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Nursing homes are on the front lines in the increasingly urgent battle against antibiotic-resistant infections, according to a comprehensive new report that ranks the most dangerous antibiotic-resistant microorganisms. The report identifies four core actions to fight the spread of antibiotic resistance.

More than 2 million people are sickened by antibiotic-resistant infections and 23,000 die as a result each year in the United States, according to the 114-page report released yesterday by the Centers for Disease Control and Prevention. These numbers are based on “conservative assumptions” and are “likely minimum estimates,” the CDC stated.

For the first time, the CDC ranked 18 antibiotic-resistant microorganisms based on how dangerous they are, categorizing them as urgent, serious or concerning. Three infections ranked as urgent: Clostridium difficile, Carbapenem-resistant Enterobacteriaceae and drug-resistant Neisseria gonorrhoeae. Although C. diff is not itself resistant to antibiotics, it is caused by antibiotic use, the CDC noted. Methicillin-resistant Staphylococcus aureus and multi-drug resistant Pseudomonas aeruginosa are among the “serious” threats.

Hospitals and nursing homes are the most common settings where death occurs due to these infections, the CDC noted — and C. diff alone causes an estimated 14,000 deaths each year. LTC providers have also been on high alert for cases of CRE, following alarming information about its spread released earlier this year.

Healthcare providers are considered critical players in an effort to reduce antibiotic resistance, which is caused primarily by the overuse and misuse of these drugs. Up to half of all antibiotics prescribed are not needed or are not optimally effective, according to the CDC report. Therefore, “improving the use of today’s antibiotics” is one of four “core actions” recommended in the report. The other three are: promoting new antibiotic development/diagnostic tests for resistant bacteria; tracking resistant bacteria; and preventing infections and the spread of resistance.

While healthcare providers should be at the forefront of these efforts, the potential public health crisis calls for widespread participation from all stakeholders, including patients, CDC officials stressed in a call with reporters. Patients should press hospitals and other providers for details of their antibiotic stewardship program, the officials said. CDC Director Tom Frieden, M.D., M.P.H., said a “farm-to-table” approach is also called for, to reduce the unnecessary use of antibiotics in the nation’s food supply.

Frieden painted a stark picture of the consequences of inaction, saying “the medicine cabinet will be empty” for future generations.

Click here to access the full report.