Antimicrobial Resistance: Living on the Edge!!

Less than a generation ago, the first antibiotics were introduced as a medical treatment and it revolutionized the field of medicine. In the pre-antibiotic era, a simple scrape to the knee could become infected leading to death.

Before antibiotics were used to treat infections the major causes of mortality were due to pneumonia, gastrointestinal infections, and tuberculosis. During World War I, 1 out of 3 soldiers died from infection or disease because antibiotics were not available. Contrasted with World War II when antibiotics were being used, thousands of soldiers would return home. For civilians, the introduction of antibiotics greatly expanded the ability of doctors to safely perform surgeries, caesarian sections, and organ transplants.

Today these miracle drugs are severely threatened, and we stand in stark contrast to the golden age of antibiotics. Antibiotic-resistant infections are increasingly common and resistance mechanisms have now been identified against all clinically used antibiotics. The grave consequences of this reality have been extensively communicated by the World Health Organization and The Centers for Disease Control and Prevention (CDC). They warn that if antimicrobial abuse is not stopped and the development of new antimicrobials are not prioritized, we will globally lose antibiotics in the fight against bacterial infections. Startling projections tell us that on our current path, by 2050, 10 million people will die per year of bacterial infections. By contrast, fewer people die of cancer today. The associated cost of treating these infections will be upwards of 100 trillion USD, a blistering cost to the global economy.

Antibiotic resistance occurs when a bacterium becomes non-susceptible to an antibiotic treatment. The antibiotic effectively loses its activity against that bacterium, and the organism continues to cause infection.

One of the reasons for the development of antibiotic-resistance is due to the abuse of antibiotics. In the United States, it is estimated that 1 in 3 antibiotic prescriptions are unnecessarily prescribed. In urgent care clinics, almost half of all antibiotic prescriptions are misused for flu, coughs, colds or unrelated conditions. In fact, antibiotics have no ability to treat viral infections and only act as one of the causes of antimicrobial resistance. The second source of misuse and the far greater abuser is the agricultural industry. In the United States, an estimated 80% of all antibiotic consumption is by the agricultural industries. Medically useful antibiotics are unregulated in agricultural sectors, which have led to tremendous misuse for the purposes of food production. Antibiotics in agriculture are used to indiscriminately prevent infection and increase meat production by making animals put on weight in a shorter amount of time. In China, for example, agricultural sectors depend on the unregulated use of colistin, which is a medically-useful antibiotic. Moreover, colistin was considered as an “antibiotic of last resort” to treat resistant infections in humans because it was assumed bacteria had no resistance against it. In 2015, an alarming study found colistin-resistance in bacteria isolated from pig abattoirs and infected patients in two Chinese hospitals. This was a dire tipping point in infectious disease history since colistin was considered a drug with no resistance mechanisms. The fact that these infections were colistin-resistant meant there was capacity for bacteria to become resistant to all antibiotics. Despite colistin’s use in medicine, some countries have no policies on the use of these drugs for agricultural purposes, accelerating our downward spiral. The report from China was just the beginning, subsequent reports have identified bacteria with resistance to multiple classes of antibiotics, even one case where resistance to all known antibiotics was reported.

Within 100 years, we may be witnessing the rise and fall of modern medicine, and a return to the pre-antibiotic era. Without a concerted effort to stop antibiotic misuse and a sustained push to develop new antibiotics and antimicrobial molecules, we will continue this march towards a bleak future.

Dr. Dinesh Fernando