Download CDC Antibiotic Resistance Threats Report

CDC estimates that in the United States, more than 2 million people are infected every year with antibiotic-resistant infections, with at least 23,000 dying as a result. These are likely conservative estimates.

Urgent Threats

  • Clostridium difficile
  • Carbapenem-resistant Enterobacteriaceae (CRE)
  • Drug-resistant Neisseria gonorrhoeae

Serious Threats

  • Multidrug-resistant Acinetobacter
  • Drug-resistant Campylobacter
  • Fluconazole-resistant Candida
  • Extended Spectrum β-lactamase Producing Enterobacteriaceae (ESBLs)
  • Vancomycin-resistant Enterococci (VRE)
  • Multidrug-resistant Pseudomonas aeruginosa
  • Drug-resistant non-typhoidal Salmonella
  • Drug-resistant Salmonella typhi
  • Drug-resistant Shigella
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Drug-resistant Streptococcus pneumoniae
  • Drug-resistant Mycobacterium tuberculosis

Concerning Threats

  • Vancomycin-resistant Staphylococcus aureus (VRSA)
  • Erythromycin-resistant Group A Streptococcus
  • Clindamycin-resistant Group B Streptococcus

Staphylococcus aureus

(Tamma PD, Robinson GL, Gerber JS, Newland JG, DeLisle CM, Zaoutis TE, Milstone AM. Pediatric Antibiotic susceptibility trends across the United States. Infect Control Hosp Epidemiol. 2013 Dec;34(12):1244-51.)

  • A pooled pediatric antibiogram representing 200 pediatric healthcare institutions across the United States from 2005 and 2011 demonstrated that 50% of all Staphylococcus aureus isolates were methicillin-resistant and 21% of S. aureus isolates were resistant to clindamycin.

Enterococcus faecium

(Tamma PD, Robinson GL, Gerber JS, Newland JG, DeLisle CM, Zaoutis TE, Milstone AM. Pediatric Antibiotic susceptibility trends across the United States. Infect Control Hosp Epidemiol. 2013 Dec;34(12):1244-51.)

  • In the pooled pediatric antibiogram described above, among Enterococcus faecium isolates, the prevalence of resistance to ampicillin was 75%, to vancomycin was 55%, and to linezolid was 8%.

ESBL-Producing Enterobacteriaceae in Children

Logan LK, Braykov NP, Weinstein RA, Laxminarayan R; CDC Epicenters Prevention Program. Extended-Spectrum β-Lactamase-Producing and Third-Generation Cephalosporin-Resistant Enterobacteriaceae in Children: Trends in the United States, 1999-2011. J Pediatric Infect Dis Soc. 2014 Dec;3(4):320-8.

  • National data from The Surveillance Network Database demonstrated an increase in prevalence of third generation cephalosporin-resistant and ESBL-producing Enterobacteriaceae, from 1.39% and 0.28% in 1999–2001 to 3% and 0.92% in 2010–2011 respectively.

Carbapenem-resistant Enterobacteriaceae

Logan LK, Renschler JP, Gandra S, Weinstein RA, Laxminarayan R; Centers for Disease Control; Prevention Epicenters Program. Carbapenem-Resistant Enterobacteriaceae in Children, United States, 1999-2012. Emerg Infect Dis. 2015 Nov;21(11):2014-21.

  • Logan et al analyzed 316,253 isolates from children and identified 0.08% as carbapenem-resistant Enterobacteriaceae (CRE).
  • CRE infection rate increases were highest for Enterobacter species, blood culture isolates, and isolates from intensive care units, increasing from 0% in 1999–2000 to 5.2%, 4.5%, and 3.2%, respectively, in 2011–2012.

Antibiotic Resistant Organisms in Food-Animals and Meat

Methicillin-resistant Staphylococcus aureus (MRSA)

Extraintestinal E. coli Infection

Non-typhoidal Salmonella Species

5% are now resistant to 5 or more classes of antibiotics

Campylobacter Species

Ciprofloxacin resistance has overall increased from 13% in 1997 to almost 25% in 2011. FDA removed enrofloxacin from use in poultry in 2005.

Antibiotic Resistance: Tackling a Crisis for the Health and Wealth of Nations

  • Commissioned by the UK Prime Minister, economist Jim O’Neill conducted an independent analysis of the global problem of antimicrobial resistance (AMR) and proposed concrete actions.
  • The report estimates that unless effective action is taken, drug-resistant strains of tuberculosis, malaria, HIV, MRSA, E. coli and Klebsiella pneumoniae could claim 10 million lives each year by 2050. This would cost of 100 trillion USD over the next 35 years.

Historically, antibiotics have been used in food animals for growth enhancement, disease prevention, and to treat diagnosed disease in sick animals. U.S. Food and Drug Administration (FDA) regulations effective January 2017 will no longer allow the use of antibiotics for growth promotion, and require veterinarian oversight for use of antibiotics in food animals. However, there is a concern that allowance of antibiotics for disease prevention could perpetuate industrial methods of livestock production that emphasize confining a large number of animals in close quarters. Crowding and confining animals prompts a higher risk of disease outbreaks and of transmission of antibiotic resistant bacteria between animals and from animals to environment. For many years, widespread antibiotic use in animal agriculture has contributed to the selection of antibiotic resistant bacteria within livestock hosts and their waste products. This puts the public at risk of being exposed to resistant bacteria through contact via soil or water, interaction with farm workers, and handling or consumption of contaminated meat products Practices that promote meticulous antibiotic stewardship are vital in the effort to control antibiotic resistance. Veterinarians in the agriculture industry are working to address this use through more stewardship efforts.

According to the Food and Drug Administration (FDA), more kilograms of antibiotics sold in the United States are used for food producing animals than for people. In 2011, 13.8 million kg of antibiotics were attributed to sales and distribution in food-producing animals; this translates to approximately 70% of the overall tonnage of antibiotic agents sold in the United States. Despite the widespread use of antibiotics in food animals that these sales data suggest, we actually know very little about which antibiotics are used in what species and for which indications; this knowledge gap contrasts rather sharply with the data available for human clinical use. For more information on incorporating food stewardship into an ASP, see the “Meat Procurement Strategies” section of the Antibiotic Stewardship Through Food Animal Agriculture Module produced by CCCAS.

Antibiotic Stewardship Beyond Clinical Care