Antibiotic resistance and its burden on the economy

Antibiotics save patients’ lives and play an important role in patients who have undergone surgery such as for organ transplants or cardiac surgeries. They successfully prevent and/or treat infections in patients who are receiving chemotherapy treatments, also those with chronic diseases such as diabetes, end-stage renal disease, or rheumatoid arthritis.

Antibiotics were first used to treat infections in the 1940s. The first antibiotic to be used was Penicillin, it was used to treat infections in World War II soldiers. However, resistance to Penicillin became a problem. In response to this issue, new beta-lactam antibiotics were developed and distributed. However, the first case of methicillin-resistant Staphylococcus aureus (MRSA) in the United States in 1968.

Currently all antibiotics that have been developed have had cases of resistance. Vancomycin was introduced in 1972 for the treatment of methicillin resistance in both S. aureus and coagulase-negative staphylococci. Unfortunately, cases of vancomycin resistance were reported in coagulase-negative staphylococci in 1979 and 1983. The pharmaceutical industry introduced many new antibiotics to solve the resistance problem, but the antibiotic issue has continued to grow.

According to many epidemiological studies, there is a direct relationship between antibiotic consumption and dissemination of resistant bacteria strains. In other words, overuse of antibiotics is the main driving force of resistance.

In addition, another cause of resistance is the innapropriate prescription of antibiotics. Studies have shown that treatment indication, choice of agent, or duration of antibiotic therapy is incorrect in 30% to 50% of cases. Subinhibitory and subtherapeutic doses of antibiotics further encourage the development of antibiotic resistance because these support genetic alterations.

S. pneumoniae can cause life- threatening infections. These infections are a major cause of bacterial pneumonia and meningitis, as well as bloodstream, ear, and sinus infections; they account for nearly 1.2 million illnesses and 7,000 deaths per year. S. pneumoniae has developed resistance to drugs in the penicillin class and erythromycins. In 30% of severe S. pneumoniae cases, the bacteria are fully resistant to one or more antibiotics.

The CDC separates evaluates antibiotic-resistant infections by the following aspects: clinical impact, economic impact, incidence, 10-year projection of incidence, transmissibility, availability of effective antibiotics, and barriers to prevention.

Antibiotic-resistant infections result in a health and economic burden to the U.S. health care system; in addition to affecting patients and their families. They usually occur in hospitals, because many patients who have antibiotic-resistant infections gather together and transmit the infections to others, making the infection prevail. When first-line and then second-line antibiotic treatment options do not work, prescribers are forced to use antibiotics that are more toxic and/or more expensive. These issues make antibiotic-resistant infections are can economic burden to the health care system.

The U.S. health care system needs to execute new policies for the prescription of antibiotics, make more research efforts, and follow steps to manage the crisis.

• Kimberly Parada

References

Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015;40(4):277‐283.