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Stomping out the Superbugs

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Since Alexander Fleming first discovered penicillin nearly 100 years ago in 1928, antibiotics have been used to help treat infections and save millions of lives around the world. But recently, overuse of antibiotics in everything from prescriptions to livestock to agricultural products has taken what was once seen as a lifesaving cure and created a looming global health crisis—antimicrobial resistant infections. The micro-organisms that cause infections such as pneumonia, tuberculosis, HIV, and post-operative infections are becoming increasingly difficult to predict. Over time, these organisms have mutated and evolved to outsmart the very medications that were designed to treat them—becoming what’s commonly known as a superbug.

Each year, 700,000 people die from superbug infections and a new study estimates that that number could rise to 10 million by 2050—making superbug infections one of the biggest known threats to humanity today—and unless urgent action is taken, that threat will only continue to grow.

 “Antibiotic resistance threatens our ability to treat even simple bacterial infections,” said Ebbing Lautenbach, MD, MPH, MSCE, chief of the division of Infectious Diseases in the Perelman School of Medicine at the University of Pennsylvania. “Superbugs are quickly becoming one of the biggest threats to modern medicine.”

That’s why the United Nations and its 193 member states are looking to make big strides in the coming years to stomp out these superbug infections. Last week, during the United Nations General Assembly in New York, the UN made history by signing a global declaration to combat these infections.  To date, the UN has only agreed on three other global health interventions: HIV in 2001, non-communicable diseases in 2011, and Ebola in 2013—putting superbugs in an elite but urgent group of public health challenges that impact people around the world.

Lautenbach was one of many experts who attended the global forum in New York last week, urging UN countries to take the pledge.

“The acknowledgment from the UN is long overdue,” Lautenbach said. “Superbugs used to be thought of as local or regional challenges, but we are now seeing that these organisms can spread rapidly from country to country, meaning the response to antimicrobial resistance must be a global one.”

Research suggests that as many as half of all antibiotic prescriptions are unnecessary, but doctors provide them because patients demand them—thinking the medication will make them better when the opposite could be true.

“The most important driver of superbugs is the overuse of antibiotics,” Lautenbach said. “There are many health conditions not caused by bacteria, yet antibiotics are often prescribed. We need to do a better job of identifying situations in which antibiotics are truly needed and then prescribe them to patients for as short of a duration as possible.”

And overuse of antibiotics goes far beyond medicine. Antibiotics are also used in agriculture to treat sick animals, prevent infections, and to help them gain weight, a practice that is deemed controversial by many experts.

The question now becomes, how can we turn back the tide on these superbugs?

“The UN declaration is an excellent first step,” Lautenbach said. “We need a commitment on the global scale to stop the overuse of antibiotics and work together to develop new ways of treating infections that won’t be prone to the same mutations that lead to superbugs in the first place.”

The UN Declaration calls on its member countries to:

  • Develop surveillance and regulatory systems on the use and sales of antimicrobial medicines for humans and animals
  • Encourage innovative ways to develop new antibiotics, and improve rapid diagnostics
  • Educate health professionals and the public on how to prevent drug-resistant infections

As part of the effort to develop innovative approaches to prevention superbugs, Penn, in partnership with the Children’s Hospital of Philadelphia, has been a U.S. Centers for Disease Control and Prevention (CDC) Prevention Epicenter site since 2010. Penn is one of 10 academic medical centers to receive the designation as part of the CDC‘s patient safety research effort known as the Prevention Epicenters Program, which was created in 1997 to address the emerging problem of health care-associated infections.

Lautenbach is the principal investigator for the Penn-CHOP site, which includes research on efforts to enhance antimicrobial stewardship strategies to optimize antibiotic use in the hospital, better identify patients who have a low likelihood of infection, and develop strategies to address the potential role of the hospital environment itself in the spread of superbugs. Jeff Gerber, MD, PhD, an attending physician at CHOP and a senior scholar in Penn’s Center for Clinical Epidemiology and Biostatistics, also serves as co-principal investigator.

“We can hope that with these new commitments from the UN and the ongoing research being done here at Penn and around the world, we can make significant progress to end this epidemic,” Lautenbach said. “Consider HIV, which since 2004 has seen a 45 percent decrease in deaths thanks to global campaigns to treat and prevent the virus.  The same level of urgency must now be applied to superbugs if we aregoing to have an impact in addressing this critical threat.” 

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