Antibiotics and the Post-Antibiotic Era
What Is Antibiotic Resistance in the Post-Antibiotic Era?
Each year in the U.S., at least 2.8 million people are infected with antibiotic-resistant bacteria, and more than 35,000 people die as a result. Ever since the discovery of penicillin in 1928, there has been an acknowledgment of antibiotic resistance — resulting in bacteria finding new ways to survive and resist the drugs. Today, there is growing awareness that the problem goes beyond the use (or overuse) of antibiotics; superbugs and new diseases are emerging that have greater resistance to common cleaners and chemicals we rely on to sanitize, disinfect, and clean up spaces and tools every day. What used to be a problem for medical professionals is becoming a challenge in many areas of public and private life, impacting everything from how we prepare food to how we wash our hands.
Antibiotics are prescribed to fight bacterial infections. When bacteria and other microorganisms are resistant to antibiotics, they withstand the effects to which they were once sensitive — known as antibiotic resistance. The more antibiotics are used, the more the surviving bacteria (or superbugs) inherit a resistance. This is because the more sensitive bacteria are killed, yet the stronger ones grow and multiply. This repetitive cycle, hastened by improper use of antibiotics, is just one of the contributing factors to the overall process.
Traditionally, antibiotic resistance, as the name might suggest, was associated mostly with hospitals and prescription medication used to fight common illnesses and infections. While hospitals and doctors’ offices are still on the frontlines of the fight against superbugs, they are not the only places where these bacteria are prevalent — nor are they the only places that play a key role in fighting back or preventing the spread of superbugs.
Foods, including both plant and animal sources, are recognized as potential carriers of antibiotic-resistant bacteria and fungi. In particular, these potential hosts may serve as vehicles for the transmission of superbugs to humans, as well as a significant way genetic immunities to antibiotics get passed onto future generations of superbugs.
What Makes Superbugs Dangerous
According to the Food and Drug Administration (FDA), “When a person is infected with an antibiotic-resistant bacteria, not only is [the] treatment of that patient more difficult, but the antibiotic-resistant bacterium may spread to other people.” When the normal treatments don’t work it can lead to:
- Longer, more complicated illnesses
- Increased number of doctor visits
- The use of stronger and more expensive drugs
- More deaths due to bacterial infections.
Methods of preventing or slowing antibiotic-resistant infections include:
- Taking the antibiotics as prescribed
- Not skipping doses
- Don’t save antibiotics/don’t take leftover medication
- Do not take antibiotics that are prescribed for someone else
- Speak with your healthcare professional about any questions, comments, or concerns.
Even though there are preventative measures, they may not be 100% effective. Surface disinfection can also help reduce cross-transmission of these germs between hands and surfaces, helping to stem illness outbreaks.
Levels of Threat
The Centers for Disease Control and Prevention (CDC) reports on and creates a watch list of the biggest antibiotic-resistant threats that are categorized into three levels: urgent, serious, and concerning. The report lists a total of 18 different antibiotic-resistant bacteria and fungi and separates them into the proper level based on the amount of concern that each organism has to human health. The watch list is influenced by seven different factors:
- Clinical impact
- Economic impact
- 10-year projection of incidence
- Availability of effective antibiotics
- Barriers to prevention
Listed below are the three levels of the watch list with their corresponding bacteria/fungi.
- Candida auris: CDC is concerned about C. auris for three main reasons: it is often multidrug-resistant — meaning that it is resistant to multiple antifungal drugs commonly used to treat Candida infections, it is difficult to identify with standard laboratory methods, it can be misidentified in labs without specific technology, and it has caused outbreaks in healthcare settings.
- Carbapenem-resistant Acinetobacter: Acinetobacter is a group of bacteria commonly found in the environment, like in soil and water.
- Carbapenem-resistant Enterobacteriaceae: Enterobacteriaceae are a large family of different types of germs (bacteria) that commonly cause infections in healthcare settings.
- Clostridioides difficile: diff is a bacterium that causes diarrhea and colitis (inflammation of the colon).
- Drug-resistant Neisseria gonorrhoeae: Gonorrhea has progressively developed resistance to the antibiotic drugs prescribed to treat it.
- Drug-resistant Campylobacter: People can get Campylobacter infection by eating raw or undercooked poultry or eating something that touched it. Campylobacter causes an estimated 1.5 million illnesses in the United States each year.
- Drug-resistant Candida: Candida normally lives on the skin and inside the body, in places such as the mouth, throat, gut, and vagina, without causing any problems. Candida can cause infections if it grows out of control or if it enters deep into the body (for example, the bloodstream or internal organs like the kidney, heart, or brain).
- Drug-resistant nontyphoidal Salmonella: CDC estimates Salmonella bacteria cause about 1.35 million infections, 26,500 hospitalizations, and 420 deaths in the United States every year. Food is the source of most of these illnesses.
- Drug-resistant Salmonella serotype Typhi: Typhoid fever is a life-threatening illness caused by Salmonella Typhi bacteria. Paratyphoid fever is a life-threatening illness caused by Salmonella Paratyphi bacteria.
- Drug-resistant Shigella: Most who are infected with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after they are exposed to the bacteria.
- Drug-resistant Streptococcus pneumoniae: In 2017, there were about 31,000 cases of invasive pneumococcal disease.
- Drug-resistant Tuberculosis: Tuberculosis (TB) is a disease caused by bacteria that are spread from person to person through the air.
- ESBL-producing Enterobacteriaceae: Enterobacteriaceae are a large family of different types of bacteria that commonly cause infections both in healthcare settings and in communities.
- Methicillin-resistant Staphylococcus aureus (MRSA): The symptoms of a MRSA infection depend on the part of the body that is infected. For example, people with MRSA skin infections often experience swelling, warmth, redness, and pain in infected skin.
- Multidrug-resistant Pseudomonas aeruginosa: Of the many different types of Pseudomonas, the one that most often causes infections in humans is called Pseudomonas aeruginosa, which can cause infections in the blood, lungs (pneumonia), or other parts of the body after surgery.
- Vancomycin-resistant Enterococci (VRE): Enterococci are bacteria that are normally present in the human intestines and in the female genital tract, and are often found in the environment, like in soil and water.
- Clindamycin-resistant Group B Streptococcus: Group B Streptococcus are bacteria that naturally come and go in the body. Most of the time the bacteria are not harmful, but they can cause serious illness in people of all ages, most common in newborns.
- Erythromycin-Resistant Group A Streptococcus: Bacteria called group A Streptococcus (group A strep) can cause many different infections. Some of these are common, relatively minor infections, like strep throat. Others are less common but very serious.
Treatments and Preventions
As you can see from the list above, the bacteria spreading antibiotic resistance aren’t just a clinical problem. They’re part of the air we breathe, the ground we walk on, and the food we eat. No one can entirely avoid contracting an infection; however, there are ways to reduce the risk of infection. Protect yourself and your family by:
- Knowing the risks of antibiotic resistance
- Asking questions
- Taking care of yourself and your health
- Properly washing your hands
- Getting vaccinated
- Being aware of any changes in your health
- Using antibiotics as instructed
- Practicing healthy habits around animals
- Properly preparing foods
- Staying healthy when traveling abroad
- Preventing sexually transmitted diseases
- Keeping environments clean and sanitizing or disinfecting surfaces regularly
In addition to environmental cleanliness and patient awareness, healthcare professionals can help stem the spread of and prevent antibiotic resistance by:
- Prescribing an antibiotic only when it is likely to benefit the patient
- Prescribing an antibiotic that targets the bacteria that is most likely causing their patient’s illness
- Encouraging patients to use the antibiotic as instructed
- Collaborating with each other, office staff, and patients to promote appropriate antibiotic use
Raising Awareness of Antibiotic Resistance
Raising awareness of antibiotic resistance may be one of the most important preventative measures to implement. By doing so, it increases the public consciousness of the negative outcomes, what preventative measures to take, and how to reduce the incidence. We can raise awareness by:
- Educating the public, ourselves, and our families of antibiotics do’s and don’ts
- Asking your healthcare provider what they’re doing to help
- Being aware of how diseases are spread and how rapidly antibiotic resistance can occur
Education on Proper Cleaning, Disinfecting, and Sanitizing Surfaces
Another important method of antibiotic-resistant prevention is knowing how to properly clean and disinfect or sanitize surfaces, objects, and our hands. Best practices from healthcare can be applied to foodservice and beyond.
In regards to foodservice, there are many foodborne illnesses that can result from improper sanitation techniques (some of which are a part of the biggest threats). In fact, preventing foodborne illnesses such as Listeria Monocytogenes, the deadliest foodborne pathogen, should be a priority for all foodservice locations — especially those in healthcare foodservice. Basic elements of equipment cleaning and sanitizing in the food industry include:
- Proper cleaning, rinsing, and sanitizing
- All wet reusable towels/cloths should be laundered or discarded daily. The wiping cloths may be laundered in a mechanical washer, a sink designated only for laundering wiping cloths, or dishwasher or food preparation sink that is cleaned and sanitized before use
- Dispose of trash in the designated receptacle
- Use a new/sanitized utensil for all food items to prevent cross-contamination
- Keep disposable sanitizing wipes or multi-surface spray nearby to quickly clean and sanitize affected areas
Improved Antibiotic Use and Further Research
The CDC is continuously trying to combat antibiotic resistance by furthering their research methods. In fact, the CDC is leading efforts to:
- Tackle the threat of antibiotic resistance
- Drive aggressive action with healthcare, veterinary, and agriculture partners nationwide
- Empower the nation to respond comprehensively, efficiently, and effectively
They are doing so by using:
- Antibiotic resistance lab networking for nationwide detection of new and known threats
- Whole-genome sequencing to track resistance and stop outbreaks
- Robust systems to track resistance, antibiotic use, and infections in human health
- Containment of novel resistance threats
The complete elimination of antibiotic-resistant pathogens may not be achievable; however, we can decrease the rate at which these pathogens spread. Improved education and enhanced prevention methods can help.