Authored by: Venkat Rao
Superbugs are certain strains of viruses, bacteria and fungi that are resistant to most currently available antibiotics and other drugs to treat infectious disease. Drug resistant pathogens is the most formidable health security challenge faced by the public health authorities globally.
With COVID-19 pandemic still in play, there is a renewed focus on infectious diseases as more and more drugs to treat dangerous infectious diseases such as pneumonia, septicemia, tuberculosis, urinary tract, and skin infections are becoming less effective and, in many cases, totally ineffective. Until recently, infectious diseases were not a top-priority area for pharmaceutical companies, as they viewed this category as a narrow market, until recently when COVID-19 pandemic hit the global stage. Infectious diseases were considered for the most part a public health burden of the developing world, which is the least profitable market for global pharmaceutical companies.
As a result, there is no research and development pipeline of new anti-microbial drug and antibiotics that we need to combat the growing global challenge of infectious diseases in general, and drugs to target multi-drug resistant superbugs, in particular. So far hospitals and medical facilities were faced with the problem of multi-drug resistant pathogens, but a recent study from the US Centers for Disease Control and Prevention (CDC) indicate that the infections caused by multidrug-resistant bacterial pathogens are moving beyond healthcare settings.
According to the just published report in the American Journal of Infection Control and
based on US emerging diseases public health surveillance data, one in ten public health departments reported infections caused by Carbapenem-Resistant Enterobacterales (CRE) occurred outside hospital settings, and occurring in patients without known healthcare risks, like hospitalization or residence in long-term care facilities. Most were found in individuals with urinary tract infections.
Why is this a significant public health and health security concern?
CRE infections are extremely difficulty to treat as it is resistant to most categories of antibiotics and are considered by the CDC as a major public health threat. Until recently, CRE was reported mostly from within the hospital settings and remain a key target for hospital hygiene and infection control measures. An earlier CDC study reported 12,700 hospitals centric CRE infections in the United States in 2020, an increase of 35% from 2019. However, the recent study using emerging infectious surveillance data delineated CRE cases as hospital-associated and community-associated cases and found among the 1,499 CRE cases a total of 149 (or 10%) categorized as community-associated CRE infection. According to this report, the highest number of community-associated CRE were from New York and New Mexico and the sites with highest number of hospital-associated CRE were Maryland and Georgia.
New surveillance data show CRE infections in community settings and among a broader population outside of the hospital as an extremely serious issue. Control measures at the community-level are difficult to establish and are less likely to be successful. Even with strict infection control and hygiene practices, hospitals find it extremely hard to prevent CRE infection and provide successful treatment and control measures. These challenges grow many folds if the problem spreads outside of healthcare settings to the broader population.
How to stop Superbugs?
Unfortunately, there is no silver bullet, so to speak, to stop emergence and spread of superbugs. With very limited private sector investment until recently towards research and development of new antibiotics and anti-infective agents against superbugs, public health agencies have adopted various ad hoc interim strategies, some with prospect of modest success such as:
1. Engaging communities to judiciously use antibiotics. Reckless prescription of antibiotics is one the primary causes for the emergence of superbugs.
2. Educate communities on superbugs and extend preventive measures in use at healthcare settings to more broadly at community-level recreational, cultural, and educational establishments.
3. Invest in innovative methods to research and development of new drugs and antibiotics. Fund product development facilities in countries, such as India, which has a large generic drug development infrastructure.
4. Change antibiotics prescribing practices at the medical service provider level. This is a crucial control point to judicious use of antibiotics.
5. Detect superbug emergence in veterinary population and in the Agro-bio industry sector. Very large-scale use of antimicrobial products in this industry sector is a conducive environment for the origin of superbugs.
In summary, we need an aggressive global health and health security agenda to combat the scary prospect of superbugs emergence and spread at the community level.