Preserving the lives of seniors and all Americans means preserving antibiotic use

Older Americans make up 15 percent of the U.S. population but account for more than one-third of the deaths from antibiotic-resistant bacterial infections. That’s one of the main findings of a new study from The Pew Charitable Trusts, University of Utah, and Infectious Diseases Society of America — a study that reinforces the need for Congress and the Centers for Medicare and Medicaid Services (CMS) to act to curb the spread of antibiotic-resistant bacterial infections, also known as superbugs.

The research looked at six bacteria that kill nearly 30,000 people in the U.S., and cost $4.6 billion to treat, each year. The analysis found that, among these victims, more than 11,500 were at least 65 years old, with their treatment costing $1.9 billion. 

The importance of antibiotics for Americans of any age can’t be overstated. However, they’re especially critical for seniors, who tend to be more vulnerable to infectious diseases than younger people. Since their discovery about a century ago, antibiotics have turned once-lethal infections into mere nuisances for many, and significantly reduced the risk of infection from surgery and other procedures.

But unfortunately, the more we use antibiotics, the less effective they become. That’s because while most bacteria die off when they’re exposed to the drugs, a select few with the right genetic mutations survive. Eventually, these resistant germs become the norm and we need a new antibiotic to kill them. The new antibiotic again kills most pathogens, but again another subset survives and thrives. This cycle repeats until the emergence of superbugs — microbes that resist many or, in some cases, all antibiotics. When that happens, we risk losing everything antibiotics make possible, including critical therapies and medical procedures, such as chemotherapy and hip replacement surgeries, that many seniors rely on.

We’ve known about antibiotic resistance for decades. Indeed, the scientist who discovered the curative power of penicillin, Sir Alexander Fleming, warned in 1945 that the drugs would grow less effective over time. In the decades that followed, new antibiotic discoveries kept humanity a few steps ahead of the germs. However, innovation in antibiotic development has now slowed to a crawl: Thirty-two different antibiotic classes were discovered before 1984, but none since. Meanwhile, bacteria keep evolving and becoming more drug-resistant.

Research from the Centers for Disease Control and Prevention and The Pew Charitable Trusts published in 2016 determined that about 30 percent of all outpatient antibiotic prescriptions — 47 million in total — are unnecessary. In another study, Pew and CDC found that nearly 80 percent of inpatient antibiotic prescriptions for two of the most common infections — community-acquired pneumonia and urinary tract infections — were clinically inappropriate. Fortunately, some trends are moving in the right direction. For example, in recent years, outpatient antibiotic prescribing dropped 5 percent, and deaths from antibiotic-resistant infections overall and in hospitals are down 18 percent and 28 percent, respectively.

The federal government has a critical role to play in advancing these positive trends by improving prescribing and spurring the development of new medicines. Specifically, CMS should:

• Incentivize hospitals, physicians and other health care practitioners to track antibiotic use and resistance data and report it to public health authorities through CDC’s National Healthcare Safety Network. This could identify patterns of disease and inappropriate prescribing that inform further action to improve care;
• Develop and implement quality measures around antibiotic prescribing and resistance in nursing homes, which would strengthen antibiotic stewardship programs in long-term care settings. These measures would enable CMS to assess — and share with consumers — the quality of antibiotic prescribing and how well nursing homes prevent antibiotic resistant infections. They would also help guide these facilities to identify areas in need of improvement, and;
• Reduce inappropriate antibiotic prescribing by outpatient health care providers by incorporating stewardship activities into CMS’s existing quality measures and reimbursement programs.

In addition, Congress should:

• Provide funds to CDC’s Antibiotic Resistance Solutions Initiative to help health care facilities implement antibiotic stewardship programs, which are now required for hospitals and long-term care facilities that participate in Medicare and Medicaid. As COVID-19 has highlighted, these programs are critical when responding to infectious disease outbreaks; they ensure that physicians have access to the information needed to treat patients and minimize inappropriate antibiotic use;
• Spur the development of new treatments by supporting solutions like the Pioneering Antimicrobial Subscriptions To End Up Surging Resistance (PASTEUR) Act of 2021. When stewardship programs work, antibiotic use drops and, with it, the revenue that pharmaceutical companies need to recoup their investments in research, development, and testing. The PASTEUR Act would help reinvigorate the pharmaceutical pipeline by incentivizing drug makers with sizable, subscription-based government contracts for the development of novel, high-priority antibiotics and;
• Consider additional legislation to fix the antibiotics market, such as the Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act of 2019. Reimbursement reform measures such as DISARM would require hospitals to establish stewardship programs and shift how hospitals are repaid for the antibiotics they use, curbing the overuse of low-cost antibiotics that occurs simply because they’re less expensive than other, more clinically appropriate options. Combined with other solutions, this would help provide antibiotic drug developers a fairer return on their investments and encourage the development of new drugs. 

The burden of antibiotic resistance among seniors underlines something that the pandemic has made clear: Older Americans are at significantly heightened risk of infectious diseases. Yet, like COVID-19, antibiotic-resistant bacteria threatens us all, from “the greatest generation” to Generation Z: Each year, these pathogens sicken millions of Americans across every age group and add billions of dollars to the cost of health care — a tab that taxpayers have to pick up. We must act now to preserve antibiotic effectiveness and protect ourselves from superbugs.

David Hyun, M.D., directs The Pew Charitable Trusts’ antibiotic resistance project.