Drug-resistant bacteria are a global problem:

 

The last decade has seen the inexorable proliferation of a host of antibiotic cresistant bacteria, or bad bugs, not just MRSA, but other insidious players as well. ...For these bacteria, the pipeline of new antibiotics is verging on empty. 'What do you do when you're faced with an infection, with a very sick patient, and you get a lab report back and every single drug is listed as resistant?' asked Dr. Fred Tenover of the Centers for Disease Control and Prevention (CDC). 'This is a major blooming public health crisis.'" -Science magazine; July 18, 2008

 

In recent testimony by the Infectious Diseases Society of America (IDSA), June 2010, before a US House Committee on Energy and Commerce Subcommittee on Health the following key points emerged:

 

In response to the expanding crisis, IDSA recently launched the 10 x '20 initiative. The 10 x '20 goals are to create a sustainable antibiotic R&D enterprise, which in the short-term can produce 10 new safe and effective antibiotics by 2020.

 

The bottom line: The relentless spread of a growing number of drug-resistant infections in our hospitals and communities and the diminishing number of antibiotics being approved have made it more and more difficult for physicians to protect patients and save lives-morbidity and mortality are on the rise. The dearth of new antibiotics in development is deeply troubling to health experts and has the potential to change the practice of medicine as we know it. A number of advanced interventions that we currently take for granted-e.g. surgery, cancer treatment, transplantation and care of premature babies-would be impossible to perform without effective antibiotics.

 

In the United States:

• Two million people each year acquire healthcare-associated infections (HAIs)
• 100,000 die as a result (more than AIDS, breast cancer and traffic accidents combined)
• Annual cost to society is $5.7 - 6.8 billion based on latest CDC figures
• 29% of the population carries Staphylococcus aureus
• 79 million people carry MSSA, of which 4 million carry MRSA
• 94,000 serious MRSA infections occurred in 2005
• 19,000 patients died from MRSA infection in 2005
• Older people are particularly at risk

In the United Kingdom:

• 5,000 deaths each year from HAIs
• 300,000 patients suffer non-fatal HAIs
• HAIs affect an estimated one in ten UK NHS patients each year
• Annual cost to the UK NHS is £1 billion

In Asia:

• Drug-resistant strains now common in hospitals
• Singapore - 63%
• Korea - 70%
• Japan - 74%
• Taiwan - 82%

MRSA is one of many drug-resistant bacteria that cause serious infections. Life-threatening infections are also caused by Clostridium difficile, vancomycin-resistant Enterococci (VRE), fluoroquinolone-resistant Pseudomonas aeruginosa (FQRP), and multidrug-resistant forms of other pathogens such as Streptococcus pneumoniae, Mycobacterium tuberculosis, Acinetobacter spp. and Salmonella spp.

Tackling the problem of MRSA

Given the limitations of treating MRSA infections with existing antibiotics, increasing emphasis is being placed on prevention, with screening and decolonisation taking their place alongside increased levels of hygiene. Routine screening and decolonisation of patients is now an established part of many infection control protocols and has been shown to be highly effective in preventing infection.

• In the USA, as of October 1, 2008, the Centers for Medicaid and Medicare services will no longer reimburse hospitals for costs associated with certain avoidable healthcare-associated infections
• 2010 heralded a landmark clinical trial publication in the New England Journal of Medicine by Bode et al which presented data demonstrating the value in decolonisation (nasal & body) of the most common cause of hospital bacterial infections, namely methicillin sensitive Staphylococcus aureus (MSSA). The clinical data indicated a halving of the number of post-surgical MSSA infections by adopting a decolonisation regimen. This study builds and extends the decolonisation regimen already in widespread use for reducing the infection risk posed by the notorious Superbug MRSA This publication has, and is, impacting healthcare bodies around the world and the implications for widespread nasal decolonisation of Stapylococci (MRSA and now MSSA) are significant
• Routine, mandatory MRSA screening and decolonisation has been part of the National Health Services (NHS) front line infection control since 2008. Andrew Lansley, Minister for Health recently confirmed that screening would be extended to MSSA, in other words all patients entering the NHS for surgery (some 3 million per annum) will be nasally screened for any Staphylococci carriage (MSSA or MRSA). A number of NHS hospitals now also decolonise MSSA-carrying hospital patients, particularly those undergoing "high infection risk" surgeries
• In the Netherlands, years of routine screening, decolonisation and isolation has kept MRSA prevalence below one per cent - a fraction of the levels seen in countries without such infection control policies
• Tony Fauci (Head of the National Institute for Allergy & Infective Disease {NIAID}, USA) made a number of key announcements at the Infectious Disease society of America (IDSA) in October 2010 where he announced that NIAID will extend their Service Offering - i.e. funding clinical development of promising new anti-infective drugs in the USA. He also indicated that the US Government will make new funds available for Public:Private partnerships in recognition of funding gap for SME Pharma/Biotech to clinically develop new anti-infective drugs

Unfortunately, increased use of existing antibiotics for prevention may lead to increased resistance - a vicious circle. New antibacterials are urgently needed to which resistance will not develop. Such products would revolutionise infection control and offer reliable prevention of infection.