(For more information on resistant bacteria, see app. Data Insufficient to Determine Full Extent of Public Health Burden Associated With Antibacterial Resistance

Although we found many sources of information about the public health burden in the United States attributable to resistant bacteria, each source provides data on only part of the burden. Data from laboratories that monitor for resistant bacteria, however, show that resistance in human and animal bacteria is increasing in four ways. Bacteria are becoming resistant to additional antibacterials. Antibacterial drugs are used in both people and animals. Antibacterial residues in some foods are monitored, but little is known about other residues. A Number of Federal and International Agencies Are Collecting Some Information About Antibacterial Resistance

A number of federal agencies and international organizations that receive U.S. funds collect information about the number of resistant infections, the prevalence of resistant bacteria, the cost of treating resistant disease, and the use of antibacterials; some ongoing efforts involve collaboration among several agencies. Conclusions

Although many studies have documented cases of infections that are difficult to treat because they are caused by resistant bacteria, the full extent of the problem remains unknown. The development and spread of resistant bacteria worldwide and the widespread use of various antibacterials create the potential for the U.S. public health burden to increase. A number of federal and federally funded agencies are collecting information about different aspects of antibacterial resistance, and some ongoing efforts involve collaboration among agencies. However, there is little information about the extent of the following: common diseases that can be caused by resistant bacteria, are acquired in the community, and do not typically result in hospitalization, such as otitis media; the development of resistant properties in bacteria that do not normally cause disease but that can pass these properties on to bacteria that do; antibacterial use, particularly in animals, and antibacterial residues in places other than food; and the development of resistant disease and resistant bacteria and the use of antibacterials globally. Our focus is on what is known about the burden in the United States resulting from resistance, but we considered global developments in assessing the potential future burden. We did not attempt to examine all federal efforts related to antimicrobial resistance, but focused on efforts to collect and provide information on cases of resistant infections, resistance in bacteria, use of antibacterials, and the cost of treating resistant diseases. To conduct our work, we reviewed scientific and medical literature; identified sources of data; and consulted experts in government, including those at the Centers for Disease Control and Prevention (CDC), the National Institutes of Health, the Food and Drug Administration (FDA), the Health Care Financing Administration, the Agency for Health Care Policy and Research, the Environmental Protection Agency (EPA), the U.S. Department of Agriculture (USDA), the Department of Veterans Affairs, the Department of Defense (DOD), the U.S. Agency for International Development, and the World Health Organization. Many studies are also focused on bacteria isolated from patients.
Why GAO Did This Study

Pursuant to a congressional request, GAO provided information on the potential threat to the public's health from antimicrobial resistant bacteria, focusing on: (1) what is known about the public health burden--in terms of illnesses, deaths and treatment costs--due to antimicrobial resistance; (2) potential future burden, given what is known about the development of resistance in microbes and usage of antimicrobials; and (3) federal efforts to gather and provide information about resistance.

What GAO Found

GAO noted that: (1) although many studies have documented cases of infections that are difficult to treat because they are caused by resistant bacteria, the full extent of the problem remains unknown; (2) GAO found many sources of information about the public health burden in the United States attributable to resistant bacteria, but each source has limitations and provides data on only part of the burden; (3) the public health burden attributable to resistant tuberculosis and gonorrhea is relatively well characterized because nationwide surveillance systems monitor these diseases; (4) little is known about the extent of most other diseases that can be caused by resistant bacteria, such as otitis media (middle ear infection), gastric ulcers, and cystitis (inflammation of the bladder) because they are not similarly monitored; (5) the development and spread of resistant bacteria worldwide and the widespread use of various antibacterials create the potential for the U.S. public health burden to increase; (6) data indicate that resistant bacteria are emerging around the world, that more kinds of bacteria are becoming resistant, and that bacteria are becoming resistant to multiple drugs; (7) while little information is publicly available about the actual quantities of antibacterials produced, used, and present in the environment, it is known that antibacterials are used extensively around the world in human and veterinary medicine, in agricultural production, and in industrial and household products and that they have been found in food, soil, and water; (8) a number of federal agencies and international organizations that receive U.S. funds collect information about different aspects of antibacterial resistance, and some ongoing efforts involve collaboration among agencies; (9) the Centers for Disease Control and Prevention (CDC) is the primary source of information about the number of infections caused by resistant bacteria; (10) CDC also collects information on resistance found in bacterial samples and the use of antibacterial drugs in human medicine; (11) CDC, the Department of Agriculture, and the Food and Drug Administration are collaborating on efforts to monitor resistant bacteria that can contaminate the food supply; (12) the Department of Defense conducts surveillance for antibacterial resistance at 13 military sites in the United States and at its 6 overseas laboratories; and (13) the World Health Organization serves as a clearinghouse for data on resistance in bacteria isolated from people and animals from many different countries.