More Bugs, No Drugs: The Growing Threat of Antibiotic Resistance

Antibiotic resistance, particularly the rise of superbugs, bacteria resistant to multiple antibiotics, has become a challenge in modern healthcare. Amesh A Adalja, MD, FIDSA, a senior scholar at the Johns Hopkins Center for Health Security, and an adjunct assistant professor at the Johns Hopkins Bloomberg School of Public Health, practicing infectious disease physician, and spokesperson for the Infectious Disease Society of America (IDSA), discussed the growing issue of antibiotic resistance and its impact on healthcare.

What Are Superbugs?

Adalja explained that the term “superbug” is not a formal medical classification but refers to bacteria that have developed resistance to multiple antibiotics. “Superbugs are not a medical term or a medical class. They’re a way of denoting bacteria that have become resistant to multiple different classes of antibiotics, giving them kind of an additional power to infect and cause disease, because there are limited to no countermeasures you can use against them due to the level of resistance they’ve evolved.” This resistance makes these bacteria much harder to treat and control.

Combating Antibiotic Resistance in Healthcare Institutions

Adalja emphasized that healthcare institutions need to prioritize antibiotic resistance and take proactive steps to address the issue. “The first thing that institutions need to do is recognize that these are a major problem and not just something that infectious disease doctors continually harp about,” he said. “They can really disrupt hospital operations in the form of causing outbreaks... in addition to making it very difficult for surgeries to occur if somebody is colonized with a drug-resistant bacteria.”

Acknowledging the problem is just the first step. Dr. Adalja noted that hospitals must invest in infection control resources and adopt modern diagnostic tools. “Many hospitals don’t adequately resource infection control and infectious disease departments, where there are not enough personnel or people doing multiple jobs, one person doing multiple jobs,” he said.

He also pointed out the importance of implementing advanced diagnostic methods. “There are many diagnostic tests that can be put in place in microbiology labs, very modern things that enable clinicians to understand what's going on much faster, to link people to the correct treatment, to understand there’s a resistance problem at a very granular level.”

Advanced technologies like whole genome sequencing can also help identify outbreaks and connect cases that might initially appear unrelated. “Things that don’t look linked, maybe, because they’re on different floors, might actually be linked,” he explained.

Ultimately, Adalja stressed that preventing antimicrobial resistance goes hand in hand with effective hospital infection control. “Combating antimicrobial resistance makes patients safer and eventually will lead to a better and more successful healthcare facility.”

Educating Patients on Antibiotic Use

Educating patients on the responsible use of antibiotics is another key strategy in tackling antibiotic resistance. Adalja advised clinicians to start with the basics: “You have to educate them, starting with the very basics: having them understand why bacteria develop resistance, how they develop resistance, what antibiotics are capable of doing, and what they can’t do.”

He emphasized that antibiotics are not a cure-all and should only be used when appropriate. “Many infections are not going to be something that antibiotics are indicated for, and there are other treatments—maybe antivirals or symptomatic treatments—that could be used in lieu of antibiotics.”

Adalja also explained the long-term consequences of improper antibiotic use. “Using them, even if it might not cause adverse side effects in the patient, does cause adverse side effects in the bacteria that live in the patient.”

He noted that antibiotics are different from other medications, such as pain relievers, because their use can affect future generations of bacteria. “Your use of antibiotics can impact other people’s use of antibiotics in the future. It can drive evolution of another species.”

Clinicians should help patients understand that the overuse of antibiotics can have far-reaching consequences. “For too long, people kind of thought of antibiotics as something that were just like everything else, and didn’t think about the consequences,” he said. “We’re in a situation where we have bad bugs and no drugs. It’s very difficult to develop new antibiotics, and it is very costly to develop new antibiotics.”

Recent Advancements in Antibiotic Treatments

While the problem of antibiotic resistance continues to grow, there have been some recent advancements in diagnostics and treatment options. Adalja pointed out that diagnostic tools have improved, enabling clinicians to better differentiate between bacterial and viral infections. “We’re getting better at diagnosing infections and realizing that not everything that we once thought was a bacterial infection is a bacterial infection,” he said. This allows for more targeted treatment, such as antivirals for viral infections like influenza or COVID-19.

Adalja also mentioned several new antibiotics developed to treat highly resistant gram-negative bacteria. “We do have some new antibiotics that have been developed primarily to treat very resistant gram-negative drugs,” he explained. These include drugs like cefiderocol, imipenem-cilastatin/relebactam, ceftolozane-tazobactam, and meropenem-vaborbactam.

In addition to new antibiotics, researchers are exploring alternative treatments, such as bacteriophage therapy. “Bacteriophages are viruses that infect bacteria,” Adalja explained. “We’re starting to see bacteriophage therapy being something that is being tried in infections of last resort.” At centers like the University of Pittsburgh, bacteriophage therapy is being tested to treat resistant infections by matching a specific bacterial infection with a corresponding bacteriophage.

The Global Urgency of Antibiotic Resistance

The issue of antibiotic resistance is not just a medical challenge, but a global one, and Adalja emphasized the importance of addressing it at all levels. “It’s become a priority for the world,” he said. The United Nations recently held a high-level meeting to discuss the issue.

Adalja concluded by underscoring that antibiotics are essential for the continuation of modern medicine. “If we are to keep modern medicine functioning and advancing, organ transplantations and new cancer therapies, it’s going to be antibiotics that facilitate that, because infection is the major thing that we’re trying to prevent in those vulnerable patients.”