A rise in antimicrobial-resistant infections is in the global spotlight as world leaders on Wednesday will discuss the growing threat of a post-antibiotic world.
The one day meeting of the United Nations General Assembly marks only the fourth time the group has met to discuss a health crisis.
The move marks a new era of heightened urgency regarding antibiotic resistance. Health experts warned for years that overprescribing and prioritizing development of more lucrative drugs over cheap antibiotics led to an increase in “superbug” infections that are resistant to one or multiple antibiotics.
Wednesday's meeting is the first toward developing a coordinated global plan that focuses on reducing antibiotic use while creating ways to give companies incentives to develop new drugs.
Efforts to encourage improved antibiotic stewardship within the healthcare field has led to some successes among a number of providers.
“In a sense, this U.N. meeting will allow the world to see just how dangerous a problem this is,” said Dr. Amesh Adalja, infectious disease expert and senior associate at the UPMC Center for Health Security.
An estimated 700,000 people around the world die every year from antimicrobial-resistant infections, with more than 23,000 deaths and 2 million illnesses occurring within the U.S., according to the Centers for Disease Control and Prevention.
But the problem of overuse remains a huge concern. An analysis of U.S. acute-care hospitals found a little more than one-third had stewardship programs that met all seven of the CDC's recommended elements for best practices.
A study published in May in JAMA found 1 in 3 antibiotic prescriptions written in the U.S. was considered unnecessary for the conditions they are used to treat.
A more recent analysis of more than 300 hospitals published Tuesday in JAMA Internal Medicine found that between 2006 and 2012, the rate of antibiotic use had not changed much over the time studied. Perhaps more disturbing was that there was a significant increase in the use of broad-spectrum antibiotics, which are considered the drugs of last resort for the worst infections.
Adalja said that if stewardship falters, or there's not enough leadership buy-in by hospital administrators, the task will be impossible. "Every new antibiotic we discover is invariably going to be met with resistance,” he said. “It's very easy to do compared to developing new antibiotics. This is something that every hospital can do now, today.”
But recent moves by the Joint Commission as well as the CMS aim to develop standards of practice for prescribing antibiotics. In July, the Joint Commission released a document entitled New Antimicrobial Stewardship Standard, which goes into effect Jan. 1 for acute-care and critical-access hospitals, as well as nursing-care centers, ambulatory-care organizations and office-base surgical practices.
In June, the CMS issued a proposed rule for Medicare and Medicaid participants requiring them to have an antibiotic stewardship program in place and designate qualified infectious disease personnel to lead those programs.
“Those two key activities that have really come down in less than the last six months have really made everyone stand at attention to ask what do they have in place for antibiotic stewardship, what do they need to get in place, and how can they be prepared for both the Joint Commission and CMS,” said Kristi Kuper, senior clinical manager of infectious disease for member-owned healthcare company Vizient.
But reducing antibiotic prescribing within healthcare only solves part of the problem. Antibiotics, some of which are medically important to humans, continue to be fed to livestock to cure and stave off disease, or in some instances, they are used to promote weight gain in livestock without having to increase the animals' food intake.
A report released in December 2015 by the Food and Drug Administration found that despite efforts in recent years to limit the use of antibiotics in food-producing animals, sales of such drugs for livestock increased by 3% between 2013 and 2014.
For years, health officials have called for a multisector, multigovernmental approach to combating antimicrobial resistance. At the World Economic Forum in January, a number of the world's largest drug manufacturers signed a declaration pledging to work with governments on promoting greater antibiotic stewardship.
But even with such commitments, the pipeline for new antibiotics remains low. An estimated 37 new antibiotics with the potential to treat serious bacterial infections are in clinical development for the U.S. market as of March, according to an analysis from the Pew Charitable Trusts.
Only seven currently in Phase 3 trials are expected to work against gram-negative pathogens, which are multidrug resistant and considered to be among the toughest to treat. An estimated 1 out of 5 drugs that reach Phase 1 human testing win approval for use.
But drugmakers find little incentive to develop new antibiotics.
“I think it's an important context to remember that it costs about $1 billion to bring a drug to market,” UPMC's Adalja said. “When drugmakers try to look at what the revenue stream is from an antibiotic, if it's only going to be used for the most drug-resistant organisms, that's not very appealing to a company because it isn't something that they're going to be able to easily recoup their $1 billion investment on.”