Antibiotic Resistance: A Continued Threat -Resistant : CDC 2019 Threat Report

Antibiotic Resistance: A Continued Threat

• More than 2.8 million antibiotic-resistant (AR) infections occur in the US annually • AR infections result in over 35,000 deaths each year • In 2017, approximately 223,900 patients in the US required hospitalization due to Clostridioides difficile (C. difficile) and at least 12,800 died Antibiotic-Resistant Infections: CDC 2019 Threat Report

Urgent Threats • The 2019 list of “urgent” threats has grown with the addition of drug-resistant Candida auris and carbapenem-resistant Acinetobacter • Carbapenem-resistant Enterobacteriaceae (CRE), , and C. difficile continue to be listed as urgent threats Antibiotic-Resistant Infections: CDC 2019 Threat Report Drug-Resistant Candida auris • Candida auris is emerging as a multidrug- resistant fungus that can cause outbreaks particularly in long-term healthcare facilities • 323 cases in 2018; increase of 318% compared with numbers reported in 2015 to 2017 • 90% of isolates resistant to at least 1 antifungal, 30% resistant to at least 2 antifungals • Common healthcare disinfectants may not be as effective in eliminating the fungus • In 2018, FDA approved the first test to identify C. auris (Bruker Maldi Biotyper CA System) Antibiotic-Resistant Infections: CDC 2019 Threat Report Carbapenem-Resistant Acinetobacter

• Carbapenem-resistant Acinetobacter infections often occur in hospitalized patients and can cause pneumonia as well as wound, bloodstream, and urinary tract infections • 8500 cases and 700 deaths in 2017 • The can survive a long time on surfaces in healthcare facilities • Some strains are resistant to almost all ; treatment options for carbapenem-resistant Acinetobacter baumannii are very limited • Few drugs in development for treatment Antibiotic-Resistant Infections: CDC 2019 Threat Report Watch List

• A “watch” list has been added to the 2019 report

• on the watch list have yet to Aspergillus fumigatus spread resistance widely in the US, but have the potential if not closely monitored and if an aggressive approach is not taken • These include: genitalium • Azole-resistant Aspergillus fumigatus • Drug-resistant Mycoplasma genitalium • Drug-resistant Bordetella pertussis Bordetella pertussis Antibiotic-Resistant Infections: CDC 2019 Threat Report Azole-Resistant Aspergillus fumigatus

• Can cause -threatening infections in immunocompromised patients • Symptoms similar to other respiratory infections • Few infections detected in US; more reported in other countries • Most US labs unable to test for resistance Antibiotic-Resistant Infections: CDC 2019 Threat Report Drug-Resistant Mycoplasma genitalium

• Sexually transmitted infections; can cause in males and in females • Untreated infections can lead to pelvic inflammatory disease in women • is the current recommended treatment, however resistance is growing globally • In 2018, FDA approved the first test for M. genitalium bacterium detection (Aptima Mycoplasma genitalium Assay) Antibiotic-Resistant Infections: CDC 2019 Threat Report Drug-Resistant Bordetella pertussis

• Causes pertussis (also known as whooping cough) • Best protection is through vaccination • Antibiotic-resistance rarely reported in the US, however it has been documented in other countries • Current recommended treatments include azithromycin and Antibiotic-Resistant Infections: CDC 2019 Threat Report Serious Threats

• Drug-resistant Campylobacter • Drug-resistant Candida • ESBL-producing Enterobacteriaceae • Vancomycin-resistant Enterococci (VRE) • Multidrug-resistant Pseudomonas aeruginosa • Drug-resistant nontyphoidal Salmonella • Drug-resistant Salmonella Serotype Typhi • Drug-resistant Shigella • Methicillin-resistant (MRSA) • Drug-resistant pneumoniae • Drug-resistant Tuberculosis Antibiotic-Resistant Infections: CDC 2019 Threat Report Concerning Threats • Erythromycin-resistant Group A Streptococcus • Clindamycin-resistant Group B Streptococcus

Group A Streptococcus Group B Streptococcus Antibiotic-Resistant Infections: CDC 2019 Threat Report Recommendations for Healthcare Professionals • Follow infection prevention and control recommendations • Ensure patients receive recommended vaccines • Alert receiving facilities of patients colonized or infected with drug-resistant pathogens • Follow clinical and treatment guidelines • In patients with respiratory infections not responding to antibiotics, consider fungal infections • Watch for sepsis; start antibiotics as soon as possible • Diagnostic tests should be performed to guide therapy • Be aware of outbreaks, resistance patterns • Report cases of resistant isolates to health department