospital as the uninfected patients. Three recent studies of the costs of infections caused by antibiotic-resistant pathogens versus antibiotic-susceptible pathogens show the annual cost to the US health care system of antibiotic-resistant infections to be $21 billion to $34 billion and more than 8 million additional hospital days. At least 25,000 patients in the European Union die from an infection caused by multidrug -resistant bacteria with estimated health care costs productivity losses of more than 1.5 billion Euros.

Community-acquired infections (CA) are increasing as well. The hospitalization rates in New York City for community-acquired Staphylococcus aureus (CA_MRSA) tripled between 1997 and 2006.

In some parts of the United States, infectoins associated with Clostridium difficile – a bacterium that can cause severe diarrhea and colitis – are growing faster than MRSA. Overall, Clostridium difficile-related deaths increased 35 percent each year from 1999 to 2004 in the united States, claiming more than 20,000 lives. Resistance to multiple antibiotics has been reported for this superbug.

Drug-resistant infections cost the
U.S. health care system up to $26 billion
each year and result in more than
eight million additional days
of hospitalization.

The median cost of treating patients with MRSA over a six-month period was 118 percent higher than the cost of treating patients with drug-susceptible strains of the same bacteria.

Global Effects

There little global data on the number of cases of resistant bacterial infections. However, anecdotal reports suggest that we are looking at the tip of the iceberg. “Superbug” strains of gonorrhea which are becoming untreatable accounted for one in 10 cases of the disease in Europe in 2010. This was more than double the 2009 rate. The resistant strains are rapidly spreading across Europe – They were found in 17 countries in 2010, seven more that in 2009. The percentage of gonorrhea cases that were resistant to treatment rose from 4% in 2009 to 9% in 2010. In June of 2012 the World Health Organization released a statement on this issue as well as a global action plan for curbing drug-resistant gonorrhea. Recently a new antibiotic resistance mechanism, New Delhi metallo-beta-lactamase 1 or NDM1, was discovered in E. coli and Klebsiella strains in India and spread to the UK and the USA.

The most complete data on resistance in developing countries comes from tertiary care facilities, usually in large cities. Little information exists on resistance in other settings and there is almost none for rural areas. Data from community settings in Indian and South African urban and peri-urban areas show high levels of resistance. Urine specimens collected from healthy women in November 2003 and December 2004 showed that more than 70% of Escherichia coli were resistant to ampicillin and nalidixic acid and more than 50% were resistant to fluoroquinolones. China’s health ministry is launching new regulations August 2012 in the hopes of slowing a country-wide pandemic. In 2009 more than 60% of Staphylococcus aureus isolates from Chinese patients in hospitals were methicillin resistant (MRSA) up from 40% in 2000. The proportion of Streptococcus pneumoniae and Escherichia coli resistant isolates now is over 70% in China. That is the highest rate in the world.

The lack of effective treatments and diagnostics for resistant organisms make this situation frightening, uncontrolled and deadly.

The lack of effective treatments and diagnostics for resistant organisms make this situation frightening, uncontrolled and deadly. Margaret Chan, the World Health Organization’s director-general told a meeting in Copenhagen in March of 2012, “If the current trends continue unabated, the future is easy to predict. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry.”