The same day reports from China signaled the return of the plague (aka Black Death)—a nightmarish disease you might have thought disappeared with the Dark Ages— new estimates were released by the Centers for Disease Control and Prevention showing that infections and deaths are on the rise in the U.S. from another scary cause: superbugs, also known as antibiotic-resistant bacteria.
Unlike superbug infections, plague is treatable with effective antibiotics—for now, at least. With resistance on the rise to all sorts of antibiotics, let's hope things stay that way.
The latest CDC estimates are that more than 2.8 million people in the U.S. get sick each year from superbugs, and these infections are the primary cause of death for 35,000 of them. Though quite a bit higher than the agency's last estimates in 2013, the CDC figure still likely understates the problem. In fact, it is more than four times lower than an alternative set of estimates published last year by infectious diseases experts at Washington University in St. Louis, which put the possible toll at more than 160,000 deaths per year.
As my colleague, Avinash Kar, puts it, "While CDC’s estimates have improved, they remain conservative." Last year's much higher estimates were derived using an approach that differed from the CDC's approach in significant respects. While CDC's death totals are limited only to those cases for which a multi-drug resistant infection was the primary cause, for example, there are far more cases where a superbug infection is only one among many factors leading to death. In those cases, it's common for the death certificate to attribute death to something like heart failure, or a car accident or a battle wound. Would that person have died of their underlying injury or disease if they hadn't also contracted a superbug? That's a hard question to answer.
Regardless of whether superbugs cause or contribute to 35,000 or 160,000 deaths each year, it's still a huge number. And a number that is quickly rising. In the latest CDC report, for example, the number of superbug infections caused by resistant Salmonella and Camplyobacter, the two most common bacteria responsible for food poisoning, were higher than in the 2013 report; cases of drug-resistant Salmonella more than doubled, to 215,000 annually.
Curbing antibiotic resistance and the deaths it is helping to cause should be our focus. Use of antibiotics is the main factor driving the development and spread of resistance to those drugs.
The CDC report correctly lauds the progress being made in curbing antibiotic use and resistance in health care settings. Unfortunately, it remains silent on our urgent need to also curb antibiotic use and resistance in livestock, where the vast majority of antibiotics of medical important are used. In fact, nearly two-thirds of sales of antibiotics important to human medicine are going to livestock, not people. And most of those are given to cows and pigs when they may not even be sick.
This continued overuse of antibiotics in American livestock is helping to create a future without many of the advantages of 'modern medicine', according to leading experts from the World Health Organization to the American Academy of Pediatrics. That future will become reality when the life-saving antibiotics we rely on simply no longer work well enough to treat common infections, or to make it possible to perform C-sections, dialysis, organ transplants or joint replacements responsibly. And, as CDC recognized, in that future “everyone is at risk.”