The Growing Concern over Antimicrobial Resistance

It seems like every week, there’s another news headline about a food recall due to bacterial contamination, or that a certain drug is no longer effective against a specific strain of bacteria, or even that the gut microbiome is on the verge of extinction. It’s scary when you think about microscopic organisms taking down an otherwise healthy human being – whether for an extended illness or sadly, a premature death. Even with our current wonder drugs, it seems as if we’ve reverted back to a time before antibiotics.

It should be noted that in decades past, when superbugs and antibiotic resistance began to emerge as a public health crisis, it typically only referred to bacteria. Today, the problem has evolved to include fungi, and so, the terminology has changed to “antimicrobial resistance.” We are now coming to terms with the fact that there are even more threats to health than we previously thought, and this will require new approaches to treatment and/or management of the microorganisms living within our environment.

What is antimicrobial resistance?
Antimicrobial resistance occurs when germs such as bacteria and fungi develop the ability to withstand the pharmaceutical drugs (i.e., antibiotics and antifungals) designed to kill them. Instead of being stopped dead in their tracks, these organisms continue to grow by adapting themselves, and they may even upset the normal balance of the gut or skin microbiomes. Antimicrobial infections can be difficult or even impossible to treat. A great danger lies in the fact that these more robust bacteria and fungi often spread to other people and inflict more havoc.

What is the magnitude of antimicrobial resistance?

Antimicrobial resistance is a global health crisis, killing at least 1.27 million annually.[1] However, the problem is not limited to developing countries, or those with inadequate sanitation, or a lack of access to effective medications. The magnitude of antibiotic resistance in the United States is also significant and increasing. According to the Centers for Disease Control and Prevention (CDC), at least 2.8 million Americans are infected with antimicrobial-resistant infections each year, and more than 35,000 die as a result. This is a major public health concern for several reasons; antimicrobial-resistant infections are more difficult to treat; often lead to longer hospital stays; result in higher healthcare costs; and have insidiously increased mortality rates.

How do bacteria and fungi outsmart current pharmaceutical drugs?
Specific bacteria and fungi have developed some very effective defense strategies over time to evade current antibiotics and antifungals. Not only does this render most antibiotics and antifungals ineffective, but these antimicrobial-resistant superbugs can share their defense strategies with other organisms and “teach” them how to become resistant themselves and evade being destroyed. In a sense, these microorganisms have figured out how to turn the tables on human scientific prowess. Five defense strategies, or mechanism to create resistance, include:

1. Restricting the antibiotic from entering the infected cell.
2. Removing the antibiotic or antifungal after it has entered the infected cell.
3. Changing or destroying the antibiotic with enzymes.
4. Changing the target (infected) cell so that the antibiotic or antifungal is no longer effective.
5. Bypassing the effects of the antibiotic.

For examples of specific bacteria and fungi that utilize these strategies, check out the CDC website.

How did antimicrobial resistance become such a big problem?

In a nutshell, ill-advised human behavior has contributed to, if not created, the ever-growing problem of antimicrobial resistance. The number one cause is the overuse and misuse of antibiotics in human health, as well as animal husbandry and livestock production. It was common practice to give patients – both humans and farm animals – antibiotics even in the absence of a confirmed bacterial infection. Additionally, broad spectrum antibiotics were typically used, rather than a narrow spectrum antibiotic. In other words, it was an approach of “kill everything possible” instead of kill just the specific bacteria that was causing the infection. With both good bacteria and bad bacteria being killed off, some of the stronger, more hardy bad bacteria remained and gained strength in both numbers and resistance capability. The good bacteria which normally helped keep the bad bacteria in-check was decimated and no longer able to perform its function of maintaining homeostasis.

Compounding the antibiotic resistance problem was that early on, antibiotics were widely used in the food production industries. Animals used as food sources (i.e., meat, poultry, fish) or used in the production of food (i.e., dairy, eggs) were regularly administered prophylactic antibiotics to promote rapid growth and to stave off infection. Similarly, if one hen had an infection or died of an infection, all her companions were given antibiotics to protect against the farmer’s potential loss. Antibiotic use in food animals has been curtailed to some extent, but the damage has been done.

In addition to widespread antibiotic use/misuse, other human factors have contributed to the growing problem of antimicrobial resistance. These include:

1. Inadequate infection prevention and control measures, especially in hospitals or care facilities
2. Unsanitary food preparation/cross contamination
3. Poor personal hygiene
4. Lack of access to clean water and sanitation
5. Global travel facilitating the spread of resistant microorganisms

It should also be noted that due to the high cost of research and development, combined with the relative low profitability of antibiotics – compared to other drugs – new antibiotics aren’t high on the pharmaceutical companies’ priority list. Because of this, new antibiotics with more efficacy towards the problem of surging resistance are non-existent and not in the development pipeline either. What remains of the limited arsenal is shrinking.

What are the best ways to address antimicrobial resistance?
There are several ways you can protect yourself and your family against increasing antimicrobial resistance and ensure good health and a homeostatic (balanced) gut microbiome:

1. Use antibiotics only when prescribed by a healthcare professional, and take them exactly as prescribed. Do not discontinue taking them, even if you feel better.
2. Avoid requesting antibiotics for a viral infection (i.e., common cold or the flu). Antibiotics are not effective against viruses.
3. NEVER take another person’s prescribed antibiotic or antifungal medication.
4. Practice good hygiene, including regular hand-washing and cleaning of surfaces. This helps prevent the spread of infections to others and helps prevent re-infection.
5. Aoid close contact with others if you are ill to prevent spreading any antimicrobial-resistant germs. Elderly, young children, and those with compromised immunity are at high risk of poor outcomes should they become infected.
6. Cook your food thoroughly to the recommended temperature. Handle “bacteria-prone” meat, poultry, and fish products properly to prevent cross-contamination to other surfaces, utensils, and your own hands.
7. Care for your gut microbiome utilizing good nutrition, prebiotic fiber, probiotic foods, moderate exercise, adequate sleep, and stress management practices.
8. Include liposomal bovine colostrum in your daily diet to help maintain balance within the gut microbiome and maintain tight junction integrity in the G.I. lining.
9. Stay informed of current outbreaks in your state or local community. Throw away any contaminated foods immediately and clean any surface they may have come in contact with.
10. Educate yourself and others about the importance of responsible antibiotic use and the risks of antimicrobial resistance.

Antimicrobial resistance has been an escalating problem in the 21^st century and until there are more effective medical treatments available, everyone must do their part. Our success in finding non-pharmaceutical ways to deal with the microbial threat will be our saving grace until new medications are developed. Perhaps, until then, harnessing the incredible power of the human body’s own immune system will have to suffice.

[1]  https://www.cdc.gov/drugresistance/about.html