Making Sense of the Antibiotic Resistance Crisis

For decades, medical professionals have relied on the use of antibiotics for combating diverse bacterial infections. These drugs have been so much used that they are fast losing their effectiveness. There are actually certain disease-causing agents that these medications are practically useless against.

Antibiotic resistance is seen by many medical experts as well as health organizations as one of the greatest threats to health across the globe. Age, race or gender is not an issue when it comes to those affected – this problem affects everyone. Millions of people in America battle with this every year.

In this article, we discuss practically everything you may want to know about antibiotic resistance, why it is an issue of great concern, and how to protect yourself against it.

Antibiotics Overview

An antibiotic is a drug that is used to treat or prevent bacterial infections. It helps to fend off bacteria in the body, especially the harmful types. It either kills these microorganisms or keeps them from multiplying to harmful levels. Each type has specific microbes it attacks.

Bacteria are very tiny, single-celled organisms that are very hard for the human eyes to detect. They are present both within and outside our bodies in large numbers. There are beneficial ones, especially within the intestines, and there are also the harmful types.

Antibiotics are used for fighting those ones that are capable of making us sick.

The history of these drugs is traced back to Alexander Fleming, who discovered Penicillin back in 1928. The antibiotic was first used for treating wound and surgical infections among soldiers of the Allied Forces during World War II before later being made available to the general public after the war.

The period from 1950s to 1970s saw tremendous increase in availability of this type of drugs. It is often regarded as the “golden age” as regards antibiotic discovery. It was during this time that agents such as tetracycline, erythromycin, methicillin, and vancomycin made their appearances.

Antibiotics are strictly meant for dealing with bacterial infections. They are not to be used to treat infections caused by viruses, including flu and colds. They are useless for such.

Antimicrobial Resistance and Antibiotic Resistance

Antibiotic resistance refers to the ability of bacteria to withstand the effect of antibiotics. The drugs fail to kill these germs or keep them from growing as they previously used to. When resistance sets in, the organisms become free to multiply.

This is not an unusual phenomenon really. Bacteria have natural ability to adapt to antibiotics. The scary thing is that they will surely find a way to become resistant to such drugs that would still be developed. The manner of use by many people also makes it easier for the bugs to succeed at this.

Fleming reportedly mentioned in his acceptance speech on the award of a Nobel Prize for his penicillin discovery that bacteria could become resistant to the antibiotic. It has.

It is possible that you might take antimicrobial resistance and antibiotic resistance to be one and the same, or come across people who do. They are not the same, although they are related.

Bacteria are just a subset of microbes that can have adverse effect on human health. Others include fungi, protozoa, and viruses. All classes of microbes are capable of developing resistance.

Antimicrobial resistance, therefore, refers to the ability of all microbes to protect themselves against the effect of drugs used for combating them.

The reduction in effects of drugs against bacteria and other microbes is a great source of concern. It means infections that were once considered treatable may no longer be. This poses considerable risk to human health.

Causes of Antibiotic Resistance

Antibiotics can really help to promote good health when you use them in an ideal way. They rank among the most prescribed and most used drugs. But then, the widespread use is the main reason for increasing resistance by bacteria. There is a problem of overuse and misuse of these medications.

Non-recommended usage

Typically, there should be a diagnosis of an infection for the appropriate antibiotic to be prescribed. But people now self-medicate in my places, especially in the developing countries. They simply assume that they should take a particular one when they are having issues, based on own past experience or others’.

Incorrect use

Failure to comply with your doctor’s advice on how to use these drugs may give rise to antibiotic resistance. Often, patients assumed there is no need to complete a full course of treatment when their condition improves midway. This can enable some bacteria to survive and develop resistance to the particular drug.

Poor diagnostics

Health professionals are not exempt of blame for rising cases of antibiotic resistance. Some doctors prescribe more drugs than are really needed to combat certain infections. Also, there are hospitals that do give critically-ill patients very high doses to help them improve. These practices stoke this problem.

Agricultural use

The modern method of agriculture is another cause for concern. It is no longer secret that antibiotics are used in many farm animals. Drug-resistant bacteria in such can pass on to humans via meat products. Also, the fecal matter from affected animal can contaminate water and soil for crops.

Experts think that antibiotic resistance is increasing to new, very worrisome levels across the globe. The world seems to be running out of drugs to combat infectious diseases with this phenomenon.

Centers for Disease Control and Prevention (CDC) data reveal that antibiotic resistance is responsible for more than 2 million illnesses in the United States. It is also responsible for at least 23,000 deaths.

How Does Resistance Develop?

By the nature of their action, antibiotics are prone to losing their efficacy. Every time scientists come up with a new one, they know there is the likelihood that it may lose its potency at some point. Scary, isn’t it?

Antibiotics usually don’t discriminate in terms of what organisms they kill. When these drugs kill germs that cause diseases, they also kill bacteria that are helpful to your body and protect it against infection.

The drug-resistant organisms are therefore allowed more freedom to go about replicating and doing damage when the good ones are shown the way out. Some of these even pass the resistance on to other bacteria that are not yet hardy.

There are certain behaviors that these bugs exhibit to develop resistance. These include:

Adaptation – Bacteria are capable of producing substances that protect them against antibiotics. They produce protective enzymes that bind to specific sites on these drugs to disrupt their ability to have the desired effects.

Genetic mutation – This can take place when the organisms reproduce. It is possible for newly-created ones to carry genes that can help them withstand the effect of antibiotics.

Prevention of drug accumulation – Pathogen may also protect itself by preventing accumulation of antibiotics to enable significant damage to it. Some are reported to have special pumps within their cell membranes which they use to eject these drugs before they do any harm.

Gene transfer – These microbes can also transfer their drug-resistance capabilities to others. This enables other microbes to also become resistant.

Biofilms and Antibiotic Resistance

A pertinent aspect to instances of bacteria being resistance to drugs is that of biofilm. This exists more as a means of enabling these organisms to counter any onslaught by antibiotics.

What is a biofilm? This is a community of bacteria. It describes a situation where these germs come together to form a potent force to improve their survival chances.

Biofilms can not only be found within the human body, but also all over the planet. They have been described as ranking among the most widely distributed modes of life on earth. They are one of the most thriving as well.

A biofilm is not necessarily a community of similar bacteria. It can also comprise of sub-communities of many different species of bugs. These organisms are protected by a dome.

The biofilm dome features a matrix of extracellular polymeric substances (EPS). Within it, you will find a mixture of fats, proteins, sugars, and DNA molecules. This affords the germs significant protection against antibiotics.

When bacteria come together in biofilms, they become very knotty to deal with. They become very resistant to different kinds of antibiotics and other things you may aim at them. This is a classic case of strength in numbers.

Another scary thing about biofilms is that the strong shield protecting them gives room for increasing resistance. Hardy strains become more able to transmit their genes to other bacteria in the community.

This explains why biofilms are very tough to eradicate. People with chronic wounds or disorders such as periodontitis and cystic fibrosis are at greater risk of having them. These communities tend to be present more around medical implants.

Examples of Antibiotic-Resistant Bacteria

As we noted earlier, antibiotics usually become useless against bacteria at some point. This creates need for newer, perhaps more expensive, ones to tackle the same germs.

There are certain bacteria that have rendered existing drugs useless. For example, the World Health Organization (WHO) published a list of bacteria for which new antibiotics are needed in 2017. They include:

  • Acinetobacter baumannii
  • Pseudomonas aeruginosa
  • Enterobacteriaceae
  • Enterococcus faecium
  • Staphylococcus aureus
  • Helicobacter pylori
  • Campylobacter spp.
  • Salmonellae
  • Neisseria gonorrhea
  • Streptococcus pneumoniae
  • Hemophilus influenzae
  • Shingella spp.

The antibiotics that these are resistant against include carbapenem, vancomycin, and methicilin. Others are fluoroquinolone, cephalosporin, clarithromycin, penicillin and ampicillin.

Acinetobacter baumannii

This is one of those bacteria whose status in terms of resistance is critical. It is highly resistant to antibiotics, including carbapenem, so much so there is now less reliance on these drugs for countering it.

  1. baumannii has the ability to survive in very harsh conditions. It is responsible for disorders such as meningitis and pneumonia.

Escherichia coli

Popular known as E. coli, these bacteria are not always harmful and are present in the digestive system. But there are strains that can lead to severe health issues, including food poisoning and meningitis.

There are also strains that are highly resistant to antibiotics, although these hardly cause diseases. The resistance is more of a reminder of dangers that possibly lies ahead with E. coli.

Mycobacterium tuberculosis

The level of antibiotic resistance of this organism is not as high as the first two, but it is significant. As its name suggests, Mycobacterium tuberculosis is responsible for tuberculosis. It can be very deadly. There is evidence of steady increase in resistance in the past two decades.

Staphylococcus aureus

The particular type of this bacterium that is resistant to drugs is called Methicillin-resistant Staphylococcus aureus (MRSA). Often treated with penicillin, the bug has become significantly resistant to antibiotics. Majority of hospital samples of the bacteria showed resistance since as far back as the 1960s.

The conditions that MSRA has a hand in include meningitis, skin disorders, and pneumonia.

Neisseria gonorrhea

First documented in the 19th century, this bacterium exhibits high resistance to antibiotics, according to the WHO list. Some of its strains have gradually mutated since the introduction of these drugs and are able to adapt very well to many of these. The organisms, which cause gonorrhea, usually spread through sexual contact.

Clostridium difficile

This one is especially popular at medical centers or hospitals across the world. Clostridium difficile, which mainly exhibits itself in form of diarrhea, is a strange one. While it is not highly resistant to the drugs that are used for treating it, experts observe that the infection has a direct relationship with antibiotic use.

Your risk of having it increases with your exposure to this kind of drugs. Antibiotics can disrupt your internal balance, thus giving room for C. difficile to exploit and cause illness.

These bacteria are dangerous. According to the CDC, they are responsible for at least 250,000 illnesses and 14,000 deaths.

Resistance by Classes

There are different classifications of bacteria. Antibiotic resistance is not the same across all the categories. Some classes of microbes are less resistant, while some are significantly more so. The preceding section gave an indication of that.

There are two main classes of bacteria, namely:

  • Gram-positive bacteria, and
  • Gram-negative bacteria.

The names of the categories derive from the Gram test, which is about adding a violet dye to bacteria.

Those microbes whose color becomes the same as the dye are called Gram-positive. On the other hand, the ones that do not have the color of the dye, but are instead pink or red are Gram-negative.

Bacteria causing pneumonia are examples of the Gram-negative class. Those responsible for Staphylococcus aureus (MRSA) are examples of Gram-positive bacteria.

It has been found that Gram-negative bugs tend to be more resistant to antibiotics than Gram-positive. The earlier WHO list suggested that. These bacteria usually have a cell wall that is highly impermeable to drugs. They can also transfer genetic material to make other germs drug-resistant.

We can also talk about aerobic and anaerobic bacteria. Aerobic organisms (or aerobes) are those ones that can survive in an environment where oxygen is available. Anaerobes do not need oxygen for growth – they may actually die when it is present.

For decades, focus had been on antibiotic resistance among aerobic organisms. Less emphasis has somewhat enabled resistance among anaerobes to rise rapidly. A steady increase has been reported since the 1970s, with the most frequently isolated group being Bacteroides fragilis.

Anaerobic bacteria are hard to isolate and culture. They grow slowly, thus making identification difficult and giving room for resistance.

Consequences of Antibiotic Resistance

What the rising cases of antibiotic resistance portend is scary to say the least. We are looking at the possibility of infections that were once treatable no longer being so. This can cause germs to remain in the body for longer and possibly lead to increase in cases of disability and deaths.

This phenomenon may rubbish many of the discoveries that have been made over the years as regards drugs for fighting infections. In essence, common injuries and infections that used to kill people in the past may start doing so again.

There is also the risk of diseases caused by antibiotic-resistant bacteria spreading from persons to persons.

Another reason this issue requires more attention is that it can cause healthcare cost to rise. Doctors will have to resort to more expensive medications.

This problem can also create economic burden in other ways, including productive hours lost to extended hospital stays.

Prevention and Control

There is obviously need to do something urgent to keep this problem of antibiotic resistance from getting worse. But what can you do?

The following are some of the steps you can take to protect yourself, and the world, against this nagging problem.

Good sanitation and hygiene

Prevention, they say, is better than cure. It is best to do all you can to guard against any infections that may warrant the use of antibiotics. Experts often recommend the good water, sanitation and hygiene (WASH) approach for preventing infectious diseases.

Make sure that the water you drink is pure – if you are not sure, it is better not to drink it. Wash your hands regularly, especially before cooking or eating. Endeavor to guard against excessive contact with sick individuals.

It is crucial to ensure you prepare your foods hygienically. You may follow WHO’s recommendations on ways to safer food, which are:

  • Keep clean
  • Keep raw and cooked foods apart
  • Cook very well
  • Store foods at safe temperatures
  • Make use of safe water and raw materials

Also, put more interest into the selection of the foods you consume. It is advisable to choose animals that are raised without the use of antibiotics. Meat products containing these drugs are believed to also contribute to resistance.

Poor WASH standards have been observed as a major factor in occurrence of infectious diseases. This causes over-reliance on antibiotics, thus reducing their efficacy.

Correct use of antibiotics

It may not be entirely possible to avoid infections, so you may still need to use drugs sometimes. You should realize that antibiotics are only useful in specific cases, not in all.

Perhaps, due to seeming readiness of doctors to prescribe antibiotics, many people simply resort to them whenever they feel a little ill. They assume that the meds can take care of any types of illnesses, including common cold and other non-bacterial infections. There is risk of continued use and, of course, resistance if there’s no immediate improvement.

Limit your use of antibiotics. Make sure you seek medical information before you use any. Also, ensure that you complete your recommended full course of treatment.

Some experts, however, think there is insufficient evidence that stopping treatment once you improve can increase resistance. Medical arguments can really get confusing sometimes.

Alternating therapy

Doctors sometimes adopt an alternating or multi-drug therapy approach for combating antibiotic resistance. In this case, there is reliance on a combination of drugs for fighting infections. The medicines are taking in rotation, with the hope that if bugs survive one, they will not survive the other.

Researchers have found that microorganisms that adapt to a certain antibiotic may become more sensitive to another type as a result. Multi-drug therapy caused reduction in emergence of resistant bugs in vitro.

There are ongoing efforts to find new drugs as existing ones lose their potency. However, there is fear that research and development (R & D) seem to have slowed in more recent years and that there may soon not be enough options left for patients.

Other Solutions to Antibiotic Resistance

Apart from the foregoing, there are several other approaches that have been suggested for combating antibiotic use. We discuss a few of them below.

Vaccines

Experts believe that boosting the immune system can be an effective way of controlling antibiotic resistance. You can achieve this by way of vaccines.

Antibiotics are agents that are introduced into the body to directly target and kill bacteria. Vaccines, on the other hand, simply enhance the ability of your immune system. The belief is that resistance is not an issue in the latter case due to the course of action.

There is also evidence indicating that greater use of vaccines can cause resistant strains of bacteria to reduce in number. It reduces reliance on antibiotics by preventing infections from developing.

Researchers continue working to develop more effective vaccines because some of these have displayed limited efficacy.

Vaccines are ideally updated from time to time. New strains of microbes capable of evading the effect of the immune system may emerge. This is why, for instance, there is need for an improved influenza vaccine every year.

Phage therapy

This is a very interesting approach to tackling antibiotic resistance. This treatment involves the use of a virus called a bacteriophage made available in drug form. It has numerous potential uses in human medicine as well dentistry and veterinary medicine.

In phage therapy, naturally-occurring bacteriophages are introduced into the body. They proceed to lyse bugs at infection sites. These organisms help to get rid of bacteria by making holes in their cell walls and membranes using lytic proteins.

It is even said that phages can be helpful for destroying the tricky biofilms that promote resistance by these bugs.

Experts believe that these viruses may be bioengineered to treat particular infections and target multi-drug resistant microbes. They argue that the therapy, possibly with the aid of biotechnology, may keep beneficial bacteria from being killed during treatment.

Probiotics

Another means of fighting bacteria without promoting resistance involves the restoration of healthy gut flora. That is another way of saying replenishing healthy balance of bacteria in your gut.

Probiotics offers a proven way of achieving this. This therapy has been widely researched as a good strategy for dealing with infections and even with effects of antibiotic use.

  1. difficile infection is an example of issues that probiotic therapy has repeatedly been shown capable of helping with. Researchers observed in a 10-year study at a community hospital in Canada that a probiotic blend given within 12 hours of taking an antibiotic prescription caused infection rates to drop from 18 cases per 10,000 patients to just over two cases per 10,000.

The above study suggests that probiotics can help to reduce infections in hospital, reducing risk of antibiotic resistance.

Another group of researchers in China found that a probiotic mixture lowered the risk of diarrhea, including C. difficile-associated diarrhea (CDAD), in patients receiving antibiotics in a hospital.

Among other alternatives for dealing with antibiotic resistance by bacteria is surgery. This is more likely to be employed for getting rid of biofilms, which usually require more aggressive approach. Doctors may also use high-velocity water sprays to break up these communities of bugs.

Work continues on finding better solutions. A novel idea for protecting against development of biofilm is the use of Sharklet pattern for surfaces of medical implants. This will make it difficult for bacteria to stick.

Conclusion

Antibiotic resistance is obviously a serious concern for everyone. Widespread and indiscriminate use of antibiotics has promoted and continues to promote adaptability by disease-causing bugs. The fear now is that the trend suggests the world is fast running out of antibiotics.

Responsible use of these drugs is crucial to guard against slight injuries and common infections that were once treatable with them becoming untreatable all over again. Only use these medications as directed by a doctor and for suggested duration.

It is better to take proactive steps that can keep you from having infections as much as possible. Practice good sanitation and hygiene. Avoid animal products containing antibiotics. Also, consider using probiotics to restore your gut flora, especially when taking the drugs.

For now, prevention is arguably the most widely accepted and effective remedy to antibiotic resistance. This includes the use of vaccines to boost immunity against infections, in addition to those mentioned earlier.

 

REFERENCES

Prevalence of Antibiotic Resistance in Anaerobic Bacteria: Worrisome Developments | Clinical Infectious Diseases | Oxford Academic (https://academic.oup.com/cid/article/39/1/92/317427)

An Overview of Antibiotics | Longitude Prize (https://longitudeprize.org/blog-post/overview-antibiotics)

Advances in the diagnosis and treatment of Clostridium difficile infections | Emerging Microbes & Infections (https://www.nature.com/articles/s41426-017-0019-4)

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