The Centers for Disease Control and Prevention1 published their first Antibiotic Resistance Threats Report in 2013. The intention was to sound the alarm to the dangers of antibiotic resistance that experts had been warning about for decades.
Antibiotic-resistant bacteria are also called superbugs. The resistance occurs as bacteria adapt to chemicals and drugs in the environment. This may make standards of treatment for bacterial infections less effective, and in the case of superbugs, ineffective.
The term “superbug” was initially coined by the media, but Dr. Stephen Calderwood, who serves as president for the Infectious Diseases Society of America says,2 “It resonates because it’s scary. But In fairness, there is no real definition.”
The medical term is multidrug-resistant bacteria, referring to bacteria unaffected by two or more types of antibiotics. Brian Coombes, Ph.D., head of the department of biochemistry and biomedical science at McMaster University in Ontario speaks to the widespread impact antibiotic resistance has on public health, saying:3
“Superbugs should be a concern to everyone. Antibiotics are the foundation on which all modern medicine rests. Cancer chemotherapy, organ transplants, surgeries, and childbirth all rely on antibiotics to prevent infections. If you can’t treat those, then we lose the medical advances we have made in the last 50 years.”
More Dying From Superbugs Than Earlier Estimates
In their first report, the CDC estimated there were 2 million antibiotic-resistant infections reported in 2013, accounting for 23,000 deaths.4 The recently released report includes data not available in 2013, including electronic health records.
Writers of the 2019 report calculate the 2013 data missed nearly half of the cases and deaths.5 According to the new estimates 3 million each year are infected and 35,000 die. Put another way, on average, every 11 seconds someone in the U.S. is infected with an antibiotic-resistant bacterium, and someone dies every 15 minutes.
Other researchers believe even this estimate is too low and the true number of infections is likely much higher.6 Dr. Jason Burnham is an infectious disease specialist at Washington University. He and two colleagues surveyed data from 2010, expanding the definition of antibiotic resistant deaths.
The lower limit of their estimate of people who died in 2010 as the result of an antibiotic resistant bacterial infection is 153,113. The team believes their estimate indicates a need for better surveillance and reporting to address this crucial issue and establish a more accurate estimate of the burden of the infection, which may open more avenues for research funding.
As indicated in the CDC report, hospitals have improved tracking methods and slowed the spread of resistant germs by nearly 30% since 2013.7 Additionally, they identified a secondary infection linked to antibiotic use, Clostridioides difficile (C. diff).
This infection triggers deadly diarrhea after antibiotics upset the natural balance of bacteria in the digestive system. If deaths from C. diff are added to the CDC 2019 totals, more than 3 million infections and 48,000 deaths may be attributed to antibiotic-resistant bacteria. These numbers are likely still a conservative estimate of the damage that could be attributed to multidrug-resistant bacteria.
Antibiotic Resistance Is an Evolving Challenge
According to The Washington Post, the CDC identified five germs representing the most urgent threat. The first three are well-known. They include carbapenem-resistant Enterobacteriaceae (CRE), C. diff and drug-resistant gonorrhea. Each of these are resistant to nearly all antibiotics physicians have used to treat them, and statistics show they kill up to 50% of those who become septic.
Further, these bacteria have the ability to transfer their resistance to related bacteria. This may potentially increase the number and species of bacteria that are antibiotic-resistant. Two new pathogens were added to the list. The first is a yeast called Candida auris, which the CDC8 refers to as an “emerging fungus that presents a serious global health threat.”
The second is carbapenem-resistant Acinetobacter bacteria, which the CDC reports is resistant to nearly all antibiotics. The new report added a classification of pathogens to watch, in which they placed 18 germs with the potential to spread further resistance.
The comparison in the 2013 and 2019 data drives home what experts have warned for decades — bacteria continue to evolve and mutate, developing the ability to fight off different types of antibiotics. As more antibiotics are used in agriculture and health care, they become less effective.
Developing Superbugs Spurred by Antibiotic Overuse
The CDC report links misuse of antibiotics to the impressive rise in resistant infections. In another study9 by the CDC, researchers stated at least 30% of antibiotics prescribed in the U.S. are unnecessary. Antibiotics used in physician offices and emergency rooms were analyzed, and the data revealed most of the unnecessary antibiotics were used for respiratory conditions triggered by viruses.
Put another way, 30% of the antibiotics prescribed in the U.S. equals 47 million prescriptions each year, placing patients at risk for allergic reaction or C. diff infections. In some cases, antibiotics are prescribed proactively, as in the case of erythromycin eye ointment in newborns to prevent ophthalmia neonatorum from gonorrhea and chlamydia.10
The antibiotic is not used universally throughout the U.S. or Europe to prophylactically treat infant pink eye since mothers who receive prenatal care are screened for gonorrhea and chlamydia and treated before the birth of their child. The issue with treatment of all babies is that 25% of all gonorrhea is now resistant to erythromycin.
Despite the fact the American Academy of Pediatrics no longer recommends the universal use of eye ointment, the U.S. Preventive Services Task Force extended the 2011 recommendations citing a lack of prenatal care for many in the U.S. Dr. David Hyun from the Antibiotic Resistance Project at the Pew Charitable Trusts commented on the rising number of antibiotic resistant bacteria:11
“The fact that we’re seeing some of the greatest increases among resistant infections that are acquired outside of the hospital — combined with data we already have showing that approximately 1 in 3 outpatient prescriptions are completely unnecessary — underscores the need for improved antibiotic use in doctor’s offices and other non-hospital settings.”
Although overly prescribed antibiotics play a significant role in the development of superbugs, there are other large agrochemical contributors as well. A major source of human consumption of antibiotics comes from agricultural use. One CDC report12 showed livestock antibiotics have played a role in the development of resistant bacteria.
In 2013, estimates of antibiotic use on livestock accounted for 80% of all antibiotic use in the U.S.13 In a report in 2018,14 the FDA noted a 28% reduction in the sales and distribution of antibiotics earmarked for livestock since the FDA first compiled evidence in 2009.
Pesticide use also contributes to the development of multidrug-resistant bacteria, as I discussed in “Pesticides Compound Antibiotic Resistance.” The bottom line is, bacteria are affected by any chemical they contact and develop resistance up to 100,000 times faster after exposure to certain herbicides, like glyphosate or dicamba.
Hospital-Acquired Infections May Decline With Copper Beds
Hospital beds are another source of infection. Whether you have a planned or unplanned hospital admission, it should never be taken lightly. Research published in the Journal of the American Medical Association revealed that if the person who occupied the bed before you was prescribed antibiotics, you had a greater potential for contracting C. diff.
More than 100,000 pairs of hospitalized individuals were compared from 2010 to 2015. When the previous occupants of a bed received antibiotics, the patient who used the bed after them had a 22% greater risk of developing C. diff. However, the authors of one study show that switching to copper bed frames may reduce that number significantly.15
In the new study, published in Applied and Environmental Microbiology, it’s reported that copper beds in an intensive care unit had 95% fewer bacteria than traditional hospital beds. According to one of the scientists from the Medical University of South Carolina:16
“Hospital-acquired infections sicken approximately 2 million Americans annually, and kill nearly 100,000 — numbers roughly equivalent to the number of deaths if a wide-bodied jet crashed every day. Despite the best efforts by environmental services workers, they are neither cleaned often enough, nor well enough.”
Hospital beds are a source of nosocomial infection, or infections originating from a hospital source. Candida auris, one of the two new pathogens identified in the CDC report, are an intractable threat faced by hospitals, and have been found on hospital beds.
The findings from the study with copper beds indicate they may help infection control efforts and reduce the number of hospital-acquired infections. After the death of one man at Mount Sinai Hospital in New York from Candida auris, the hospital had to use special equipment to clean the room. The hospital president commented:
“Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump. The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”
Know This Treatment if Infection Leads to Sepsis
The CDC recommends using basic precautions to halt the spread of pathogens, including washing your hands when needed and using a good handwashing technique. Dr. Helen Boucher, chief of infectious diseases at Tufts Medical Center, commented on the need to prepare for multidrug-resistant bacteria:17
“We want to have diagnostic tools and medical treatments for problems we know we’re going to have. But we also need to prepare for the kind of resistance that we could never predict. We know from history that bacteria and Mother Nature are smarter than we are.”
One medical treatment you must be aware of is a combination therapy of vitamin C, thiamine and steroids to improve your potential for survival from sepsis — a last-ditch effort by your immune system to fight an infection. Every year 1 million people suffer from sepsis and nearly half will die.
Dr. Paul Marik, chief of pulmonary and critical care medicine at Sentara Norfolk General Hospital in East Virginia, made the discovery while treating a patient with sepsis. Despite the treatment being harmless (it doesn’t make the patient any worse than they are) and a demonstrated reduction in mortality rates in his hospital from 40% to 8.5%, many practitioners continue to wait on further studies.
It is important to recognize the signs and symptoms of sepsis early, as early treatment also increases the potential for survival. To learn more about sepsis and the treatment that could save the life of someone you know, see my past article, “Vitamin C Lowers Mortality in Severe Sepsis.”