According to the Center for Disease Control (CDC), more than 2.8 million antibiotic-resistant infections occur in the United States each year, accounting for over 35,000 deaths and a major public health concern [1]. The estimated national cost to treat these infections can be more than $4.6 billion annually [1]. In such a context, it is now more crucial than ever for healthcare providers to understand the potential for the emergence and spread of drug-resistant infections at a community level [3].

The development of mutated infectious agents exhibiting resistance to treatment agents is nearly inevitable [3]. The rate of spread of drug resistance is determined by the balance between the selective pressure for evolution of resistance imposed by drug treatment and the fitness disadvantage of resistant agents relative to the original agent in the absence of treatment [3]. At present, five pathogens are considered to pose an urgent threat to human health: carbapenem-resistant Acinetobacter, carbapenem-resistant Enterobacteriaceae (CRE), Candida auris, drug-resistant Neisseria gonorrhoeae, and drug-resistant Clostridioides difficile [2].

It is not surprising that a large proportion of these antibiotic-resistant infections originate in the community [2]. Since its discovery in 2009, Candida auris has emerged as a severe threat to human health [3]. It can colonize the skin of healthy people and cause asymptomatic infection [3]. When spread to open wounds of more vulnerable people, more than 30% of these patients die [3]. The CDC has announced that highly drug-resistant strains of Candida auris are spreading from person to person, leading to increased mortality from infection [4]. When a fungal strain is not susceptible to the three main classes of antifungals (azoles, polyenes, and echinocandins), it becomes known as pan-resistant [4]. Dr. Cornelius Clancy, an infectious disease physician at the VA Pittsburgh Health Care System, warns that “an untreatable fungus infection would pose a grave threat to the immunocompromised, transplant recipients and critically ill patients in the I.C.U.” [4].

Influenza A and B viruses also remain among the leading global health threats [3]. The two influenza strains are responsible for roughly 20 million respiratory illnesses and 20,000 deaths annually in the United States alone [3]. Although vaccination remains the primary public health intervention, antiviral agents have represented a useful tool for the control and treatment of influenza infection [3]. Amantadines were the first of such agents but have the drawback of a high likelihood of inducing drug resistance [3].

In Medical News Today, coauthor Jason Harris of the Massachusetts General Hospital for Children describes his anxiety about severe resistant infections existing in the community: “If we don’t do anything to address it now, these [infections] will continue to spread, and they will inevitably be the new normal everywhere” [4]. The United States has established antibiotic resistance as a national priority, taking ambitious steps to ward off this threat [1]. The formation of a U.S. National Strategy for Combating Antibiotic-Resistant Bacteria and an accompanying U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria have allowed for better response to new public health threats, stronger detection of resistance, and enhanced efforts to slow the emergence and spread of resistance in the community [1].

References 

1. Antibiotic-resistant Germs: New Threats. (2021). Retrieved from https://www.cdc.gov/drugresistance/biggest-threats.html
2. Kadri, S. (2020). Key takeaways from the US CDC’s 2019 antibiotic resistance threats report for frontline providers. Critical Care Medicine. doi:10.1097/CCM.0000000000004371
3. Ferguson, N., Mallett, S., Jackson, H. etc. (2003). A population-dynamic model for evaluating the potential spread of drug-resistant influenza virus infections during community-based use of antivirals. Journal of Antimicrobial Chemotherapy, 51(4), 977-990. doi:10.1093/jac/dkg136
4. Williams, S. (2021). CDC Warns of Person-to-Person Transmission of Resistant Fungus. Retrieved from https://www.the-scientist.com/news-opinion/cdc-warns-of-person-to-person-transmission-of-resistant-fungus-69019