Author: Ethan Covey
Antibiotic resistance remains a challenging global problem, particularly in low- and middle-income countries. However, recent efforts by the CDC and others have been aimed at addressing these issues.
Details of the CDC efforts to increase global antibiotic stewardship were presented at IDWeek 2019, in Washington, D.C.
Globally, the prevalence of antibiotic-resistant organisms is increasing. For instance, estimates exist that 60% to 80% of Enterobacteriaceae are resistant to carbapenems. Drivers for the increase of resistance, particularly in resource-limited settings, include inappropriate use of antibiotics, poor sanitation and poor infection control practices.
Although these issues are often thought of as being relevant primarily in resource-limited countries, the risk is growing for all countries.
“Antimicrobial resistance abroad will eventually affect us in the U.S. as well,” said Rachel Mann Smith, MD, of the International Infection Control Program in the CDC’s Division of Healthcare Quality Promotion. “It is really a global problem.”
A World Health Organization report on antibiotic use, released in November 2018, provided a glimpse of global antibiotic usage. However, the report did not delve into appropriate versus inappropriate use, focusing instead on broad consumption data. Additionally, data were lacking from many countries—many low-income countries in Africa and Asia, and others, such as the United States, which did not participate in the study.
Available data on inappropriate use in resource-limited countries show a complicated set of factors, such as over-the-counter availability of antibiotics, poor stewardship, and the lack of training and financial resources to address the problem. “This reminds us that there are both access and excess issues in low- and middle-income countries,” Dr. Smith said.
As part of efforts to address this, the CDC is involved in a three-tier portfolio of antibiotic stewardship work:
- laying building blocks for stewardship programs,
- assisting with the collection and analysis of antibiotic use data, and
- supporting stewardship programs at both the national and facility level.
While many of these efforts will take time to put into effect, even minor changes can lead to trackable improvements. “You can’t expect people to adhere to what you think appropriate use is if it’s not written down, available, publicized,” Dr. Smith said. “Even just writing those guidelines can be considered a stewardship activity.”
For Dr. Smith, these small steps show progress. “We’ve really been striving to not let perfect be the enemy of good,” Dr. Smith said. “We need to start somewhere with what we have, as opposed to waiting for things to line up in perfect shape.”