US effort to combat antibiotic-resistant bacteria

the US White House just released a report (see https://www.cdc.gov/drugresistance/pdf/report-to-the-president-on-combating-antibiotic-resistance.pdf) outlining a 5-point 5-year plan to reduce and combat antimicrobial resistance, including plans to:

        --improve surveillance efforts

        --slow the emergence and spread of resistant bacteria

        --develop rapid tests to identify and characterized resistant bacteria

        --accelerate development of antibiotics and vaccines

        --improve international collaboration

specific targets include:

        --c. difficile: reducing incidence of infection by 50% over 2011 estimates

        --carbapenem-resistance Enterobacteriaceae infections acquired during hospitalization: reducing by 60%

        --n. gonorrhoeae: maintaining ceftriaxone-resistance below 2%

        --multi-drug resistant pseudomonas acquired during hospitalization: reducing by 35% over 2011 estimates

        --methicillin-resistant s. aureus bloodstream infections: reducing by 50% over 2011 estimates

        --multi-drug resistant non-typhoidal salmonella infections: reducing by 25% over 2010-12 estimates

        --multi-drug resistant TB infections: reducing by 15%

        --antibiotic-resistant invasive pneumococcal disease in <5 year olds: reducing by 25% over 2008 estimates

        --antibiotic-resistant invasive pneumococcal disease in >65 year olds: reducing by 25% over 2008 estimates

specific goals include:

        --judicious use of antibiotics in health care and agricultural settings, including eliminating the use of medically-important antibiotics for growth promotion in animals

        --increased use of vaccines to prevent infections

        --integrated surveillance data monitoring human pathogens

        --regional public health laboratory networks to standardize resistance testing

        --enhanced monitoring of antibiotic sales, usage, resistance, and management practices in the food-production chain and all the way to supermarkets

        --improved diagnostic testing capabilities, which should translate into knowing better the cause of infections and targeting treatment more accurately (and finding out more accurately when antibiotics are not indicated)

        --supporting basic and applied research into the development of new antibiotics/vaccines

        ​--developing international collaboratives for detection, analysis and reporting of antibiotic use and resistance, creating incentives for development of therapeutics and diagnostics, and strengthening global efforts to prevent and control antibiotic-resistant bacteria.

overall, a very impressive roadmap, with very specific short-term (1- and 3- year) and longer term (5-year) goals. although many of the goals are new items, some are incorporated into existing programs (eg, adding antibiotic use and resistance data to Stage 3 of Meaningful Use certification), and some are extensions of existing relationships -- eg, having Agency for Healthcare Research and Quality review the state of and gaps in knowledge, or requiring all hospitals getting CMS money (Centers for Medicare and Medicaid Services) to comply with policies to decrease and control antibiotic resistance. one issue of concern (which i think was only mentioned obliquely) is the wide availability of antibiotics as over-the-counter medications in much of the world, an issue we see frequently in our international patients. and another point not mentioned is the profound role of climate change in the dramatic changes in infectious diseases spreading across the globe.  but, overall this report is a very important and hopefully significant step in dealing with the very real and potentially disastrous potential for uncontrollable "superbugs".