August 14, 2013
New Analysis Suggests That Antibiotic Resistance in Nosocomial Infections Worse Than Reported

Los Angeles—Antibiotic resistance to hospital-acquired infections is rising more quickly than public health officials have reported, and the effectiveness of the U.S. government’s response has been “mixed” at best.

That’s according to an article published recently by the journal Antimicrobial Agents and Chemotherapy.

The authors report that the rise of antibiotic resistance among nosocomial infections is greater than the CDC found in its 2008 analysis, while a promise by the FDA to “reboot” antibiotic development rules a year ago could be too little, too late.

The commentators analyzed privately gathered data to conclude that antibiotic resistance among hospital-acquired infections is “at crisis levels.”

“With antibiotic-resistant microbes infecting more than two million Americans every year and killing more than 100,000 annually, we must act to find new weapons in the global battle against deadly superbugs,” said co-author Brad Spellberg, MD, an infectious disease specialist at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center. “Our analysis found the rise in antibiotic resistance among three common forms of hospital-acquired infections is much greater than previously reported by the CDC based on older data, leading us to conclude that more than an FDA ‘reboot’ is needed. To encourage antibiotic development, the pharmaceutical industry must see that there is a path for a return on its investment in antibiotic development.”

The authors found “very positive aspects” in the FDA's most recent guidance on antibacterial therapies for patients with unmet medical needs, but, overall, called the FDA's approach to the development of antibacterials in traditional indications, such as pneumonia and urinary tract infections, “mixed.”

Analysis used as background for the commentary included the following information:

• Resistance for acinetobacter (A. baumannii) to carbapenems is more than 50%, while the CDC found it to be 11%.
• Resistance among E. coli to third-generation cephalosporins was 8% to 11%. The CDC found it to be 5%.
• Resistance to klebsiella (K. pneumonia) to third-generation cephalosporins was 20% to 27%. The CDC found it to be 15%.

Noting that carbapenems are already obsolete for a common intensive care unit infection, Acinetobacter baumannii, the commentary adds, “This holds true for both intensive care and non-intensive care patients and for urinary and non-urinary infections.”

“None of the antibiotics under development today can address all of these antibiotic-resistant infections,” Spellberg said. “A complete overhaul of the approaches to resistance, disease and prevention could change the continuing upward trajectory of antibiotic resistant infections. To do anything less invites a bleak post-antibiotic future, in which infectious diseases once again reign supreme.”

U.S. Pharmacist Social Connect