Antimicrobial Resistance

Staphylococcus aureus bacterium--one of the most common causes of infections worldwide--were found to be resistant to most available antimicrobial drugs, including vancomycin, the last line of treatment for these infections. A number of these patients have died. Although many studies have documented cases of infections that were difficult to treat because they were caused by resistant bacteria, the full extent of the problem remains unknown. The development and spread of resistant bacteria around the globe and the widespread use of antibacterials could potentially increase the U.S. public health burden. For example, antibacterials are used extensively worldwide in human and veterinary medicine, in agricultural production, and in industrial and household products. Antibacterials have also been found in food, soil, and water. Several federal agencies and international organizations that receive U.S. funds collect information about different aspects of antibacterial resistance, and some ongoing efforts involve collaboration among agencies. In the next several years, ongoing efforts to improve existing data sources and to create new ones may allow better characterization of the public health burden. Moreover, several agencies have data or access to data that could be used to learn more about the number of resistance infections, treatment costs, and antibacterial usage.

GAO noted that: (1) although many studies have documented cases of infections that are difficult to treat because they are caused by resistant bacteria, the full extent of the problem remains unknown; (2) GAO found many sources of information about the public health burden in the United States attributable to resistant bacteria, but each source has limitations and provides data on only part of the burden; (3) the public health burden attributable to resistant tuberculosis and gonorrhea is relatively well characterized because nationwide surveillance systems monitor these diseases; (4) little is known about the extent of most other diseases that can be caused by resistant bacteria, such as otitis media (middle ear infection), gastric ulcers, and cystitis (inflammation of the bladder) because they are not similarly monitored; (5) the development and spread of resistant bacteria worldwide and the widespread use of various antibacterials create the potential for the U.S. public health burden to increase; (6) data indicate that resistant bacteria are emerging around the world, that more kinds of bacteria are becoming resistant, and that bacteria are becoming resistant to multiple drugs; (7) while little information is publicly available about the actual quantities of antibacterials produced, used, and present in the environment, it is known that antibacterials are used extensively around the world in human and veterinary medicine, in agricultural production, and in industrial and household products and that they have been found in food, soil, and water; (8) a number of federal agencies and international organizations that receive U.S. funds collect information about different aspects of antibacterial resistance, and some ongoing efforts involve collaboration among agencies; (9) the Centers for Disease Control and Prevention (CDC) is the primary source of information about the number of infections caused by resistant bacteria; (10) CDC also collects information on resistance found in bacterial samples and the use of antibacterial drugs in human medicine; (11) CDC, the Department of Agriculture, and the Food and Drug Administration are collaborating on efforts to monitor resistant bacteria that can contaminate the food supply; (12) the Department of Defense conducts surveillance for antibacterial resistance at 13 military sites in the United States and at its 6 overseas laboratories; and (13) the World Health Organization serves as a clearinghouse for data on resistance in bacteria isolated from people and animals from many different countries.