ANTIBIOTIC-RESISTANT BACTERIA A MODERN PUBLIC HEALTH PHENOMENA

By Ayman Lone and Ruka Adichi

Ricky Lanetti was a 21-year-old star football player for Lycoming college in Pennsylvania, at the pinnacle of his health. In December of 2003, after a week of having flu-like symptoms, the soon-to-be All-American was taken to the hospital the night before the NCAA quarterfinal. Twelve hours after he checked in, Ricky died the morning of the game. His cause of death was ruled as MRSA – methicillin-resistant Staphylococcus aureus – bacteria that entered his body through a small pimple. In half a day, a fully healthy individual succumbed to a seemingly trivial bacterial infection.

Ricky’s tragic death is a warning of a modern public health phenomena – antibiotic-resistant bacteria. Antibiotic resistance refers to certain bacteria becoming resistant to antibiotics that normally kill the strain. ake the MRSA mentioned above: since its discovery in 1961, it has become immune to penicillin, methicillin, amoxicillin, penicillin, oxacillin, and many other common treatments. Other notable resistant bacteria include C. difficile and N. gonorrhoeae, AKA super gonorrhea. Where do these superbugs come from?

The mechanisms behind these superbugs developing resistance revolve around population and evolutionary biology, or selective pressure. Consider a few fundamental traits of bacteria: their extremely high replication rates and subsequently high mutation rates. When encountering an antibiotic, the majority of a bacterial population will die, minus a small few that carry adaptive mutations that allow them to survive the effects of the drug. These adaptations may include limiting the number of entryways on the membrane for a drug to enter or having enzymes that break down a drug. The small population with such abilities will quickly replicate and evolve into a new strain that the antibiotic can not eradicate as effectively. Rinse and repeat with multiple strains against multiple drugs, and now you have a whole new generation of bacteria resistance to our antibiotics. This process is a microscopic example of natural selection and an inescapable fact of biology, which is impossible to override. This is why it is equally important to consider what’s happening with drugs and bacteria on a macroscopic level.

Over the years, society has misused antibiotics, allowing bacterial resistance to emerge rapidly. Ironically enough, some of the issues have stemmed from inside the hospitals. Having sicker patients in such close quarters in a hospital provides the perfect breeding grounds for new bacterial strains, especially if many of them are on a number of drugs. In other cases, doctors and other health workers may inappropriately prescribe antibiotics, particularly in cases of imperfect diagnoses or succumbing to a persistent and uninformed patient. In countries without proper public health guidelines, certain drugs may be acquired even without a prescription. The other major brewing grounds of antibiotic resistance are the animal and crop industries. Over half of all antibiotics in the US are used by this sector of the economy to cultivate healthier crops and livestock. The issue is that the use of antibiotics may not be required with other methods such as vaccination and proper hygiene of animals and farmers,. In comparison, those treatments do not promote bacterial evolution to the level that antibiotic overuse does. This applies to the misuse of antibiotics everywhere, as ideally, they are used as a last resort or only or only when absolutely needed. However, our society’s overuse of antibiotics has propagated drug-resistant bacteria faster than they should have emerged.

Because of this trend of antibiotic misuse yielding resistant bacteria, we are now facing a point in our public health history dubbed the “post-antibiotic era.” This era is exactly what it sounds like: a time in which “common infections and minor injuries can kill…a very real possibility for the twenty-first century,” due to even the most simple of bacterial infections being untreatable by traditional methods, says Keiji Fukuda of the WHO. Furthermore, many scientists believe we are fully in the post-antibiotic era right now. For some facts, the WHO reports, “in some areas of the world, more than half the infections caused by one major category of bacteria — Gram-negative, which includes Escherichia coli and Klebsiella pneumoniae — involve species resistant to carbapenem drugs,” the most powerful kind of antibiotic. Vox reports that the deaths per year from bacterial resistance may go up from 700,000 today to 10 million by 2050 if our antibiotic use trends don’t change.The research and development of newer antibiotics are facing difficulty as well, as they are antithetical to a firm’s interests. Unlike a traditional product that is meant to be sold and consumed as much as possible, antibiotics are ideally regulated in their consumption. On top of that, producing successful antibiotics takes many years and trials. The time, money, and resources invested would likely outweigh the sales, meaning a company would If the bacteria that the bacteriophage binds to is not present, the phage will not replicate. The specificity of phages also means that they won’t disturb the beneficial bacteria in our bodies, a potential side effect of antibiotics. A 2020 study from the Iran University of Medical Sciences found phages to be effective in treat- ing infections from multidrug-resistant, extensively-drug-resistant, and pan-drug-resistant bacteria, even calling phages “one of the biggest hopes in the future for the treatment of resistant bacteria.” The same study still mentioned a need for more research and development. Although they seem like a perfect successor to antibiotics, phage therapy has not been researched yet and is still not approved for humans in the US or Europe. However, bacteriophages are beginning to be used in the farming industry, which may alleviate the issue of superbugs coming from livestock and crops. However, the biggest kicker is that bacteria may still develop resistance to phages due to the inescapable fact of evolution and natural selection.

With this knowledge, scientists and doctors will likely be more cautious in issuing bacteriophages for patients for a while, and we may not see the treatments in hospitals for years.

The bottom line, the responsibility falls on us. Once new treatments like bacteriophages become approved for use, society must make the right decisions to avoid the catastrophe that is phage-resistant bacteria. In the meantime, we still have the power to fight these invisible killers. As they say, prevention is the best cure; maintain good hygiene in all parts of life, be responsible in the prescription and use of antibiotics, stay up to date on current events in infectious diseases and treatments. We, humans, are a resilient species, and we have what it takes to prevent tragedies such as Ricky’s in the future.

Credits: https://www.who.int/news-room/factsheets/detail/antibiotic-resistance https://www.vox.com/future-perfect/2019/11/14/20963824/drug-resistance-antibiotics-cdc-report https://www.niaid.nih.gov/research/ antimicrobial-resistance-causes https://www.idsociety.org/public-health/patient-stories/patient-stories/ https://www.healthline.com/health/ phage-therapy#:~:text=Phage%20therapy%20(PT)%20is%20also,the%20natural%20enemies%20of%20bacteria. https://www.cdc.gov/drugresistance/ about/how-resistance-happens.html https://www.ncbi.nlm.nih.gov/pmc/