Antibiotic Resistance: A Continued Threat

• More than 2.8 million antibiotic-resistant (AR) infections occur in the US annually

• AR infections result in over 35,000 deaths each year

• In 2017, approximately 223,900 patients in the US required hospitalization due to Clostridioides difficile (C. difficile) infection and at least 12,800 died

Antibiotic Resistance: A Continued Threat

Antibiotic-Resistant Infections: CDC 2019 Threat Report

Urgent Threats

• The 2019 list of “urgent” threats has grown with the addition of drug-resistant Candida auris and carbapenem-resistant Acinetobacter

• Carbapenem-resistant Enterobacteriaceae(CRE), Neisseria gonorrhoeae, and C. difficilecontinue to be listed as urgent threats

Antibiotic-Resistant Infections: CDC 2019 Threat Report

Antibiotic-Resistant Infections: CDC 2019 Threat Report

Drug-Resistant Candida auris

• Candida auris is emerging as a multidrug-resistant fungus that can cause outbreaks particularly in long-term healthcare facilities

• 323 cases in 2018; increase of 318% compared with numbers reported in 2015 to 2017

• 90% of isolates resistant to at least 1 antifungal, 30% resistant to at least 2 antifungals

• Common healthcare disinfectants may not be as effective in eliminating the fungus

• In 2018, FDA approved the first test to identify C. auris (Bruker Maldi Biotyper CA System)

Antibiotic-Resistant Infections: CDC 2019 Threat Report

Carbapenem-Resistant Acinetobacter

• Carbapenem-resistant Acinetobacterinfections often occur in hospitalized patients and can cause pneumonia as well as wound, bloodstream, and urinary tract infections

• 8500 cases and 700 deaths in 2017• The bacteria can survive a long time on

surfaces in healthcare facilities• Some strains are resistant to almost all

antibiotics; treatment options for carbapenem-resistant Acinetobacterbaumannii are very limited

• Few drugs in development for treatment

Antibiotic-Resistant Infections: CDC 2019 Threat Report

Watch List

• A “watch” list has been added to the 2019 report

• Pathogens on the watch list have yet to spread resistance widely in the US, but have the potential if not closely monitored and if an aggressive approach is not taken

• These include:• Azole-resistant Aspergillus

fumigatus• Drug-resistant Mycoplasma

genitalium• Drug-resistant Bordetella pertussis

Aspergillus fumigatus

Mycoplasma genitalium

Bordetella pertussis

Antibiotic-Resistant Infections: CDC 2019 Threat Report

Azole-Resistant Aspergillus fumigatus

• Can cause life-threatening infections in immunocompromised patients

• Symptoms similar to other respiratory infections

• Few infections detected in US; more reported in other countries

• Most US labs unable to test for resistance

Antibiotic-Resistant Infections: CDC 2019 Threat Report

Drug-Resistant Mycoplasma genitalium

• Sexually transmitted infections; can cause urethritis in males and cervicitis in females

• Untreated infections can lead to pelvic inflammatory disease in women

• Azithromycin is the current recommended treatment, however resistance is growing globally

• In 2018, FDA approved the first test for M. genitalium bacterium detection (Aptima Mycoplasma genitalium Assay)

Antibiotic-Resistant Infections: CDC 2019 Threat Report

Drug-Resistant Bordetella pertussis

• Causes pertussis (also known as whooping cough)

• Best protection is through vaccination• Antibiotic-resistance rarely reported in

the US, however it has been documented in other countries

• Current recommended treatments include azithromycin and erythromycin

Antibiotic-Resistant Infections: CDC 2019 Threat Report

Serious Threats

• Drug-resistant Campylobacter• Drug-resistant Candida• ESBL-producing Enterobacteriaceae• Vancomycin-resistant Enterococci (VRE)• Multidrug-resistant Pseudomonas aeruginosa• Drug-resistant nontyphoidal Salmonella• Drug-resistant Salmonella Serotype Typhi• Drug-resistant Shigella• Methicillin-resistant Staphylococcus aureus (MRSA)• Drug-resistant Streptococcus pneumoniae• Drug-resistant Tuberculosis

Antibiotic-Resistant Infections: CDC 2019 Threat Report

Concerning Threats

• Erythromycin-resistant Group A Streptococcus• Clindamycin-resistant Group B Streptococcus

Group A Streptococcus Group B Streptococcus

Antibiotic-Resistant Infections: CDC 2019 Threat Report

Recommendations for Healthcare Professionals

• Follow infection prevention and control recommendations• Ensure patients receive recommended vaccines• Alert receiving facilities of patients colonized or infected with

drug-resistant pathogens• Follow clinical and treatment guidelines• In patients with respiratory infections not responding to

antibiotics, consider fungal infections• Watch for sepsis; start antibiotics as soon as possible• Diagnostic tests should be performed to guide therapy• Be aware of outbreaks, resistance patterns• Report cases of resistant isolates to health department