The Antibiotics Resistance Threat
Welcome to Morbus & Curis, a blog about disease and healthcare. Today’s blog post is about antibiotic resistance; what it is and the threats it creates.
If you’d first like to learn about what antibiotics are and how they work, please read this article.
The COVID-19 pandemic has been a harsh reminder of how much microbes can impact our day to day lives.
Unfortunately, viral pandemics are not the only major public health issue we face.
More and more antibiotic-resistant strains of bacteria are evolving and our futures may drastically change if we cannot find new solutions to tackle them.
The keyword in the above sentence is solutions because the fight against antibiotic resistance is one that will never end. Our best bet is to try to stay one step ahead.
I think of the battle against antibiotic resistance like a never-ending race.
We are currently ahead in the race but we cannot afford to fall to second place. We can use existing antibiotics to slow, stop or destroy competitor racers, but there will always be some racers that are immune to our antibiotics.
Our best course of action is to stay ahead by discovering new antibiotics that we can use to fend off new or changed competitors.
In real life, changed competitors equate to bacteria evolving to become resistant to the antibiotics used to slow their growth or kill them.
Unfortunately, when bacteria become resistant to multiple types of antibiotics we can run out of options to help patients fight bacterial disease or infection. In the worst cases, this can result in the patient dying.
Let’s dive a bit deeper into the issue of antibiotic resistance…
How do Antibiotics Work?
Some antibiotics are bacteriostatic, meaning they inhibit bacterial growth and reproduction, while others are bactericidal are result in bacterial cell death.
Antibiotics achieve this by disrupting various cellular processes such as protein synthesis, cell wall synthesis, and DNA and RNA transcription.
You can read more about the different types of antibiotics here.
What is Antibiotic Resistance?
Antibiotic resistance is when bacteria can no longer be killed or their growth slowed by specific antibiotics. The bacteria develop the ability to neutralise or defeat the antibiotic administered to inhibit their growth or destroy them. Consequently, the bacteria continue to grow and multiply.
Unfortunately, every time we use antibiotics we provide an opportunity for antibiotic-resistant strains to develop and multiply.
Antibiotic-resistant strains of bacteria will pass down their resistance genes to the next generations or transfer them via mobile genetic elements, such as plasmids (smaller, circular pieces of DNA in bacteria).
Plasmids can easily be replicated then transferred to other bacteria, including other strains or species of bacteria, accelerating the spread of antibiotic resistance.
Consequently, the more we use antibiotics, the less effective they will become. That’s why ensuring their use is only permitted when appropriate is key to slowing the spread of antibiotic-resistant strains. Inappropriate use (e.g. for the treatment of viral infections such as the flu) or overuse of antibiotics will accelerate the spread of resistant strains.
Overuse or inappropriate use of antibiotics allows bacteria to develop resistance.
Why is the battle against bacteria never-ending? Because DNA is fragile. It always has been and it always will be.
When new mutations occur in bacterial DNA they can change or create a process or structure that neutralises the effect of an antibiotic or destroys the antibiotic, giving the bacterium resistance against it.
Some of the resistance mechanisms bacteria use against antibiotics include:
Stopping or limiting the antibiotic from entering the bacterial cell. This can occur if the route the antibiotic uses to enter the cell changes or the number of routes is reduced.
Removal of the antibiotic from the bacterial cell via a pump.
Destruction of the antibiotic by enzymes which break down the antibiotic into smaller, ineffective parts.
Changing the antibiotic target. Antibiotic bind to their target with high specificity, thus if there is a structural change to the target molecule or protein inside the bacterium, the antibiotic may no longer be able to bind and disrupt a cellular process.
Bypassing the antibiotic target. If a bacterium develops a new process or uses a new substrate that renders the antibiotic’s target unnecessary, then the effect of antibiotic is nullified.
A Global Health Threat
Increasingly drug-resistant bacterial infections are a global health threat.
Not only are they a health threat to the patient that they infect but since antibiotics are ineffective at controlling the bacterial infection, it persists in the patient’s body, increasing the chances that it may be spread to others.
A Lancet study estimated that in 2015 over 33,000 deaths in the EU and EEA were due to antibiotic-resistant bacteria. In the US, the CDC estimates that more than 35,000 people in the US die as a result of antibiotic-resistant bacteria or fungi infections each year. Globally the figure may already be as high as 700,000.
If new solutions are not found then it’s predicted that as many as 10 million deaths per year could be due to antibiotic-resistant bacteria by 2050.
Not only will antibiotic-resistant bacteria pose a direct health threat to people, but they’ll also threaten modern medicine as we know it. This is because certain treatments and procedures cannot be carried out safely without antibiotics. These include:
Surgery (including organ transplants)
Sepsis treatment
Conditions and medicines that weaken the immune system (e.g. chemotherapy)
Dialysis
Antibiotic resistance doesn’t only threaten our future health, it also threatens the economy. In fact, it’s estimated that antibiotic resistance will cost the global economy £66 trillion in lost productivity.
Antibiotic resistance is not a new global health threat. Sir Alexander Fleming, who discovered the first antibiotic, penicillin, predicted the risk and challenges of antibiotic resistance back in 1945:
The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism.
It’s not all doom and gloom though. Stay tuned for future articles exploring what governments, industry, health care organisations and others are doing to combat the threat of antibiotic resistance.
Sources
If you found this blog post helpful why not consider subscribing.