Antibiotic resistance at ‘epic proportions’

Between 1995 and 2003, the major “bad bugs” causing respiratory infections in hospitals have grown increasingly resistant to commonly prescribed antibiotics, according to data from the Antimicrobial Resistance Management (ARM) Program. The sharpest decline was between 1995 and 1998.

Approximately two million people acquire bacterial infections in US hospitals each year and 90,000 die. Approximately 70% of those infections are resistant to at least one drug.

“The magnitude of antimicrobial resistance has reached epic proportions,” said John G. Gums, PharmD, ARM Program Director, during the 70th annual international scientific assembly of the American College of Chest Physicians. “Once a phenomenon restricted to developing countries or Asia, the impact of resistance to antibiotics is now being felt by every hospital and community practice in the United States.”

The national decline in susceptibility of the primary pathogens causing respiratory tract infections in hospitals to antibiotics now in use “underscores the necessity for hospitals and institutions to benchmark resistance at the local level to limit the effect of antibiotic resistance on patients and the public,” added Dr. Gums, Professor of Pharmacy and Medicine in the Departments of Pharmacy Practice and Community Health and Family Medicine at the University of Florida, Gainesville.

The analysis included several classes of antibiotics, from the penicillins to newer agents such as the fourth-generation cephalosporins and fluoroquinolones.

“Antibiotic resistance has been identified as an impending public health crisis,” he said.  For example, “Fifteen years ago, there were no appreciable levels of vancomycin-resistant enterococci (VRE); seven years ago, vancomycin-intermediate Staphylococcus aureus (VISA) did not exist; and two years ago, we only hoped that vancomycin-resistant staphylococcus aureus (VRSA) would never materialize.

“There was a time when one could consider treating upper respiratory infections in children with 40mg/kg/day of amoxicillin,” Dr. Gums continued. “Well, VISA, VRSA, and penicillin-resistant Streptococcus pneumoniae (PRSP) are here and continue to spread. While there are many factors that have been identified as triggers for increasing resistance, one factor most experts believe contributes is the increased use of inappropriate antibiotics.

“The ARM Program was developed to assist institutions and outpatient centers in identifying the scope of the resistance problem unique to their patient population or geographic location. Local recognition of resistance trends is mandatory to determine the appropriate strategies that will eventually reduce the pressures for resistance.”

SOURCES: “Bad Bugs Causing Respiratory Infections Are Increasingly Resistant to Antibiotics,” D.A. Hughes & Associates, Lusby, MD., Oct. 2004.
Gums JG. “Streptococcus pneumoniae susceptibility to cefotaxime and ceftriaxone, 1994-2001: Results of the Antimicrobial Resistance Management (ARM) program” [abstract]. Am J Respir Crit Care Med 2003;167:A559. Abstract C59.