What do a paper cut, cooking dinner, visiting the doctor’s office and an airplane ride have in common? All of them may seem harmless, but they may be sources of infection, and could also cause the spread of antimicrobial resistance. Antimicrobial resistance occurs when germs are resistant to “antimicrobials” (e.g. antibiotics); the medicine doesn’t cure the infection. You may have heard of antimicrobial resistance in news articles. New studies continue to unearth cases of resistant infections in many scenarios and walks of life. What once were simply nuisances treated easily with antibiotics (ear infections, bladder infections, strep throat) may be morphing into life threatening situations due to dwindling treatment options.
Antimicrobials are an umbrella group of medicines that are used to treat infectious agents (germs) such as bacteria, viruses and fungi. Antimicrobials include antibiotics like penicillin, antivirals such as HAART therapy for HIV, antifungals such as the -azole drugs which treat skin infections, and anti-septics such as alcohol based hand sanitizers or surgical prep solutions. When a microbe such as E. coli (a common cause of urinary tract infections and food poisoning) comes into contact with an antibiotic, the susceptible bacteria are slowed or killed. Resistant bacteria, however, live on despite treatment. Some microbial resistance develops naturally through gene mutations, but with increasing use of antimicrobials we will encounter greater numbers of resistant germs that are often heartier and more virulent. Some of these are called multi-drug resistant, or ‘super bugs’. Infections with super bugs might become impossible to cure because the germs are resistant to so many medicines.
Infections with superbugs were once limited to hospitals, nursing homes or doctors’ offices. However, superbugs have now infiltrated the community. Rates of colonization, in which a person carries the germ but doesn’t have symptoms, are on the rise. And colonization is occurring earlier in life, with mothers and infants being prescribed antibiotics routinely for bacteria which then become resistant. The implications of this trend are far reaching. Primarily, common sorts of infections may no longer be manageable. Pneumonia, infections of the urinary tract, eyes and ears, skin and soft tissue, digestive tract, reproductive or nervous systems and beyond can be minimized with antibiotics, but microbial resistance complicates even the simplest infection scenarios. Dental procedures, birth complications, joint replacements, and surgeries in immune-compromised patients will all become higher risk as antimicrobial resistance spreads.
Currently, over 2 million cases of antibiotic resistant bacterial infections occur in the United States annually. There are 23,000 deaths each year and 8 million unnecessary hospital days due to these resistant infections. Worldwide, it is estimated that over 700,000 deaths occur as a direct result of antimicrobial resistant infections, but a recent report estimated that by the year 2050, up to 10 million deaths could be attributed annually to resistant infections.
What the public health system is doing to fight antimicrobial resistance:
In 2014, the World Health Organization published a global assessment of antimicrobial resistance showing that in many countries, some mainstay treatments have become completely ineffective against several common but serious infections. It also formed a Global Action Plan on Antimicrobial Resistance that includes five strategic objectives to address the crisis. In the US, scholars have been calling attention to antimicrobial resistance for many years. In 2014, the White House convened a task force to address health threats from anti-microbial resistance and published a National Action Plan. To learn more about these efforts, find updates under the WHO programme for antimicrobial resistance website, or the US Centers for Disease Control and Prevention antimicrobial resistance website.
What the public can do:
When it comes to preventing antimicrobial resistant infections, you can play a part in preventing the transmission of resistant bugs and preventing the development of newly resistant ones. Start with good hygiene; use clean practices such as regular handwashing, especially between activities such as food handling, cooking, wound care or helping an ill friend or family member. Ask your healthcare provider if you are up to date with your immunizations. If you have an infection, ask your doctor about the risks for resistance and how you can avoid generating antimicrobial resistance during your treatment. Also, since sexually transmitted infections (STIs) such as gonorrhea are one of the CDC and WHO top priorities due to their increasing resistance to last-line antibiotics, practice safe sex. For more resources on “Protecting Yourself and Your Family”, visit the CDC’s website.
What health professionals can do:
Health professionals of all kinds have a role to play. Facility administrators must notify staff of any resistant organisms detected in the facility and assure coordination between health professionals, laboratory, sanitation and ancillary services so that containment guidelines can be implemented. Lines of microbial transmission can be disrupted at multiple steps along the sequence of care including patient transport and transfers between and within healthcare facilities. Local, state and national reporting laws should be treated as equivalent to any other mandatory reporting rules. And, communication with patients is extremely important. Make sure to discuss the potential for resistant infections due to over-prescribing antimicrobials. For inpatient care providers, the CDC’s Get Smart for Healthcare initiative seeks to inform caregivers on appropriate, efficient prescribing, infection prevention, and management. For more guidance on antimicrobial resistance for health care workers, visit the CDC website for Protecting Patients and Stopping Outbreaks.
Bush, Karen, et al (2011). Tackling antibiotic resistance. Nature Reviews- Microbiology, 9, pp. 894-896.
Centers for Disease Control and Prevention (2013). Antibiotic resistance threats in the United Sates, 2013.
Centers for Disease Control and Prevention (2016). Antibiotic/antimicrobial resistance. Accessed online at: http://www.cdc.gov/drugresistance/index.html
Meropol, S. B., Stange, K. C., Jacobs, M. R., Weiss, J. K., Bajaksouzian, S., & Bonomo, R. A. (2016). Bacterial colonization and antibiotic resistance in a prospective cohort of newborn infants during the first year of life. Open Forum Infectious Diseases. doi:10.1093/ofid/ofw221.
The White House (2015). National action plan for combating antibiotic resistant bacteria. Accessed online at: https://www.whitehouse.gov/the-press-office/2015/03/27/fact-sheet-obama-administration-releases-national-action-plan-combat-ant.
World Health Organization (2015). Global action plan on antimicrobial resistance. Geneva, Switzerland.
World Health Organization (2016). Antimicrobial resistance programme (web). Accessed online at: http://www.who.int/antimicrobial-resistance/en/.
December 2016. This post was authored by Jim Curry, University of Illinois at Chicago medical student and edited by Susan Buchanan, MD, MPH, Director of the Great Lakes Center for Children’s Environmental Health – Region 5 Pediatric Environmental Health Specialty Unit (PEHSU).