Half a century has elapsed since the introduction of a new antibiotic capable of combating CRAB, a formidable drug-resistant bacterial infection. However, a recent breakthrough has offered a glimmer of hope. Scientists have unveiled a novel class of antibiotics effective against CRAB, signifying a long-awaited advancement in the fight against carbapenem-resistant Acinetobacter baumannii. Previously impervious to most available antibiotics, CRAB has posed a considerable challenge for medical professionals and patients alike. Its capacity to provoke severe infections in the lungs, brain, and urinary tract, potentially leading to life-threatening conditions like pneumonia and meningitis, underscores the urgency of finding effective treatments.
The CRAB dilemma is just one facet of a broader challenge posed by the rise of superbugs – bacteria and fungi resistant to conventional treatments. Notably, over 20 pathogens have evolved resistance, including gonorrhea and group A Streptococcus, responsible for strep throat. Alarming trends indicate a steady increase in the prevalence of these superbugs.
On a larger scale, the United States witnesses over 2.8 million antimicrobial-resistant infections annually, with global estimates projecting approximately 1.27 million deaths attributed to antibiotic-resistant bacteria and contributing to nearly 5 million fatalities. A bleak forecast by the United Nations warns of a potential annual death toll of 10 million worldwide by 2050 if current trends persist.
For frontline healthcare providers, the escalating superbug crisis is not merely a statistical phenomenon but a stark reality encountered in daily practice. The frequency of CRAB cases, for instance, has surged from sporadic occurrences to weekly encounters over the past eight years. While strides were made in combating certain drug-resistant microbes before 2020, the COVID-19 pandemic disrupted these advancements, precipitating a resurgence in cases. Initial uncertainty surrounding the nature of the novel disease led to heightened antibiotic prescriptions, exacerbating the problem.
Hospital settings, often inundated with patients, serve as breeding grounds for infections, especially among vulnerable populations like those on ventilators. Consequently, the incidence of drug-resistant hospital-acquired infections witnessed a concerning uptick in 2020, with CRAB infections alone surging by nearly 80%.
The toll exacted by antimicrobial resistance extends beyond individual patients, straining healthcare systems and necessitating prolonged hospital stays for treatment with intravenous antibiotics. Moreover, dwindling antibiotic options force clinicians to resort to drugs with severe side effects, such as colistin, which can lead to renal impairment and necessitate lifelong dialysis in extreme cases.
In dire scenarios where no effective antibiotics remain, surgical intervention becomes the only recourse, evoking parallels with the pre-antibiotic era, now ominously dubbed the post-antibiotic era.
Addressing the superbug crisis demands multifaceted interventions. Heightened awareness within the medical community, coupled with stringent antibiotic stewardship programs in healthcare facilities, is imperative to curb the rampant emergence of drug resistance. State governments play a pivotal role in overseeing public health initiatives, from bolstering laboratory capacities to regulating interfacility transfers to contain superbug transmission.
However, meaningful progress hinges on federal action. Legislative measures like the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act offer a viable pathway to incentivize the development of new antimicrobials targeting the most resistant pathogens. By adopting a subscription-based model, the government can foster innovation while ensuring equitable access to lifesaving treatments.
The superbug crisis may be gathering momentum, but concerted efforts across all levels of society offer a glimmer of hope in averting its catastrophic consequences.
Kellie Wark, MD, MPH, serves as an assistant professor in the Division of Infectious Diseases at the University of Kansas Medical Center.
- : public
