On September 16, 2013, the Centers for Disease Control and Prevention (CDC) issued a report “Antibiotic Resistance Threats in the United States, 2013”. This report detailed the impacts, causes and recommended solutions related to antibiotic resistance within the US (although the concerns are similar worldwide).
The report takes the form of an incident investigation. Specifically, the report addresses the impacts to the goals of the CDC, the cause-and-effect relationships resulting in these impacts, and what is recommended to reduce the risk of these impacts continuing. The information presented in their report can be captured in a Cause Map, or visual root cause analysis, which allows a demonstration of the interaction of the various causes presented in the report.
The report begins with the goals being impacted by the problem of antibiotic resistance. Specifically, the CDC conservatively estimates that more than 2 million people are sickened in the US every year by antibiotic-resistant infections. More than 23,000 are estimated to die as a result. The risk is not just for the general public, but healthcare providers as well, who are implicated in the report as having resistant strains on their hands, which causes a health risk for them as well as patients. The report identifies not only person-to-person spreading of infection, but also spreading from environmental causes, such as food. The presence of these strains impacts the environmental goal as well.
The cost of these infections is staggering. It is estimated that up to $20 billion per year is spent on direct excess healthcare costs as a result of these infections in the US alone. The productivity cost (loss of productivity across industries due to employees being out sick) is estimated to be as high as $35 billion per year. (While the causes discussed in the report are of concern globally, the impacts to the population are specific to the US.)
Increased illness from resistant infections results from exposure to resistant infections, decreased protection from infection, and a shortage of drugs available to treat these infections. Exposure to antibiotic-resistant infections results from either person-to-person or environmental spread. Spread can pass from anybody who has antibiotic resistant bacteria or fungus, but a primary source is healthcare providers, who can easily pass the infection with improper hand washing (or none at all). Environmental causes include surfaces (again, healthcare providers are a frequent source here) but also food. Food animals are given antibiotics to control disease, but also sometimes are given antibiotics without a diagnosis to prevent infection or promote growth. These antibiotics kill off non-resistant bacteria but not resistant bacteria, which remains in the meat and feces. If meat is improperly cooked, the bacteria can be passed on to humans. But the issue is not just with improperly cooked meat. Other foods can be contaminated with animal feces, which can also contain the resistant bacteria.
When a person is taking antibiotics, they have a decreased protection from infection. This is because antibiotics kill all bacteria – including “good” bacteria that helps prevent infection. While antibiotics are used to treat disease, the CDC estimates that 50% of prescriptions are unnecessary or not optimally effective. The use of antibiotics has been identified as the single most important factor leading to antibiotic resistance.
The increase of antibiotic-resistant bacteria (and fungi) means that more and more drugs are becoming ineffective in treating these infections, increasing the risk of death when infections occur. Additionally, research and development into antibiotics is slowing, compounding the problem of effective drug availability.
As part of the report, the CDC provides wide-ranging recommendations to limit antibiotic-resistant infections. The recommendations are for healthcare providers, communities and individuals. They aim to first prevent the spread of infection by ensuring that antibiotics are prescribed and used properly, as well as by better tracking the spread of antibiotic resistant pathogens. This includes stopping the use of antibiotics in feed animals for growth promotion. Additionally, better cleanliness control for healthcare providers, food preparers and the general population will reduce the spread of disease. Secondly, the CDC aims to provide better treatment for these infections by investing in research and development to provide new antibiotic treatment options. It is also hoped that surveillance data can provide more effective diagnostic tools and use of the treatments currently available.
To view the Outline and Cause Map, please click “Download PDF” above.