As Antibiotic-Resistance Threat Grows, Treatment Is Becoming ‘More Complicated’: Expert

As Antibiotic-Resistance Threat Grows, Treatment Is Becoming ‘More Complicated’: Expert
George Citroner
Antibiotic resistance is an increasingly significant public health issue in the United States. The problem is rapidly growing and is predicted to kill 10 million people every year by 2050 (pdf).

Some pathogens have already become “superbugs” that are resistant to many types of antibiotics.

“Diseases that have been treatable may become incurable as time goes on,” warned Dr. Miriam Smith, chief of infectious disease at Long Island Jewish Forest Hills, part of Northwell Health in New York.

Already Causing Thousands of Deaths Every Year

According to the U.S. Centers for Disease Control and Prevention (CDC), about three million people in the United States currently acquire antibiotic-resistant infections each year, causing over 35,000 deaths annually.

Antibiotic resistance, a main part of antimicrobial resistance (AMR), occurs when bacteria evolve and become resistant to the drugs used to treat them. This happens when bacteria mutate or acquire resistance genes, making them able to survive exposure to antibiotics.

Overuse and misuse of antibiotics have contributed to the development of antibiotic resistance. This includes using antibiotics when they are not needed, such as for viral infections like the common cold, and failing to complete a full course of antibiotics as prescribed.
In addition, the use of antibiotics in livestock and agriculture can also contribute to the development of antibiotic-resistant bacteria.

Some people are more vulnerable to antibiotic-resistant infections.

These include individuals with weakened immune systems, such as cancer patients and transplant recipients, as well as elderly individuals and young children.

Additionally, people who live or work in health care settings, such as hospitals and long-term care facilities, are at an increased risk of developing antibiotic-resistant infections due to the frequent use of antibiotics in these environments.

One of the most concerning antibiotic-resistant infections is Methicillin-resistant Staphylococcus aureus (MRSA), a type of bacteria that is resistant to many commonly used antibiotics.

MRSA infections can range from mild skin infections to life-threatening bloodstream infections and are especially common in health care settings.

Another example is carbapenem-resistant Enterobacteriaceae (CRE), which is a group of bacteria that is resistant to some of the strongest antibiotics available.

We’ve Lost Ground Since the Pandemic

It was reported that among 191 COVID-19 hospitalized patients in Wuhan, 95 percent were treated with antibiotics.
A recent review of studies conducted worldwide finds that antibiotics like macrolides, cephalosporins, fluoroquinolones, and penicillin have been prescribed to a large number of COVID–19 patients to treat secondary bacterial infections. Consequently, the possibility of increasing “antimicrobial resistance and its associated fatalities” soon can’t be ruled out.

Smith said the U.S. pandemic response was very similar and worsened the problem of antibiotic resistance.

The United States lost progress in combating antimicrobial resistance in 2020 due, in large part, to the effects of the COVID-19 pandemic. A 2022 report finds progress made on antibiotic stewardship (pdf) was reversed as antibiotics were often the first option given to treat patients with lung infection-related fever.

“Infection prevention methods and control of antibiotic use demonstrated an 18 percent reduction in mortality due to antimicrobial-resistant organisms between 2012 and 2017,” said Smith. “The U.S. lost ground combating antimicrobial resistance during the COVID pandemic.”

She explained that the setbacks were due to multiple factors, including the increased use of antibiotics at the beginning of the pandemic for pneumonia that was thought to be bacterial in origin.

Another issue was that the CDC and local departments of health that had been focusing on antimicrobial resistance were repurposed to deal with COVID.

“This dramatically accelerated vaccine development and implementation,” said Smith. “These efforts were remarkable but detracted from the fight against increasing antimicrobial resistance.”

The Era of Rapid Development Has Ended

“Early on, 40 or 50 years ago, as antibiotics started to be used and resistances accumulated, the pharmaceutical drug industry was able to discover, and/or create new antibiotics,” said Dr. William Schaffner, professor of preventive medicine in the Department of Health Policy, and professor of medicine in the Division of Infectious Diseases at Vanderbilt University Medical Center.

“So we were able to ‘stay ahead’ of antibiotic resistance because we always had a new antibiotic that we could pull off the proverbial shelf and use,” he continued.

In those early days of drug development, the “easy” antibiotics were discovered, but we’re in a difficult situation now, and advances have slowed.

“So we can’t just research our way out of a problem by creating new antibiotics,” said Schaffner. “Therefore, our options for appropriate therapy become diminished.”

Schaffner said three solutions are being implemented to address the looming crisis:

The first is that physicians are taught to be more prudent in the use of antibiotics. Virtually every hospital now has an antibiotic stewardship program, which supervises the use of antibiotics, and takes corrective action if overuse is detected.

The second is infection prevention, and there are two ways to do that. One is for hospitals to maintain sophisticated infection control programs, and for the general population to keep good hygienic practices.

“We’re constantly making recommendations to the general population about how to shelter your cough, to encourage hand hygiene, all those things to reduce infections so we won’t have to treat,” he said.

The third is through vaccinations.

“There are clearly some vaccines that have been deployed, particularly among children, and they clearly have helped turn around antibiotic resistance in certain bacterial strains,” said Schaffner.

He pointed out the pneumococcal vaccine as one example. This vaccine prevents infection with Streptococcus pneumoniae, which can cause painful middle ear infections.
“There was an increasing development of resistance among some pneumococcal strains,” he explained. “These were included in the vaccines, and once they were deployed, the occurrence of those [resistant] strains virtually disappeared.”

Treatment Is Becoming ‘More Complicated’

Schaffner noted other pathogens that are becoming more antibiotic resistant. These include:
  • E-Coli
  • Enterobacter
  • Acinetobacter
“These are gram-negative bacteria that can complicate the treatment of particularly very sick people who will have intravenous lines; they’re being treated with ventilators, catheters to help drain their bladders,” he said.

He added that the treatment of gonorrhea is also becoming “more complicated,” meaning that it's harder to find drugs that work against the disease, and prescription regimes are more involved.

“The antibiotics we have are more restricted and they have to be given over a period of time,” he explained. “It’s not just one-dose treatment, and of course, compliance with treatment is not always assured, and that becomes a big problem.”

Nearly 87 percent (pdf) of patients don't comply with doctors' instructions for antimicrobial therapy, which increases the risk that a pathogen evolves antibiotic resistance.
He said a new threat on the national and international scene is not a bacteria, but a yeast: Candida auris, which is very drug resistant.

“It occurred around the globe in several different locations and once it gets into a hospital, it can be very vexing to try to get rid of,” said Schaffner.

Another factor is related to the increasing cost of health care in the United States, particularly surgical procedures, which forces some people to seek less expensive treatment abroad. “They can come back to this country with infections that are multidrug resistant,” Schaffner noted. “What’s over there can be over here very quickly.”
George Citroner reports on health and medicine, covering topics that include cancer, infectious diseases, and neurodegenerative conditions. He was awarded the Media Orthopaedic Reporting Excellence (MORE) award in 2020 for a story on osteoporosis risk in men.