What is antibiotic resistance and why is it a problem?
Antibiotic resistance is the ability of bacteria to overcome drugs designed to kill them. According to the CDC’s “Antibiotic Resistance Threats in the United States, 2019” report, 35,000 people die from 2.8 million antibiotic resistant infections yearly. Five groups are listed as urgent threats on account of how many drugs are ineffective against them and how many infections they cause: Carbapenem-resistant Acinetobacter, Candida auris, Clostridioides difficile, Carbapenem-resistant Enterobacteriaceae, Drug-resistant and Neisseria gonorrhoeae. These are all also referred to as “superbugs,” which is an awfully cool name for something so terrible. In the 2013 report, only 3 germs were listed as urgent threats, so resistance continues to increase despite us being aware for years. Another eleven germs are listed as serious threats, including bacteria that cause salmonella, typhoid fever, staph infections, pneumonia, and tuberculosis. Infections that cannot be treated with typical antibiotics require stronger ones that may be increasingly toxic or more likely to cause dangerous side effects. Some bacterial strains, like totally drug resistant tuberculosis (TDR-TB), are resistant to all known antibiotics and cause fatal infections.
How has antibiotic resistance come about?
While all bacteria have some innate resistance due to their cell walls or metabolic processes or the like, antibiotic resistance of concern arises from spontaneous mutations that allow bacteria to produce enzymes that counteract specific drugs (carbapenamases, penicillinases), to modify the molecule targeted by the drug, to reduce uptake of a drug, or to increase the rate of elimination of a drug. Mutated bacteria may be given the opportunity to multiply if antibiotics are not taken appropriately; in which case, the normal microbiota (see Health’s Home- the Microbiome for more) is destroyed by the antibiotic, and the newly resistant bacteria is left to multiply without competition. In addition, bacterial cells can share resistance with each other by transferring plasmids carrying resistance genes. Inappropriate use of antibiotics can mean attempting to use antibiotics to treat viral infections (antibiotics do not work on either the flu or a cold), not taking the full course of antibiotics, or taking antibiotics that are ineffective for the given bacterial infection. Consultation with a doctor and testing of the infection is necessary to avoid an infection becoming deadly from antibiotic resistance.
According to WHO, antibiotic resistance has also grown because of the use of antibiotics to fatten or prevent disease in cattle, poultry, and other farm animals raised for meat. Antibiotic-resistant bacteria multiply in the animal, and can be transferred to humans through contact with the animal or its feces or the consumption of undercooked meat.
What science is doing about it
The CDC and other organizations around the world are adopting One Health as part of their approach to addressing antibiotic resistance. One Health combines multiple disciplines to understand how humans, animals, microorganisms, and the environment interact in disease. Using this approach recognizes that overuse of antibiotics in animals raised for food as well as improper use of antibiotics by humans has helped create the crisis we are facing today. According to a Science Daily article, researchers have found that the environment–in wildlife and water sources in particular– is the most significant factor in the proliferation of antibiotic-resistant bacteria in Tanzania. Changing our outlook on and approach to antibiotics is necessary to slow the rate of resistance and prevent countless deaths. WHO recommends a drastic reduction in the number of antibiotics used in food-producing animals such that antibiotics are only used after testing a sick animal to determine the appropriate medication for the infection. Researchers around the globe are racing against complete antibiotic resistance, identifying new ways in which human behavior and medical treatment have contributed to this issue, and how we might modify our approach to defeat antibiotic resistance from an evolutionary perspective.
Meanwhile, pharmaceutical scientists are now using AI to screen millions of chemical compounds in days to find new antibiotics to fight increasingly resistant bacteria. This technology identified a drug that in lab tests killed many antibiotic-resistant bacteria, including some resistant to all known antibiotics. The tech could also enable researchers to create antibiotics with greater chemical diversity, giving us more time with effective antibiotics.
What we can do about it
Our most proven approach to dealing with antibiotic resistance is to be extremely prudent in our use of antibiotics and educate the general public about the importance of subscribing to their full course of drug therapy. In addition, doctors can be better about making sure their patients can afford the drugs prescribed and help them find alternatives if need be, so that patients don’t skip drugs to cut personal costs. One study found that 30-60% of antibiotics used in intensive care units are “unnecessary, inappropriate, or suboptimal.” We need to reach the point where this number is 0. This means increasing the availability of testing and effective antibiotics, especially in developing nations where the same few inexpensive drugs are often used to treat every infection.
One of the best things every one can do daily is to take measures to avoid being infected. They can do so through washing their hands thoroughly, cleaning their homes and objects they commonly touch frequently, and avoiding touching their face, eyes, or any other entry point to the body as much as possible. If you don’t get sick, you won’t need antibiotics, and you won’t risk the bacteria developing resistance. In schools and in doctors offices, people can be taught simple aseptic techniques that can decrease their likelihood of infection, and reduce the frequency of their need for antibiotics.
Don’t let the bugs win.
Hannah Biowell Blog 