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Antibiotic overuse and microbial resistance
CDC: Antibiotic resistance
"Antibiotics, also known as antimicrobial drugs, are drugs that fight infections caused by bacteria. After their discovery in the 1940's they transformed medical care and dramatically reduced illness and death from infectious diseases. However, over the decades the bacteria that antibiotics control have developed resistance to these drugs. Today, virtually all important bacterial infections in the United States and throughout the world are becoming resistant. For this reason, antibiotic resistance is among CDC's top concerns."
CDC: Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
- Each year nearly 2 million patients in the United States get an infection in a hospital.
- Of those patients, about 90,000 die as a result of their infection.
- More than 70% of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs most commonly used to treat them.
More than 50 million unnecessary antibiotic prescriptions are written each year in the United States for patients outside of hospitals, according the the Centers for Disease Control and Prevention
It is striking how reticent the CDC is to place blame on physicians, who are primarily responsible for the mass overuse of antibiotics, and totally responsible for their overprescription. The medical director for CDC's National Campaign for Appropriate Antibiotic Use, Richard Besser, M.D., is quoted thusly on the CDC site: "The biggest problem is inappropriate prescribing of antibiotics. Up to 40% of antibiotics prescribed in doctor's offices are for viral infections, which are not treatable with antibiotics. There are many reason's for this, including demand from patients, time pressure on physicians, and diagnostic uncertainty." Dr. Besser deftly avoids citing the major reason for the overuse of antibiotics, that physicians irresponsibly prescribe them when they are neither needed nor effective. Can we expect the CDC's campaign to be effective if it neglects the main cause of antibiotic resistance? The claim that "demand from patients" is a major reason for "inappropriate prescribing of antibiotics," is nonsensense. A physician who prescribes a drug which he knows to be inappropriate is behaving irresponsibly and unethically. He should cease the practice of medicine. Physicians have demanded and received complete control over the dispensing of most drugs, but they seek to avoid responsibility for the consequences of this paternalism.
Impacts of Antibiotic-Resistant Bacteria
U.S. Congress, Office of Technology Assessment, OTA-H-629, September 1995
The Rise of Antibiotic-Resistant Infections
"Antibiotic resistance spreads fast. Between 1979 and 1987, for example, only 0.02 percent of pneumococcus strains infecting a large number of patients surveyed by the national Centers for Disease Control and Prevention were penicillin-resistant. CDC's survey included 13 hospitals in 12 states. Today, 6.6 percent of pneumococcus strains are resistant, according to a report in the June 15, 1994, Journal of the American Medical Association by Robert F. Breiman, M.D., and colleagues at CDC. The agency also reports that in 1992, 13,300 hospital patients died of bacterial infections that were resistant to antibiotic treatment."
Ricki Lewis, FDA Consumer magazine, Sep 1995.
Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians
This report suggests that a substantial percentage of American doctors are either poorly trained, irresponsible, or incompetent.
"Although antibiotics have little or no benefit for colds, upper respiratory tract infections, or bronchitis, these conditions account for a sizable proportion of total antibiotic prescriptions for adults by office-based physicians in the United States. Overuse of antibiotics is widespread across geographical areas, medical specialties, and payment sources."
Gonzales et al. JAMA 1997 Sep 17;278(11):901-4
The Challenge of Antibiotic Resistance
A major health problem driven by physician irresponsibility. Doctors will submit to "pressure" to prescribe antibiotics, but they will not submit to pressure to prescribe pain medications because they might lose their licenses. It is outrageous that doctors, who have a cartel monopoly of drug prescribing, would blame patients for pressuring them to issue those prescriptions.
"Researchers at the Centers for Disease Control and Prevention have estimated that some 50 million of the 150 million outpatient prescriptions for antibiotics every year are unneeded. At a seminar I conducted, more than 80 percent of the physicians present admitted to having written antibiotic prescriptions on demand against their better judgment."
Stuart B. Levy, Scientific American, Mar 1998
Antibiotic Prescribing for Children With Colds, Upper Respiratory Tract Infections, and Bronchitis
Physicians continue to waste billions of dollars and decrease the value of antibiotics by prescribing them for illnessnes against which they have no effect.
"Antibiotic prescribing for children diagnosed as having colds, URIs, and bronchitis, conditions that typically do not benefit from antibiotics, represents a substantial proportion of total antibiotic prescriptions to children in the United States each year.
Nyquist et al. JAMA. 1998;279:875-877"
The origins and molecular basis of antibiotic resistance
"We frequently refer to bacteria as being resistant to antibiotics, but rarely do we consider what that means."
Peter M. Hawkey, BMJ 1998;317:657-660
The epidemiology of antimicrobial resistance in hospital acquired infections: problems and possible solutions
"Hospitals, and particularly intensive care units, are an important breeding ground for the development and spread of antibiotic resistant bacteria. This is the consequence of exposing to heavy antibiotic use a high density patient population in frequent contact with healthcare staff and the attendant risk of cross infection. 1 2 Antibiotic resistance increases the morbidity and mortality associated with infections and contributes substantially to rising costs of care resulting from prolonged hospital stays and the need for more expensive drugs.1-3 In this review I will outline the current problems caused by major drug resistant nosocomial pathogens, examine factors that promote antibiotic resistance in hospitals, and discuss strategies for control."
Marc J Struelens, BMJ 1998;317:652-654
Strategies for promoting judicious use of antibiotics by doctors and patients
Recent antibiotic use is a well documented risk factor for infection or colonisation with resistant pathogens.1-7 Despite this recognition, unnecessary antibiotic prescribing remains common. In the United States more than a fifth of all antibiotic prescriptions for children and adults are written for upper respiratory tract infections or bronchitis, conditions that are almost always viral. 8 9 Similar rates of unnecessary antibiotic use have been described in Britain.10 These findings are consistent with results from focus groups among doctors, in which participants have estimated that 10% to 50% of outpatient antibiotic prescriptions are unnecessary.
Edward A Belongia and Benjamin Schwartz, BMJ 1998;317:668-671
It Is Time for Action: Improving Hand Hygiene in Hospitals
"As delivery of medical care moves increasingly to outpatient settings, patients who require hospitalization have more acute illness and heightened susceptibility to nosocomial infections. Such infections result in substantial morbidity and are estimated to cause or contribute to 80 000 deaths annually in the United States. Many nosocomial infections are caused by pathogens transmitted from one patient to another by way of health care workers who have not washed their hands between patients. Although Semmelweis demonstrated 150 years ago that mortality related to hospital-acquired infections could be reduced when health care personnel washed their hands with an antiseptic solution between patient contacts, compliance of health care workers with recommended handwashing practices remains unacceptably low, often in the range of 30% to 50%. Even the current spread of multidrug-resistant pathogens in hospitals has not compelled health care workers to wash their hands as frequently as recommended. . . After tolerating poor handwashing compliance for 150 years, it is time for hospitals and health care professionals to get serious about improving hand hygiene in hospitals."
John M. Boyce, Ann Intern Med. 1999;130:153-155.
Superbug death toll rises
"Hong Kong's medical authorities are on the alert for further cases involving a powerful strain of antibiotic-resistant "superbug" which has now killed four in the former colony."
BBC, Nov 4, 1999
Drug resistance
"The Centers for Disease Control and Prevention estimates that U.S. physicians write 50 million unnecessary antibiotic prescriptions annually, including 17 million to treat the common cold."
Stedman's (onling medical dictionary)
Overcoming Microbial Resistance
"This report describes the growing threat of antimicrobial resistance. It documents how once life-saving medicines are increasingly having as little effect as a sugar pill. Microbial resistance to treatment could bring the world back to a pre-antibiotic age."
World Health Organization Report on Infectious Diseases, 2000
Antibiotic Resistance: an Alarming Health Care Issue
"Every year, 17 million people die of infectious diseases. Emerging highly infectious viral agents, resurgent diseases, and mutating bacteria have combined to create a global health care crisis.(1) Despite major strides in prevention and control, infectious diseases continue to take a significant and economic toll on society. The cost to the health care system is enormous. One report estimated the annual cost of antibiotic resistance to a single pathogen, Staphylococcus aureus, was $122 million.(2) In 1995, the annual cost was estimated to be at least $1.5 billion.(3) Organisms that once displayed uniform susceptibility now exhibit resistance to specific antibiotics." Carolyn Twomey, AORN Journal, July 2000.
Antibacterial Debate : Does antibacterial product use over time contribute to antibiotic resistance in homes and hospitals?
"... several studies are underway or recently have been completed that show no risk of development of resistance to topical antimicrobials outside the laboratory."
Lorri Grube, Global Cosmetic Industry, April 2001.
Alternate viewpoint:
Antibacterial household products: cause for concern (pdf 380k)
Stuart B. Levy, Emerging Infectious Diseases, Vol 7 No 3 Supp., June 2001
Antibiotic Treatment of Adults With Sore Throat by Community Primary Care Physicians
"There were an estimated 6.7 million annual visits in the United States by adults with sore throat between 1989 and 1999. Antibiotics were used in 73% (95% confidence interval [CI], 70%-76%) of visits. Patients treated with antibiotics were given nonrecommended antibiotics in 68% (95% CI, 64%-72%) of visits."
Linder, JA and Stafford, RS, JAMA. 2001;286:1181-1186
Press release from Massachusetts General Hospital regarding this study:
Study shows excessive, inappropriate antibiotic prescriptions for sore throats
"Most adult patients who see their doctors for a sore throat receive a prescription for an antibiotic, despite the fact that antibiotic treatment may be appropriate for only 10 percent of such patients. And even though the inexpensive traditional antibiotics penicillin and erythromycin are the recommended treatment for sore throats that do require antibiotics, physicians often prescribe newer, more expensive 'broad-spectrum' antibiotics."
Doctors claim that they are giving our unnecessary prescriptions because patients demand them. Are the patients also demanding the nonrecommended antibiotics that this study reveals doctors to be using?
CDC Warns About Overuse of Antibiotics
[CDC is an apologist for the irresponsible prescribing of antibiotics by doctors. When it comes to giving out unnecessary prescriptions, CDC says victimized doctors aren't able to "just say no.]
"Director of Antimicrobial Resistance for the CDC, Dr. Richard Besser, told an audience of physicians attending a medical conference that each year US physicians write $50 million worth of prescriptions that are ineffectual and unnecessary. A common reason for unnecessary prescriptions is patient demand for treatment."
Alliance for prudent use of antibiotics
Erythromycin-Resistant Group A Streptococci in Schoolchildren in Pittsburgh
"In January 2001, during a longitudinal study of schoolchildren, we detected the emergence of erythromycin resistance in pharyngeal isolates of group A streptococci. This clonal outbreak also affected the wider community."
Martin et al. N Engl J Med 2002 Apr 18;346(16):1200-6
Prevalence of methicillin-resistant Staphylococcus aureus colonization in surgical patients, on admission to a Welsh hospital
This small study is interesting in that it suggests that many people may enter hosptial already infected with resistant bacteria rather than becoming infected while in hospitals.
Samad et al., J Hosp Infect 2002 May;51(1):43-6
The Commonality of Risk Factors for Nosocomial Colonization and Infection with Antimicrobial-Resistant Staphylococcus aureus, Enterococcus, Gram-Negative Bacilli, Clostridium difficile, and Candida
"To better understand common risk factors among multiresistant organisms, this review explores risk factors for nosocomial infection with methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, Clostridium difficile, extended-spectrum -lactamase-producing gram-negative bacilli, and Candida."
Nasia Safdar, Dennis G. Maki. Ann Intern Med. 2002;136:834-844.
Infection epidemic carves deadly path
"A hidden epidemic of life-threatening infections is contaminating America's hospitals, needlessly killing tens of thousands of patients each year."
Chicago Tribune, 21 July 2002
Lax procedures put infants at high risk
"The Tribune linked the deaths of 2,610 infants in 2000 to preventable hospital-acquired infections. Examining patients of all ages, the Tribune identified 75,000 preventable deaths where hospital-acquired infections played a major role. This analysis, based on the most recent national data, is the most comprehensive of its kind and draws on thousands of hospital and government inspection reports."
Chicago Tribune, 21 July 2002
Infection epidemic carves deadly path
"Over several weeks starting in October 1998, 31 children contracted flulike infections and eight died as the microscopic invader snaked through the 93-bed long-term care center, which is operated by the Sisters of Mercy with the support of the Catholic Church ... The outbreak on the Southwest Side was one of several nationally linked to the rare virus. But these incidents went largely unreported in the media, and in Chicago the Department of Public Health still is not releasing public records on the outbreak--an example of how health-care facilities and public agencies are able to keep damaging information about infections under wraps."
Chicago Tribune, 22 July 2002
Drug-resistant germs adapt, thrive beyond hospital walls
"Lapses in infection control and overuse of antibiotics are spawning drug-resistant germs that are spreading from hospitals into the community at unprecedented rates ... These new super germs--stronger, more elusive and deadlier--have multiplied for decades inside thousands of hospitals and now are hitching rides into outside communities on the clothes and skin of patients, workers and visitors."
Chicago Tribune, 23 July 2002
Nurse leads hospital's war on germs
"The success of Children's Hospital in Birmingham, Ala., underscores how any hospital can virtually eradicate infections, even among the sickest children."
Chicago Tribune, 22 July 2002.
Virus attacked Chicago children in outbreak kept under wraps
"The germ raced through the Misericordia Home for handicapped children in Chicago, masquerading as a cold-weather flu as it moved from bed to bed. "
Chicago Tribune, 21 July 2002.
Ignaz Philipp Semmelweis
"Every woman who has given birth in the last century owes a huge debt of gratitude to a doctor born in 1818 in Buda, Hungary and who died insane because the scientific world refused to accept his simple solution to a medical problem that was killing thousands of women every year."
Project Creation
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"I just don't see how we couldn't tell patients (about hospital infection rates), We're talking about their lives."