Battle Over Antibiotic Resistance

The evolution of bacteria resistant to most — or even all — antibiotics is a major global health threat. In response, the U.S. Centers for Disease Control and Prevention (CDC) has launched an initiative designed to allow stakeholders to more quickly react to new types of multidrug- resistant pathogens. As part of its efforts, the CDC has established the Antibiotic Resistance Laboratory Network (ARLN) to provide testing for two emerging antibiotic-resistant organisms that are of special concern, carbapenem-resistant Enterobacteriaceae (CRE) and carbapenem-resistant Pseudomonas aeruginosa.¹

Carbapenemases are a type of enzyme that have appeared in bacteria in response to antibiotics and render most antibacterial products ineffective. When ARLN testing began, a concerning number of samples were positive for carbapenem- resistant bacteria,² especially among the Enterobacteria types of bacteria. Tom Frieden, MD, MPH, former head of the CDC, has referred to multidrug-resistant CRE as a “nightmare bacteria”³ because it is not only deadly, it also survives readily on surfaces, increasing the risk of transmission.

While transmission of infectious agents among patients and oral health professionals is rare, according to the CDC, when transmission occurs, it typically involves breaches of asepsis protocols.⁴ Beyond a commitment to infection prevention, dentists also have an important role to play in reducing the overuse of antibiotics that gives bacteria more opportunities to develop resistance. After all, while improving the response to outbreaks of multidrug-resistant organisms is important, so is reducing the odds that such organisms evolve in the first place.

A 2016 Canadian study found that from 1996 to 2013, dentists in the area they studied increased their rate of antibiotic prescriptions by 62.2%.⁵ Since then, increased awareness of the global threat of antibiotic resistance is causing clinicians to rethink their prescribing practices — and ongoing efforts in this capacity will certainly be a critical task for the field going forward.

REFERENCES

1. U.S. Centers for Disease Control and Prevention. Germs with Unusual Antibiotic Resistance Widespread in U.S.; 2018. Available at: https://www.cdc.gov/media/releases/2018/p0403-antibiotic-resistant-germs.html. Accessed April 16, 2018.
2. U.S. Centers for Disease Control and Prevention. Vital Signs: Containment of novel multidrug-resistant organisms and resistance mechanisms — United States, 2006–2017. MMWR Morb Mortal Wkly Rep. 2018;67:396–401.
3. U.S. Centers for Disease Control and Prevention. Action Needed Now to Halt Spread of Deadly Bacteria. Available at: https://www.cdc.gov/media/releases/2013/p0305_deadly_bacteria.html. Accessed April 16, 2018.
4. U.S. Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Available at: https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care2.pdf. Accessed April 16, 2018.
5. Marra F, George D, Chong M, Sutherland S, Patrick D. Antibiotic prescribing by dentists has increased. Why? J Am Dent Assoc. 2016;147:320–327.
6. U.S. Centers for Disease Control and Prevention. Containing Unusual Resistance. Available at: https:// www . cdc.gov /vitalsigns/containing-unusual-resistance/. Accessed April 16, 2018.

From Decisions in Dentistry. May 2018;4(5):60.