The term “superbugs” usually refers to strains of bacteria (or fungi) that are resistant to many different antibiotics. These strains can be difficult or impossible to treat with the current medications available. Developing resistance is a natural occurrence that is only accelerated by the improper use of antimicrobial medications. When bacteria are treated with a drug that disrupts their normal biological processes, there will eventually be a few that have some beneficial mutation that prevents the drug from being effective. Those mutant bacteria will therefore survive the treatment and multiply, leading to a new population filled with antibiotic-resistant organisms.
The CDC’s 2019 Antibiotic Resistance Threats report estimated that “more than 2.8 million antibiotic-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result.” The report also listed the most concerning antibiotic-resistant organisms of the year in three categories: urgent, serious, and concerning. Of the urgent organisms, the two that caused the most deaths were Clostridioides difficile (C. difficile) and Carbapenem-resistant Enterobacteriaceae (CRE). C. difficile is a bacteria that causes life-threatening diarrhea and colon inflammation, and occurs most frequently in people who have been on antibiotic treatment. This is because antibiotics also attack the good, protective bacteria of your microbiome, which leaves you more vulnerable to an infection by a resistant pathogen. C. difficile causes 223,900 infections per year, and 12,800 deaths per year in the United States. Enterobacteriaceae is an entire family of bacteria composed of Gram-negative bacteria that includes Escherichia coli, Salmonella, Shigella, and Klebsiella pneumoniae. Carbapenems are a class of antibiotics that share a similar foundational structure to penicillins, but have more dangerous side effects and and are usually reserved for the most severe infections. There is less widespread to resistance to carbapenems than penicillins, but when there are Carbapenem-resistant strains, they are very difficult to treat (they are often resistant to nearly all antibiotics, leaving only very toxic or less effective antibiotic alternatives). CRE caused an estimated 13,100 hospitalizations and 1,100 deaths in the U.S. in 2017.
Improper use of antibiotics is increasing the rate of developing resistance, and pharmaceutical companies are struggling to make new antibiotics at the rate necessary to keep up with the obsolescence of old antibiotics. Overuse of antibiotics in people and animals is a primary contributor to accelerated drug resistance. First, antibiotics are overprescribed to patients. Antibiotics are given to people with viral illnesses or those with resistant/unsusceptible pathogens, which does not help the patient and only increases the chances of causing resistance. Patients also frequently do not take antibiotics as prescribed. They do not take the drugs enough times per day, at the right times, or do not use the full course, and stop taking them once they “feel better.” They will often “save the rest for later” when they feel sick again, because they don’t want to pay for more antibiotics or they feel like their doctor was being “stingy” with them. All of these behaviors reduce the effectiveness of antibiotics and increase the chances of resistant bacteria surviving and repopulating.
The lack of understanding about antibiotics among the general population and even health care providers is very concerning. People often get sick with some minor illness, and then go to their doctors demanding to be “fixed.” Even if there is no effective treatment for the pathogen (like a cold virus), or treatment is not necessary, people expect to be given something to make them feel better. This is a very short-sighted perspective, and is a leading cause of an impending antibiotic crisis. Doctors frequently give antibiotics when they are not needed or useful, for a plethora of reasons. There is probably a combined effect of patient pressure (“I want to be cured, and I want it now!”), relative effort (easier to just prescribe something “harmless” than to deal with a whiny patient), risk emphasis (short-term risks of not treating outweigh the risks of antibiotic resistance), and defensive medicine (“I don’t want to be sued for malpractice!”). All of these decisions are simply a result of human nature, but it is important that we emphasize the risks of widespread antibiotic resistance and why we need to slow its progress. Health care professionals are well aware of antibiotic resistance, but they overprescribe anyway. This could be greatly reduced through increased medical education of the general public, who are the same patients that are pressuring health care professionals for antibiotics they don’t need, and still won’t use effectively.
Animal agriculture is also a large consumer of antibiotics, which have been used for multiple reasons: 1) treating infected animals, 2) controlling the spread of an infection, 3) preventing infection, and 4) increased animal growth. Most concern is related to the latter two uses of antibiotics. Widespread use of antibiotics in animals, just like in humans, also increases risk for the development of resistance. According to the CDC, as of 2017, “medically important drugs” (meaning they are relevant to human health) are no longer allowed for the use of growth promotion in the U.S. The FDA also requires “veterinary oversight” for the use of medically important medications in food animals. Antibiotic use is approved by the FDA for treatment, control, and prevention (although “prevention” is intended to target certain groups of animals that are “at risk,” such as weaning calves). Food labels such as “antibiotic free” do not have a standardized meaning approved by the USDA, and do not necessarily mean than an animal was raised without antibiotics. It means that there were not detectable amounts of antibiotics in the animal before it is killed. This can be accomplished by taking the animal off antibiotics in time to remove them from its system, instead of never giving the animal antibiotics in the first place.
If we lose the ability to use antibiotics, we can no longer defend against pathogens that we could previously easily fight with medicine. In a post-antibiotic world, people could die just as easily from infections as before antibiotics were discovered. In some cases, we will be forced to use more expensive and more difficult treatments for the same disease. In addition, losing antibiotics as an infection-fighting tool puts so many more people at risk when it comes to surgeries. People who get c-sections, organ transplants, and other invasive surgeries are often given antibiotics to reduce the likelihood of infection post-procedure. Doctors do their best to avoid contamination, but when the skin (our first line of defense) is broken, it greatly increases the risk for infection. Antibiotics are also important to people who are immunocompromised, and cannot fight off infections as well on their own. Without effective antibiotics, all people are vulnerable to the same pathogens as before, except now they are stronger than ever before due to new resistance.
Evelyn's blog 