It is well known that antibiotic-resistant bacteria have created an increasing challenge to healthcare providers and have caused significant morbidity and mortality in our society. The Centers for Disease Control and Prevention (CDC) estimates 23,000 deaths and 2 million illnesses occur each year in the United States as a result of resistant bacteria.
The global burden far exceeds this threshold, however, with many countries experiencing far higher rates of gram negative–resistant organisms than are present in the United States. The continuous threat of increasing antibiotic resistance may throw society back into a pre-antibiotic era, significantly curtailing many of the advances made in medicine that require antibiotics to work to remain viable treatment modalities, including surgery, ventilator/ICU care, and many aggressive cancer chemotherapy regimens.
Many forms of antibiotic-resistance mechanisms are ancient and have evolved over the millennia, as many of our current antibiotics are derivatives of naturally occurring antibiotics. Our antibiotic derivatives were designed to initially overcome resistance mechanisms; however, as the sheer volume of antibiotics utilized increased in concentrated environments, such as farms and hospitals, the bacteria's resistance mechanisms have evolved to counter our antibiotics. Overall resistance rates have swelled and spread worldwide as a result of inadequate infection control practices and the availability of international travel.
Despite recent efforts to curtail antibiotic use in humans through programs such as the CDC’s Get Smart About Antibiotics and recent proposals by the Joint Commission and the Centers for Medicare & Medicaid Services to enhance both infection control practices and antibiotic stewardship, these programs do nothing to control over 70% of the antibiotics made and distributed by humans. Most antibiotics are actually given to animals for the purpose of growth promotion to increase food production.1
The Society of Infectious Diseases Pharmacists recently published a position statement outlining the dangers caused by antibiotics used in agriculture in the April issue of Pharmacotherapy
The article reviews data that led to the belief that antibiotics increased animal food efficiency, but notes that these data are dated and based on old food production practices and feeds that potentially render the results invalid in modern agriculture.
The authors also describe methods of antibiotic-resistance transfer from the farm to humans other than through consumption of undercooked meats. Resistance can also spread through direct contact with the animal handlers who then have contact with the rest of society indirectly via waste water runoff from farms harboring both resistant bacteria and therapeutic levels of antibiotics, as well as through direct inoculation of flies that harbor resistant bacteria from the farm to sources outside of the farm. These modes of documented resistant-bacteria transfers highlight the complex nature of the problem.1