CDC released its report that describes antimicrobial resistance accounting for 2 million infections and 23,000 deaths each year in the United States. In addition, illness caused by the bacteria Clostridium difficile, which is associated with antibiotic use, accounts for 250,000 hospitalizations and 14,000 deaths nationally. CDC estimates that up to 50 percent of all the antibiotics prescribed for people are not needed or are not prescribed appropriately.
Minnesota has long been in the forefront of identifying and addressing antibiotic resistance threats, said Minnesota State Epidemiologist Dr. Ruth Lynfield. "We have worked extensively with our partners in public health and patient care to identify and control the spread of antibiotic-resistant infections. However, we need to continue to work on this issue aggressively and we need everyone's help." Minnesota's work falls in line with CDC's strategy of employing four core actions to combat the threat of antibiotic resistance:
• Prevent infections and prevent the spread of resistance.
• Track antibiotic resistant infections, causes of infections and risk factors.
• Improve antibiotic use and stewardship.
• Encourage the research and development of new antibiotics and diagnostic tests.
Some highlights of Minnesota's work:
• The Minnesota Department of Health (MDH) has a long partnership with infection preventionists to prevent and control infections, especially of resistant bacteria, in hospitals and other patient care settings. Task forces have targeted carbapenem resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA), C. difficile, surgical site infections, and infections in long-term care facilities.
• Minnesota has a robust disease surveillance system and has used this system to identify antibiotic resistant pathogens. MDH has participated in CDC's Emerging Infections Program, and has worked with infection preventionists, other clinicians and laboratorians in Minnesota to track invasive bacterial disease and foodborne infections since 1995. MDH has disseminated information on resistant bacteria to clinical laboratories and the broader public health and medical community through its yearly antibiogram since 1999.
• Minnesota was a pioneer in antimicrobial stewardship programs. MDH partnered with health plans, medical and pharmacists' associations in 2001 in forming the Minnesota Antimicrobial Resistance Collaborative to address issues of antibiotic resistance and appropriate antimicrobial use. A year ago, MDH launched a statewide program to help develop and implement antimicrobial stewardship programs across the continuum of healthcare settings, beginning with acute care facilities and expanding to long-term care facilities. Through an Antimicrobial Stewardship Program Steering Group, MDH has provided tools to help facilities implement their programs.
• Minnesota epidemiologists conducted some of the research that linked fluoroquinolone-resistant Campylobacter infections in humans to the use of fluoroquinolones in poultry; this work was a key factor in the removal of fluoroquinolones from use in poultry.
"Resistance to antimicrobials is an urgent and critical public health threat," Lynfield said. "Unfortunately, life-threatening drug-resistance infections are increasing at the same time that the development and availability of new antibiotics is at an all-time low. Antimicrobial resistance is a problem for everyone and everyone needs to work on preserving these precious tools." Some steps that all Minnesotans can take include:
• Use antibiotics only when needed. Do not pressure your doctor for antibiotics. They do not work for infections that are not bacterial.
• If you are given antibiotics, take as directed. Do not save your antibiotics for another illness.
• Promote the use of infection prevention interventions, such as vaccines, good hand washing and safe food handling.
Lynfield said public health and health care professionals need to work with their colleagues in veterinary medicine to ensure that antibiotics are used wisely. This includes limiting the use of antibiotics to therapeutic and disease prevention purposes only, under the supervision of a veterinarian. It is important to stop using antibiotics for promoting growth in animals.
Lynfield said it is also important for the public and policy-makers to support the development of new antibiotics. "Any antibiotic use will provide pressure for bacteria to develop resistance, so while we are preserving the tools we have today, we need to simultaneously work on the tools for tomorrow; it takes an average of 10 years for a new antibiotic to move from the laboratory bench to the pharmacy. In addition we need to work on developing new technologies to identify resistance in bacteria as laboratory diagnostics advance beyond routine culture techniques. "
More information on antibiotic resistance can be found on the MDH website at http://www.health.state.mn.us/divs/idepc/dtopics/antibioticresistance/index.html.