CDC's "Biggest Threats" Report for Antibiotic Resistance Highlights Challenge: Public Health Watch

Among other things, the holidays are a time for lists, most of the fun or entertaining variety.

Think: “Best of” rankings or gift ideas.

However, the latest list from the US Centers for Disease Control and Prevention (CDC) is anything but fun. Earlier this month, the agency released its latest “biggest threats” report on antibiotic-resistant pathogens.

And, there’s a lot to be concerned about for infectious disease and public health specialists.

“We believe there are encouraging signs of progress that reflect action,” Arjun Srinivasan, MD, CDC’s associate director of health care-associated infection prevention programs, told Contagion®. “That said, we all agree that more needs to be done.”

Indeed, the latest list includes a few “repeat offenders” from the agency’s first such report, released in 2013. Clostridioides difficile (CDI), carbapenem-resistant Enterobacteriaceae (CRE), and drug-resistant Neisseria gonorrhoeae remain as “urgent threats,” and they are joined by carbapenem-resistant Acinetobacter and Candida auris.

“CDI has gone down since the last report and continues to decline in hospitals and nursing homes,” Srinivasan noted. “Likewise, after a rapid emergence and initial rise, CRE is now holding steady. We believe the progress against both CDI and CRE are a reflection of the hard work the health community is doing in environmental cleaning, infection control and antibiotic stewardship.”

Interestingly, after remaining relatively steady throughout the 1980s, 1990s, and early 2000s, incidence of gonorrhoeae overall has climbed since 2009, when 301,174 cases were reported in the United States, through last year, when 583,405 cases were reported. Globally, incidence has also risen significantly.

According to a review published in 2014, Neisseria gonorrhoeae now shows resistance to 6 previously recommended treatment options: sulfonamides, penicillins, earlier generation cephalosporins, tetracyclines, macrolides, and fluoroquinolones. That trend is only likely to continue.

Drug-resistant Campylobacter, drug-resistant Candida, extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, vancomycin-resistant Enterococci (VRE), multidrug-resistant Pseudomonas aeruginosa, drug-resistant nontyphoidal Salmonella, drug-resistant Salmonella serotype Typhi, drug-resistant Shigella, methicillin-resistant Staphylococcus aureus (MRSA), drug-resistant Streptococcus pneumoniae, and drug-resistant tuberculosis (TB) are listed as “serious threats,” while erythromycin-resistant Group A Streptococcus and clindamycin-resistant Group B Streptococcus come in as “concerning threats.”

The agency’s “watch list” includes azole-resistant Aspergillus fumigatus, drug-resistant Mycoplasma genitalium, and drug-resistant Bordetella pertussis.

Notably, the 2019 list is significantly longer than its counterpart 6 years ago.

The 2013 version multidrug-resistant Acinetobacter, drug-resistant Campylobacter, fluconazole-resistant Candida, ESBL-producing Enterobacteriaceae, VRE, multidrug-resistant Pseudomonas aeruginosa, drug-resistant non-typhoidal Salmonella, drug-resistant Salmonella Typhi, drug-resistant Shigella, MRSA, drug-resistant Streptococcus pneumoniae, and drug-resistant TB as serious threats and vancomycin-resistant Staphylococcus aureus (VRSA), erythromycin-resistant Group A Streptococcus, and clindamycin-resistant Group B Streptococcus as concerning threats.

Srinivasan suggested that the additions to the 2019 list highlight the seriousness of the crisis—and provide clinicians with a “to-do” list for next year and beyond. “Antibiotic resistance is a dynamic threat and one that will never go away,” he said. “It’s important to note that one of the pathogens on the urgent list, Candida auris, was not even known in 2013. The decreases we see in many of the healthcare pathogens demonstrates that we can address the challenge of resistance, [but] the expansion of the list of urgent threats reminds us that our work must be on-going.”

Consider it for your own list of resolutions for 2020.