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Get a good overview on antibiotic resistance from the Centers for Disease Control.
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Episode number: 
111

Superbugs cannot be squashed, stepped on or swatted away. They are antibiotic-resistant bacteria that creep in to your physical being at the cellular level. In this episode of Second Opinion, you will learn about the correct use of antibiotics, how bacteria become drug-resistant Superbugs, why this is a serious public health problem, and what is being done to stop it.

What does not kill them makes them stronger.

Them, in this case, refers to the growing number of bacterial strains that can survive assaults by the most powerful antibiotics known to medicine. They have earned the nickname, "superbugs," and they're a potentially deadly threat that man has actually helped to create.

Like all living things, bacteria follow the laws of evolution and adapt to their environment. When you take an antibiotic, the drug kills susceptible bacteria and leaves behind those that can resist it. The survivors then multiply, creating a new bacterial strain that the old antibiotic is unable to kill.

In the United States and other developed countries, decades of overuse and misuse of antibiotics have contributed the emergence of bacterial strains that many of our "wonder drugs" cannot touch. And the more that antibiotics are used, the more bacteria evolve.

Antibiotic resistance is not a new phenomenon. Resistant disease strains started showing up soon after the discovery of antibiotics. What is different now is that antibiotic resistance is no longer an isolated problem. Almost all human diseases that can be treated with antibiotics have evolved and developed at least some degree of resistance.

Fortunately, most people are unlikely to be infected by superbugs. The greatest risk is in hospitals, adult care homes, and other environments where people tend to get sick a lot. They may be treated with a range of different antibiotics and are at greater risk of developing a drug-resistant infection. Also at risk are hospital patients with weakened immune systems who are in close quarters with other patients who may spread their infectious diseases.

Are we fighting a losing battle against superbugs? Hardly. Though resistant bacteria continue to pose a significant health risk, considerable work is in progress to counter the threat - by improving infection control, developing new antibiotics, and using drugs more appropriately.

You can help the effort in several ways:

  • Do not insist on an antibiotic when your doctor says you do not need one.
  • When you are taking antibiotics, finish your prescription. Even when your symptoms have gone away, bacteria can still survive and reproduce if you fail to complete your full course of treatment.
  • Do not take leftover antibiotics or antibiotics prescribed for someone else. They may not be the right drug for treating your symptoms. By taking the wrong medicine, you can delay the proper therapy treatment and enable bacteria to multiply.
 

Quick Facts

Bacteria live on or in most materials and environments on Earth, from soil to water to air, and from your house to arctic ice. They can subsist on nutrients from sugar and starch to sunlight, sulfur, and iron. One species can withstand radiation 1,000 times greater than would kill a human being.

Each square centimeter of your skin contains about 100,000 bacteria. A single teaspoon of topsoil contains more than one billion (1,000,000,000) bacteria.

To prevent bacteria from causing infections, wash your hands frequently, prepare foods safely, and keep current on your immunizations.

Antibiotics are among the most powerful and important medicines known. Each time antibiotics are taken, sensitive bacteria are killed, but resistant ones may be left to grow and multiply. Some resistant strains of bacteria - sometimes called superbugs - are already untreatable.

Each year in the U.S., doctors write an estimated 50 million antibiotic prescriptions for viral illnesses for which antibiotics offer no benefit.

Nearly one-fourth of Americans misuse antibiotics.

Most strains of antibiotic-resistant bacteria originate and are contracted in hospital intensive care units (ICUs). Therefore, untreatable and hard-to-treat bacteria are much more common in hospitals than in the community at large.

More than 70% of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs most commonly used to treat them.

Some superbugs can resist vancomycin, a powerful antibiotic used to treat severe bacterial infections. A strain of vancomycin-resistant enterococci (VRE) that appeared in the late 1980s continues to thrive. Scientists worry that it will continue to multiply and spread its genetic survival techniques among other bacteria.

Patients most susceptible to antibiotic-resistant bacteria include premature infants, children, the elderly, burn victims, bone marrow transplant patients, and those with weakened immune systems such as AIDS patients and leukemia patients.

People infected with drug-resistant organisms are more likely to have longer hospital stays. They  will require treatment with second- or third-choice drugs, which may be less effective, more toxic, and more expensive.

Ask Your Doctor

Provided by Caroline Breese Hall, M.D.
Professor of Pediatrics and Medicine in Infectious Disease
University of Rochester

This list of questions is a good starting point for discussion with your doctor; however, it is not a comprehensive list.

  1. Last month you gave my child antibiotics for his ear infection, but this time for his cold you do not want to give my child antibiotics. Why not?
  2. Will antibiotics treat all types of bugs that cause fever, cold and flus?
  3. What are "superbugs"?
  4. How does a "regular" bug that causes common infections become a "superbug"?
  5. Whom do these "superbugs" affect?
  6. How does someone get a "superbug"?
  7. How can I tell if I, my child, or someone else has a "superbug"?
  8. What would make you suspect that I, or a member of my family, has a "superbug"?
  9. If I get infected with a "superbug", will I be contagious, a "super typhoid Mary"?
  10. Will these "superbugs" make me or my child sick or even sicker than a regular bug?
  11. How do you treat a "superbug"?  Do you treat it differently than other bugs?
  12. If I have a "superbug" and you treat it, how will I know it is gone?

Key Point 1

Antibiotics become ineffective when they are used incorrectly.

What are antibiotics?

Antibiotics are medicines used to treat certain bacterial infections, either by killing the bacteria or stopping their growth. Penicillin, the first antibiotic, was developed in the early 1940s. Others have followed, and research into new antibiotics is continuing. These miracle drugs have proven to be enormously successful at treating illnesses that were once considered life-threatening.

Antibiotics can effectively treat many infections. When used incorrectly, however, they can do considerable damage to the user and the community at large. As a result of incorrect usage, antibiotics have begun to lose their effectiveness on the organisms that cause disease. Medical conditions such as tuberculosis, malaria, and gonorrhea, as well as common sore throats and ear infections, are becoming more difficult to treat. Once again, common infections can become life-threatening events.

This trend exists throughout the U.S. and the rest of the world. Though hospital patients and children in daycare centers are the most vulnerable to drug-resistant infections, no urban or rural population is immune.

What is the correct use of antibiotics?

Correct antibiotic use is the responsibility of both doctors and patients. Doctors must be able to make a correct diagnosis and then prescribe the appropriate treatment. Patients must also play a role, by taking the following measures:

  • Respond accurately and thoroughly to your doctor's questions. Carefully describe your symptoms and prior reactions to specific antibiotics.
  • Be aware that viral and bacterial conditions have different causes and require different treatment.
    • If a virus is causing a cold, flu, sore throat, cough, bronchitis, or fluid accumulation in the inner ear, an antibiotic will not help. For viral conditions, your doctor may suggest rest, fluids, and medicines other than antibiotics.
    • If bacteria are causing pneumonia, tuberculosis, strep throat, ear infection, cellulitis, sinus infection, urinary tract infection, or another illness that lingers, your doctor will prescribe an appropriate antibiotic.
  • Refrain from pressuring your doctor to prescribe an antibiotic for your child. A recent study showed that doctors prescribe antibiotics 65% of the time when they feel that parents expect it, compared to only 12% of the time when they feel that parents do not expect it.
  • Follow your doctor's instructions for taking prescribed medication, including the number of times a day, the correct time of day, and the number of days. Do not stop taking the medication early, even if you are feeling better. Some bacteria may linger, creating drug resistance.
  • Only take antibiotics that your doctor has prescribed for you based on your current medical condition. Do not save antibiotics for future use by yourself or others, and do not use antibiotics that others have saved.

Treatment Recommendations for Common Infections shows the therapeutic options for treating a number of common infections.

    

Key Point 2

Bacteria become resistent because antibiotics are overused and misused.

What are bacteria?

Bacteria are single-celled, microscopic organisms that live around and in each of us. While they perform some beneficial functions, they can also cause illnesses, including strep throat, ear infections, and bacterial pneumonia. When you are tired, weak, or stressed, you become more susceptible to illness-causing bacteria. This helps explain why, in the U.S. each year, close to two million patients contract infections during hospital stays.

What is bacterial resistance?

Superbugs are bacteria which have developed resistance to certain antibiotics. Treating them requires stronger antibiotics or new antibiotics to which the bacteria have not yet developed a resistance. A few types of resistant bacteria are considered untreatable.

Superbugs limit the options available for treating illnesses, allowing them to spread more widely and increasing their ability to threaten lives.

What causes bacterial resistance to antibiotics?

In all populations of organisms, some members have characteristics that differ from those of other members. A subset of bacteria may have the ability to withstand an antibiotic's attack. For example:

  • The antibiotic penicillin attaches to the cell wall of bacteria and destroys a key part of the wall. When the wall falls apart, the bacteria die. A subset of the bacteria either change their cell walls, preventing the penicillin from attaching, or produce enzymes that dismantle the antibiotic. This subset is immune to penicillin.
  • Several antibiotics - erythromycin, tetracycline, streptomycin, and gentamicin - work by attacking ribosomes, the part of the bacterial cell that is used to make proteins. A subset of bacteria has altered ribosomes to which these antibiotics cannot adhere. This subset is immune to these antibiotics.
  • Bacteria defeat antibiotics in other ways, including modifying the antibiotic so that it becomes inactive, pumping out the antibiotic, and altering or adding genetic information so that the target of the antibiotic is ignored.

In this contest for survival of the fittest, the superbugs thrive, multiply, and become dominant. They exchange their survival tactics with other bacteria and increase the population of resistant organisms.

Humans can develop a drug-resistant infection by having a resistant microbe emerge when antibiotic treatment begins. When you take an antibiotic, some bacteria will remain and grow more powerful. Bacteria treated multiple times with the same antibiotic will develop resistance, requiring stronger medication to be effective. When you do not take an antibiotic for the prescribed length of time, a greater number of bacteria survive. Repeated and incorrect uses of antibiotics are the primary causes of drug-resistant bacteria.

You can also develop a drug-resistant infection by contracting a resistant bug. Frequent air travel and extensive immigration facilitate the quick passage of pathogens from one country to another. Drug-resistant strains of malaria brought into the U.S. by travelers from other countries are becoming more difficult to treat. Resistance to antimalarial drugs like chloroquine, once widely used and highly effective, is growing.

    

Key Point 3

Resistant organisms are costly to treat, require drugs that have a higher rate of complications, and have a high rate of long-term harm.

Why are superbugs a serious problem?

Healthcare providers are taking the problem of superbugs very seriously for the following reasons:

  •  As the number of superbugs grows, the bacterial infections they create do not respond to treatments that once worked. As a result:
    • Illnesses last longer
    • More doctor visits are required
    • Treatment is more invasive. Instead of taking an antibiotic by mouth, an intravenous injection that is more toxic may be required
    • The risk of complications and death increases. Infectious diseases remain a leading cause of death in the U.S. and worldwide
    • The person with the infection is contagious for a longer period of time and able to spread the resistant bacteria
    • As the superbugs spread among the hospital population, those who are already vulnerable are subject to infection and have with fewer treatment options
  •  Illnesses that last longer increase direct costs associated with additional laboratory tests, treatments, and hospitalization, as well as indirect costs associated with loss of income. As drug options to treat common infections become limited, the use of more expensive options contributes to escalating healthcare costs.
    • A 1995 Office of Technology Assessment report estimated that the emergence of antimicrobial resistance among six common bacteria in hospitals adds approximately $661 million per year in hospital charges.
    • According to the Institute of Medicine (IOM), the total cost of treating antimicrobial-resistant infections may be as high as $5 billion annually in the United States.
    • The settings for acquiring drug-resistant infections are extensive. For example:
      • In intensive care units, patients can contract staphylococcal infections.
      • In schools, students can contract pneumococci from a classmate.
    • In cafeterias and restaurants, diners can contract salmonella from meat or eggs.

What is being done?

The U.S. recognizes the seriousness of the superbug problem and has authorized funding and programs to address it. An interagency task force led by the Centers for Disease Control, the Food and Drug Administration, and the National Institutes of Health has initiated a public health action plan that includes:

  •  Surveillance - knowing which drugs to prescribe
  •  Prevention
  •  Education
  •  Research into:
    • Improved diagnostic tests
    • Molecular mechanisms of drug resistance and risk factors associated with their spread
    • New antimicrobial drugs
    • New vaccines to prevent and control the spread of resistant infections

The FDA has recommended specific areas in which it can play a role:

  •  Promptly and effectively responding to current threats from drug resistance.
  •  Facilitating development of new products that help address the issue.
  •  Helping to improve the quantity and quality of information available to consumers and health professionals regarding antibiotics resistance and principles of appropriate usage.
  •  Maximizing and coordinating FDA's scientific research to address ongoing needs

When we misuse antibiotics and help create more drug-resistant bacteria, even common infections become difficult to treat. Surgery, chemotherapy, and other medical treatments depend heavily on antibiotics. You can do your part to combat superbugs by taking antibiotics only when needed and exactly as directed.

Medline Plus

Medline Description: 

Conduct an off-site search for Antibiotic Use information from MedlinePlus.  These up-to-date search results are based on search terms specific to Second Opinion Key Points.

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