Key points
- The U.S Government continues to take ambitious steps to fight antimicrobial resistance.
- The U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria is a coordinated, strategic plan to address antimicrobial resistance that guides CDC's antimicrobial resistance investments and activities.
Overview
Antimicrobial resistance is a national public health priority, and the U.S. Government has taken ambitious steps to fight this threat. Federal agencies are working together to:
- Respond to new and ongoing antimicrobial-resistant threats.
- Strengthen detection of antimicrobial resistance.
- Enhance efforts to slow the emergence and spread of antimicrobial resistance.
- Improve antibiotic and antifungal use and reporting of how and when they are used.
- Advance development of rapid diagnostics for antimicrobial-resistant pathogens.
- Enhance infection control measures to prevent resistant infections.
- Accelerate research on new antibiotics, antifungals, and other therapeutics and vaccines.
The U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria (referred to as National Action Plan or CARB) presents coordinated, strategic goals to accelerate the U.S. Government's response to antimicrobial resistance and improve the health of all Americans. The National Action Plan has pushed transformative improvements that strengthen and expand the response to resistance threats.
Although the main purpose is to guide U.S. Government activities, the National Action Plan is also designed to guide action by public health, healthcare and veterinary partners in a common effort to address urgent and serious antimicrobial-resistant threats that affect people in the U.S. and around the world.
Key U.S. actions: 2013 to present
2013
- CDC released the first Antibiotic Resistance Threats Report [PDF – 114 pages] to look at the burden and threats to human health posed by antimicrobial resistance in the U.S., which brought attention to the threat and prompted government and industry leaders to take immediate action.
2014
- The White House released the U.S. National Strategy for Combating Antibiotic-Resistant Bacteria [PDF – 37 Pages].
- The President’s Council of Advisors on Science and Technology (PCAST) released a report [PDF – 78 Pages] on combating antimicrobial resistance.
- The president issued Executive Order 13676 directing federal agencies to implement the PCAST report recommendations and establish:
- The Interagency Task Force for Combating Antibiotic-Resistant Bacteria, a group of federal agencies tasked to implement the National Action Plan, chaired by the U.S. Departments of Health and Human Services (HHS), Agriculture and Defense.
- The Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB), a group of voting members from non-governmental agencies, including human and animal health experts, that provides recommendations to HHS on federal programs and policies to combat antimicrobial resistance.
- The Global Health Security Agenda was launched, including action on antimicrobial resistance.
- CDC published Core Elements of Hospital Antibiotic Stewardship Programs, followed by guidance for other settings.
2015
- The White House:
- Hosted the Forum on Antibiotic Stewardship.
- Released the first U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria, outlining steps to implement the National Strategy.
- Congress appropriated $160 million to support implementing the National Action Plan, including CDC’s Antimicrobial Resistance Solutions Initiative. (CDC’s initial request was $264 million.)
- CDC launched the CDC & FDA AR Isolate Bank.
- The White House:
2016
- CDC established the Antimicrobial Resistance Laboratory Network (AR Lab Network) to support nationwide lab capacity and funded local antimicrobial resistance experts in every state, major cities and Puerto Rico.
- Under the AR Solutions Initiative, CDC awarded the first innovation funding ($40 million) to academic, industry and healthcare investigators, including CDC’s Prevention Epicenters Program.
- CDC launched the Antimicrobial Use and Resistance Module to report and analyze antibiotic use in healthcare facilities through the National Healthcare Safety Network (a national healthcare infection tracking system).
- The U.S. government participated in the United Nations (UN) General Assembly High-Level Meeting on Antimicrobial Resistance, where nations passed a resolution to combat antimicrobial resistance worldwide.
2017
- The President issued an Executive Order to continue advisory committees, including the PACCARB, reflecting the administration’s commitment to combating antimicrobial resistance.
- CDC added the National Tuberculosis Molecular Surveillance Center to the AR Lab Network.
- FDA released Veterinary Feed Directive to help ensure antibiotics are only used to treat and prevent infections in food animals.
2018
- U.S. participated in the UN General Assembly and continued efforts initiated at the 2016 High-level Meeting.
- U.S. government launched The AMR Challenge, a year-long campaign spearheaded by CDC to encourage global organizations to make formal commitments that further the progress against resistance.
- CDC co-hosted a forum focused on antimicrobial resistance in the environment (e.g., water, soil) and the potential effect on human health, resulting in a published report titled Initiatives for Addressing Antimicrobial Resistance in the Environment.
- CDC released the Containment Strategy to help stop the spread of new or emerging resistance.
2019
- PulseNet laboratories transitioned to whole genome sequencing for foodborne germs.
- The U.S. government, spearheaded by CDC and the U.S. Department of Health & Human Services (HHS), concluded The AMR Challenge with more than 350 partner commitments worldwide.
- CDC published the second Antibiotic Resistance Threats Report.
2020
- The White House released the second U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria [PDF – 47 Pages] for 2020-2025 with coordinated, strategic actions to improve the health and well-being of all Americans.
- COVID-19 pandemic began, impacting healthcare facilities, health departments, and communities, and lead to an increase in healthcare-associated, antimicrobial-resistant infections in U.S. hospitals.
2021
- CDC launched the Global Antimicrobial Resistance Laboratory and Response Network.
2022
- CDC released COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022.
- CDC and FDA co-sponsored a Virtual Public Workshop to discuss drug development considerations for the prevention of healthcare-associated infections, decolonization and pathogen reduction strategies.
2024
- CDC released Antimicrobial Resistance Threats in the United States, 2021-2022, highlighting data on the burden of seven antimicrobial-resistant threats typically found in healthcare settings.
- UN General Assembly held second high-level meeting on antimicrobial resistance and adopted a political declaration [PDF – 15 Pages], which established global goals, commitments, and targets for combating antimicrobial resistance, including a goal to reduce global deaths associated with bacterial antimicrobial resistance by 10% by 2030.
- U.S. began to require 4,500 hospitals to report antimicrobial use and resistance data through NHSN via automated mechanisms (under Centers for Medicare and Medicaid Services rule).
- CDC collaborated with other federal agencies on the development of Framework for Interagency Collaboration to Review Potential Antibacterial and Antifungal Resistance Risks Associated with Pesticide Use [PDF – 13 Pages].
- Keep Reading: CDC Leads the Public Health Fight
National Action Plan goals
The National Action Plan is organized around five goals for collaborative action by the U.S. Government, in partnership with foreign governments, individuals and organizations.
The five goals are:
- Slow the emergence of resistant bacteria and prevent the spread of resistant infections.
- Strengthen national One Health surveillance efforts to combat resistance.
- Advance development and use of rapid and innovative diagnostic tests for identification and characterization of resistant bacteria.
- Accelerate basic and applied research and development for new antibiotics, antifungals, other therapeutics and vaccines.
- Improve international collaboration and capacities for antimicrobial-resistance prevention, surveillance, control and drug research and development.
The National Action Plan takes a One Health approach, aiming to strengthen healthcare, public health, veterinary medicine, agriculture, food safety and research and manufacturing. CDC implements activities in support of the National Action Plan through its Antimicrobial Resistance Solutions Initiative.
National Action Plan history
The U.S. HHS Assistant Secretary for Planning and Evaluation led the development of the 2020-2025 National Action Plan. It was authored by agencies within the Interagency Task Force co-chaired by the U.S. Department of Health and Human Services, the U.S. Department of Agriculture and the U.S. Department of Defense.
The 2020-2025 Plan builds on the first National Action Plan, released in 2015, by expanding evidence-based activities that were shown to slow the spread of antimicrobial resistance, such as increasing infection prevention and control actions and improving the way antibiotics and antifungals are used. The National Action Plans implement the U.S. Government's 2014 U.S. National Strategy for Combating Antibiotic-resistant Bacteria (National Strategy).
The National Strategy required cooperation from the public and private sector in the U.S., as well as partnerships with international human and animal health organizations. It was released alongside Executive Order 13676 and a report on combating antimicrobial resistance by the President's Council of Advisors on Science and Technology (PCAST). PCAST's three key recommendations were to:
- Improve tracking of antimicrobial-resistant bacteria.
- Increase the life of current antibiotics and antifungals by improving use and implementing interventions.
- Increase speed to discover and develop new antibiotics, antifungals and other interventions.
Resources
- Fiscal Year 2022: U.S. National Action Plan Progress Report (published in 2024)
- Fiscal Year 2021: U.S. National Action Plan Progress Report (published in 2023)
- Year 5: U.S. National Action Plan Progress Report (published in 2022)
- Year 4: U.S. National Action Plan Progress Report (published in 2020)
- Year 3: U.S. National Action Plan Progress Report (published in 2018)
- Year 1 and 2: U.S. National Action Plan Progress Report (published in 2017)
- Slow the emergence of resistant bacteria and prevent the spread of resistant infections.