The prevalence and threat of antibiotic resistance in bacteria
For the last half-century, antibiotic drugs have been prescribed as the common treatment against bacterial infection and illness. As the medical popularity of antibiotics was climbing, so is the rate at which bacteria and other microorganisms are developing methods to withstand the effects of these drugs. Researchers explain that the excessive prescribing of antibiotics has significantly contributed to antibiotic resistance in microorganisms, as well as gene transfer between resistant and non-resistant bacterial stands. The World Health Organization reports that 444,000 new cases of multidrug-resistant tuberculosis surface every year, and are responsible for 150,000 deaths. The prevalence and threat of antibiotic resistance bacteria places the global population at risk returning to a rate of bacterial infection that has not been seen since the discovery of antibiotics.
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Antibiotic Resistant Bacteria
The Prevalence and Threat of Antibiotic Resistance Bacteria
The rate at which bacteria are becoming resistant to drug treatments that are intended to eliminate or weaken them is growing rapidly. For over half a century, antibiotic drugs have been prescribed to treat bacterial infections, and as their medical popularity was mounting, bacteria and microorganisms developed ways to withstand the effects of antibiotic drugs. The increasing amount of antibiotic resistant bacteria poses a severe threat to global health as it compromises the effectiveness of antibacterial treatment, contributing to greater incidence of bacterial infection, fatalities, and health care expenses (1). According to the World Health Organization (WHO), 444,000 new cases of multidrug-resistant tuberculosis alone surface every year, and are responsible for causing at least 150,000 deaths (2). Researchers explain that the excessive use and misuse of antibiotics has been the major contributor in causing drug resistance, as disproportionate exposure to antibiotics forced microorganisms to evolve to evade harsh environments (1, 2). The prevalence and the threat of antibiotic resistance is so severe, the WHO explains the global population is at risk of returning to a pre-antibiotic era in terms of incidence of illness (2). In addition to vulnerable immune systems, antibiotic resistance has implications on health care costs, trade, and economies (2). Rational use of antibiotics, infection prevention and control, and patient safety are all required measures to combat the current threat of antibiotic resistant bacteria.
Mechanism of Resistance
Antibiotic resistant bacteria emerged as an evolutionary response to natural selection. As bacteria are exposed to recurrent, low doses of antibiotics, that are not potent enough to kill all of the bacteria, some bacteria develop ways to survive the intended effects of the drug (1, 3, 4). The misuse and overuse of antibiotics have intensified the problem by giving bacteria the opportunity to evolve. Inappropriate doses and treatment lengths can leave bacteria in the body, even if the patient no longer has symptoms, and allows for the remaining bacteria to pass on their resistant traits to future bacteria generations (3). Bacteria are able to fight the effects of antibiotic drugs is by altering their biochemistry. Bacteria can prevent antibiotics from reaching their target cells by changing the structure of their cell walls, and keep the antibiotic drug from entering the cell (3). Bacteria can also develop biochemical methods to pump drugs outside of the cell, or produce enzymes that destroy the antibiotics (3).
Bacteria gain these drug resistance properties by receiving resistance DNA genes from other bacteria (3). Bacteria DNA evolves in order to give bacteria the biological tools to escape the affects of antibiotic drugs. Once bacteria have antibiotic-resistant DNA, they are able to pass these resistance genes to other bacteria in various ways: bacteria can join together and transfer DNA to each other; free-floating pieces of DNA, called plasmids, which carry resistance genes are taken-in by bacteria; or pieces of DNA from one bacterium are incorporated into another (3). The mechanism by which resistant and non-resistant bacteria transfer genes is depicted in Figure 1.
Figure 1. Drug resistant bacteria transfer genes to non-resistant bacteria, causing drug resistant bacteria to dominate and multiply (4).
The ability for bacteria to multiply quickly is conducive to rapid evolution (in comparison to other species), which causes several generations of antibiotic resistant bacteria to be introduced into the population.
Threat of Antibiotic Resistance
The prevalence of antibiotic resistant bacteria is not only a threat to global health, but also poses dangers for health expenditures, trade, and economy. In 2002, the cost of health care expenditures caused by antibiotic resistant microbes in the United States was estimated at $7 billion (1). Antibiotic resistance not only proves fatal to many patients, but it inhibits the control of infection diseases. This reduces the effectiveness of antibiotic treatments, causing patients to need medical care longer, and increases the risk of antibiotic resistant bacteria spreading to other patients. The WHO explains antibiotic resistance threatens to return global health to the pre-antibiotic era as many infectious diseases have the potential to become uncontrollable (2). Since conventional antibiotics can not be used on resistant bacteria, more expensive treatments are required, again causing longer hospital stays, and escalates the cost of healthcare. Growing costs of healthcare can weaken economies, both domestic and global. As antibiotic resistant bacteria continue to spread, and treatments become less effective, the growth of global trade and travel only intensifies the problem by allowing bacteria to travel the globe faster (2). Combating the threat of antibiotic resistant bacteria requires rational use of antibiotics, infection prevention and control, and patient safety at the very least.
Conclusion
The discovery of antibiotics, well over half a century ago, fundamentally transformed the way physicians treated patients as antibiotic drugs became the standard for medical intervention. Decades later, and in the wake of excessive antibiotic use and misuse, microorganisms have evolved in order to adapt to harsh environments created by antibiotic drugs, and are able to resist the effects of these drugs (5). Bacteria can resist antibiotics by altering their biochemistry, and gain resistance by receiving copies of resistance genes from other bacteria (3). Antibiotic resistant bacteria do not discriminate between the First World and Third World, and has impacted numerous countries and compromised the treatment of such diseases as MDR-TB, MRSA, and malaria. The growing prevalence of antibiotic resistance bacteria affects global health, healthcare expenditures, trade, and economy, and is not to be underestimated as a threat to global livelihood.
Personally, the one portion of the research that I found to be the most interesting was the prevalence of antibiotic resistant bacteria around the world. I knew that antibiotic resistance existed and was a medical concern, but I was not fully aware of how it exists on such a large scale. The numbers of MDR-TB reports alone is more than intimidating. I was overwhelmed by the thought of how many people go to their family practitioner for a cold and expect to receive antibiotics, and how this seemingly simple exchange between doctor and patient has led to these global health implications.
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