Antimicrobial Resistance: When “Bugs” Bite Back

The FDA warning about contaminated eye drops, issued in February, 2023, was scary, and for good reason. Using the eye drops, potentially contaminated with a rare and drug-resistant strain of bacteria, could result in blindness or death, public health officials warned—and in some cases did. As of March 21, the CDC reports, 68 patients in 16 states were identified as affected, with 3 deaths, 8 reports of vision loss and 3 reports of surgical removal of the eyeball.

Antibiotic Resistance

For many people—those affected directly as well as those listening to the news—the contamination brought home the issue of antibiotic resistance. Who hasn’t used eyedrops, at one time or another?

While antibiotic resistance is the commonly used term, public health experts prefer the term antimicrobial resistance, because much more than antibiotics are involved. Antimicrobial resistance is defined, according to the World Health Organization, as resistance that occurs ‘’when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines,” which makes infections harder to treat and also boosts the risk of disease spread, severe illness and death.

So severe is the issue that WHO has declared antimicrobial resistance, or AMR, as one of the top 10 global public health threats

Driving the issue, besides overuse of some medicines, is poor infection control and prevention.

So severe is the issue that WHO has declared antimicrobial resistance, or AMR, as one of the top 10 global public health threats. According to the CDC, antimicrobial resistance killed at least 1.27 million people worldwide in 2019. More than 2.8 million antimicrobial-resistant infections happen every year in the U.S. More than 35,000 die each year as a result, the CDC reported.

Background

None of this is news to experts like William Schaffner, MD, a professor of preventive medicine and health policy at Vanderbilt University Medical Center, Nashville, and a spokesperson for the Infectious Diseases Society of America.  Antimicrobial resistance has been an issue for years, he says.

Just as scary as the eyedrop scare is the news about a dangerous fungus that spreads in healthcare facilities. It’s called Candida auris, and the CDC says it is ‘’an emerging fungus that presents a serious global health threat.”  The CDC first issued an alert in 2016, with U.S. cases as far back as 2013. The fungus is rare but can be deadly.

According to Schaffner, “this is a troublesome fungus. If it does get into your hospital, it’s hard to get out of your hospital. It’s one of those bugs that doesn’t affect a normal healthy person, but it preys on people already quite ill, often in the ICU and receiving medical care with devices, such as bladder catheters, IV lines and respirators.”

The fungus can affect the bloodstream and also can enter the lungs and wounds, he says. While it can be tricky to identify the fungus in a lab, experts have known about it for a few years, so most hospitals are on the alert for it now, Schaffner says.

Resistance by UTIs

Antimicrobial resistance can also affect many other conditions that occur often and that used to be relatively quick and easy to treat.  For instance, Schaffner says, “the most common cause of urinary tract infection (UTI) is a simple bacteria, E. coli. But E. coli, in different parts of the country, is developing multiple antibiotic resistance.”  The most common antibiotics used don’t always work anymore, so doctors must switch drugs. And that can delay recovery, of course.

How to Fight Back

While public health experts stay on top of how to track and prevent antimicrobial resistance, people can also take a number of measures to avoid being affected personally, Schaffner says. It sounds simple, but it works: good hand hygiene. Wash your hands thoroughly and often, so you don’t get infected to begin with, Schaffner suggests.

“If you happen to be ill and you got to your doctor’s office and they say, ‘Oh that’s a viral infection, you don’t need an antibiotic,’ be pleased. Don’t argue with the doctor and says ‘No, no, I need an antibiotic.’’’ Part of that insistence, he says, springs from practices years ago of prescribing antibiotics widely—too widely. “But we’ve learned, there are profound consequences, and we have to think about the collective. So if I overuse an antibiotic, it can affect you, because the next time you get infected—or I get infected—it may be with a germ, a bacteria, that is resistant.”

Doctors have the best bet in talking people out of unneeded antibiotic by explaining the organism they have, that antibiotics won’t work against viruses—and then offering something positive—such as symptomatic relief—and assuring them their body will fight off the virus, Schaffner says. His bottom line: “You  never want to take a medicine that’s worthless,” plus have the risk of a side effect from the medicine.

Are We Doing Better?

There’s definitely more attention on the issue. “Every hospital has to have what is called an antibiotic stewardship program,” Schaffner says, which involves oversight about how antibiotics are used there. But, he adds, that doesn’t extend to doctors’ practices and clinics. While much education has occurred, as well as progress, ‘’we are not where we want to be yet.’’

So, can’t pharmaceutical companies just develop new drugs? While that was the thinking decades ago, Schaffner says, it’s not realistic now.  “It gets harder and harder, scientifically, to develop new antibiotics.” Then there’s the profit potential. Imagine two options, he says: A pharmaceutical company can invest in drugs that treat chronic disease, such as diabetes and high blood pressure, or an antibiotic used for a short course that would probably be put on the shelf to be saved for the worst cases—you know, to minimize antibiotic resistance.

Your Turn

Have you changed your personal practices, such as not begging your doctor for an antibiotic when told it’s not necessary and won’t work for what you have?

Have you had to change antibiotics because the first choice didn’t work? Let us know in the comments!

Kathleen Doheny is a Los Angeles-based independent journalist, specializing in health, behavior, fitness and lifestyle stories. Besides writing for Senior Planet, she reports for WebMD, Medscape, Endocrine Web, Practical Pain Management, Spine Universe and other sites.  She is a mom, mother-in-law and proud and happy Mimi who likes to hike, jog and shop.

Doheny photo: Shaun Newton

This article offered by Senior Planet and Older Adults Technology Services is for informational purposes only and is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition. If you think you may have a medical emergency call 911 immediately.
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