ResistanceOpen: Mapping antibiotic resistance in the US


In April 2014, the World Health Organization (WHO) released a global report highlighting the increase in worldwide antibiotic resistance and warning the public of a “post-antibiotic era“. The WHO report gathered data from 129 member states and found that antimicrobial resistance existed in every region of the globe.

A year prior, the Centers for Disease Control (CDC) published a similar report regarding antibiotic resistance in the U.S. It estimated there are approximately 2 million illnesses and 23,000 deaths caused by antibiotic resistant bacteria or fungi in the U.S. every year. Both reports represent a major warning: resistance is happening, it is widespread, and it extends to include “last resort” antibiotics.

Over the last 20 years, the rate of resistance to infections has skyrocketed from 10 to 15 percent in the 1990s to 60 percent today. Simultaneously, pharmaceutical companies have stopped investing in the development of antibiotics.  Only 11 new antibiotics were introduced between 1998 and 2014, and the last class of antibiotics in was approved in 1987 — 29 years ago.

Derek MacFadden, MD, a research fellow at Boston Children’s Hospital, and his project ResistanceOpen, hope to fight the seemingly impending post-antibiotic era.

Notes: How did ResistanceOpen get its start?

MacFadden: As a physician specializing in infectious disease and internal medicine, I’ve worked with patients with severe infections. I once had a patient whose infection could not be treated with any of the antibiotics readily available, and we tried some of the most potent drugs currently in existence. With no other options, the unresponsiveness of the infection forced the medical team to try untested courses and treatment methods, and the overall experience left me feeling helpless.

This was when I truly realized a ‘post-antibiotic era’ was near — that the rise of antimicrobial resistance could potentially set medical intervention and treatment for the most common illnesses and minor injuries back to the early 1900s. I also realized that the population — from physicians to the agricultural industry — was further intensifying antimicrobial resistance, from injecting antibiotics into livestock to prescribing antibiotics recklessly. A lack of antibiotic stewardship was creating the very problem that we were fighting.

The prospect of a “post-antibiotic era” was frightening, and that was the catalyst that set the ResistanceOpen project into motion.

Notes: Do antibiotic surveillance efforts already exist?

MacFadden: As I delved into research on resistance, I realized that an aggregated surveillance system for antimicrobial resistance did not yet exist — at least not globally. There are small national efforts and small-scale international efforts for a functioning surveillance system (for example, Europe’s EURASNET), but in many areas of the world, including North America, we have a very poor understanding of how much resistance there is, where it is and how much disease its causing. Our knowledge is exceptionally poor. We know just enough to know that this is going to be a big problem.

Notes: What makes ResistanceOpen different than existing surveillance systems?

MacFadden: What was important to me was understanding regional patterns, not just how much aggregate resistance exists in a country, but what are the differences in local areas and hospitals? Most hospitals and laboratories in community-health networks keep track of resistance using a standardized index (namely antibiograms), and many of them make this information publicly available over the Internet.

ResistanceOpen forms a patchwork quilt of publicly-available, antibiotic-resistance data. Getting single-level isolates and data across large areas — especially on a global scale — would be both slow and challenging. It’s not that it shouldn’t be done, and there are efforts underway to do just that, but I think there’s a lot of useful information already available that we can put together, so we can start to get a better understanding of antibiotic resistance.

I also feel like antimicrobial resistance should be treated with the same urgency that other communicable diseases are met with, and I believe that has to start with transparency and awareness. ResistanceOpen provides the public with both.



As an online-accessible platform, ResistanceOpen uses non-traditional techniques to acquire and display antimicrobial resistance data — mostly antibiograms — on the hospital, state, region and country-level. While the majority of the website currently consists of health facilities in the U.S. and Canada, MacFadden and his team are diligently working to include data gathered from abroad, starting with Europe.

ResistanceOpen allows healthcare facilities and workers to contribute their own antimicrobial resistance information to the database. True to the “open” philosophy, it allows anyone to view detailed data visualizations.

ResistanceOpen also uses HealthMap’s aggregate news tool, which flags and displays relative news articles on the platform’s main page. This feature could help to raise the public’s awareness about antimicrobial resistance.

While the project hasn’t come without challenges (standardization of antibiograms varies quite a bit), ResistanceOpen is a step in the right direction. MacFadden hopes this will not only raise awareness about the seriousness of antimicrobial resistance, but also engage and empower the public to act as well.

Learn more about the Division of Infectious Diseases.