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Antibiotic Resistance Threats in the United States, 2013 report

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ANTIBIOTIC RESISTANCE THREATS IN<br />

THE UNITED STATES, <strong>2013</strong><br />

Executive Summary<br />

<strong>Antibiotic</strong> <strong>Resistance</strong> <strong>Threats</strong> <strong>in</strong> <strong>the</strong> <strong>United</strong> <strong>States</strong>, <strong>2013</strong> is a snapshot of <strong>the</strong> complex problem<br />

of antibiotic resistance today and <strong>the</strong> potentially catastrophic consequences of <strong>in</strong>action.<br />

The overrid<strong>in</strong>g purpose of this <strong>report</strong> is to <strong>in</strong>crease awareness of <strong>the</strong> threat that antibiotic<br />

resistance poses and to encourage immediate action to address <strong>the</strong> threat. This document<br />

can serve as a reference for anyone look<strong>in</strong>g for <strong>in</strong>formation about antibiotic resistance. It is<br />

specifically designed to be accessible to many audiences. For more technical <strong>in</strong>formation,<br />

references and l<strong>in</strong>ks are provided.<br />

This <strong>report</strong> covers bacteria caus<strong>in</strong>g severe human <strong>in</strong>fections and <strong>the</strong> antibiotics used to<br />

treat those <strong>in</strong>fections. In addition, Candida, a fungus that commonly causes serious illness,<br />

especially among hospital patients, is <strong>in</strong>cluded because it, too, is show<strong>in</strong>g <strong>in</strong>creas<strong>in</strong>g<br />

resistance to <strong>the</strong> drugs used for treatment. When discuss<strong>in</strong>g <strong>the</strong> pathogens <strong>in</strong>cluded <strong>in</strong> this<br />

<strong>report</strong>, Candida will be <strong>in</strong>cluded when referenc<strong>in</strong>g “bacteria” for simplicity. Also, <strong>in</strong>fections<br />

caused by <strong>the</strong> bacteria Clostridium difficile (C. difficile) are also <strong>in</strong>cluded <strong>in</strong> this <strong>report</strong>.<br />

Although C. difficile <strong>in</strong>fections are not yet significantly resistant to <strong>the</strong> drugs used to treat<br />

<strong>the</strong>m, most are directly related to antibiotic use and thousands of Americans are affected<br />

each year.<br />

Drug resistance related to viruses such as HIV and <strong>in</strong>fluenza is not <strong>in</strong>cluded, nor is drug<br />

resistance among parasites such as those that cause malaria. These are important<br />

problems but are beyond <strong>the</strong> scope of this <strong>report</strong>. The <strong>report</strong> consists of multiple one or<br />

two page summaries of cross-cutt<strong>in</strong>g and bacteria- specific antibiotic resistance topics.<br />

The first section provides context and an overview of antibiotic resistance <strong>in</strong> <strong>the</strong> <strong>United</strong><br />

<strong>States</strong>. In addition to giv<strong>in</strong>g a national assessment of <strong>the</strong> most dangerous antibiotic<br />

resistance threats, it summarizes what is known about <strong>the</strong> burden of illness, level of<br />

concern, and antibiotics left to defend aga<strong>in</strong>st <strong>the</strong>se <strong>in</strong>fections. This first section also<br />

<strong>in</strong>cludes some basic background <strong>in</strong>formation, such as fact sheets about antibiotic safety<br />

and <strong>the</strong> harmful impact that resistance can have on high-risk groups, <strong>in</strong>clud<strong>in</strong>g those with<br />

chronic illnesses such as cancer.<br />

CDC estimates that <strong>in</strong> <strong>the</strong> <strong>United</strong> <strong>States</strong>, more than two million people are sickened every<br />

year with antibiotic-resistant <strong>in</strong>fections, with at least 23,000 dy<strong>in</strong>g as a result. The estimates<br />

are based on conservative assumptions and are likely m<strong>in</strong>imum estimates. They are <strong>the</strong> best<br />

approximations that can be derived from currently available data.<br />

Regard<strong>in</strong>g level of concern, CDC has — for <strong>the</strong> first time — prioritized bacteria <strong>in</strong> this <strong>report</strong><br />

<strong>in</strong>to one of three categories: urgent, serious, and concern<strong>in</strong>g.<br />

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