Superbugs as Global Crisis

Last Updated on January 23, 2020 by Sagar Aryal

Superbugs

  • microbes that become resistant to the drugs that should destroy and kill them
  • can be bacterial or fungal strains

Superbugs as Global Crisis

Image Source: Tincture and Business Insider

Sources/ Factors of Resistance

  • Natural selection
    • Antibiotic resistance gene “flow” in nature
    • Resistance genes in plasmids transferred from one bacteria to another
    • Resistant microorganisms become predominant in the environment through biological mechanisms of microbial competition and genetic exchange
  • Drugs in animal feed
    • Antibiotics used in animal feed to prevent disease and promote the growth of livestock
    • After a period, the resistant bacteria developed and shed in their feces
    • People working with livestock become infected and transfer to the others
    • Example: resistant Campylobacter infections of the digestive tract from eating antibiotic-fed chicken
  • Excessive use of antibacterial soaps and detergents
    • Increase pressure on wild bacteria to develop resistance
    • Examples: antiseptic, disinfectant, sanitizer, germicide
  • Unnecessary prescription
  • Discontinuation of therapy
    • Premature antibiotic treatment termination

Problems of Drug Resistance Over the World

According to new research, antibiotic resistance has doubled in the last 20 years. The findings by United European Gastroenterology Week Barcelona in 2019 stated that the resistance to antibiotics commonly taken for Helicobacter pylori infection which associated with gastric ulcer, lymphoma, and gastric cancer, is increasing in the recent years. The survey from more than 1200 people from 18 European countries found that the resistance to clarithromycin, an antimicrobial used to treat Helicobacter pylori infection, had increased from 9.9% in 1998 to 21.6% in 2018. H.pylori infection is difficult to treat and require a combination of medications. This bacterium will cause the inflammation of the stomach lining or gastritis, which resulting in peptic ulcers. It is common that most of the people are infected with this bacterium but will not get sick until the ulcers develop. With the uprising resistance rate to the antibiotics clarithromycin per year, the treatment options for H.pylori are limited and ineffective, which causing it to be the third leading cause of cancer death across the world.

In 2019, the Centers for Disease Control and Prevention (CDC) announced that at least 30 people are infected with the outbreak strain of Campylobacter jejuni in 13 states. The evidence showed that the likely source of this outbreak is contact with the puppies especially those at the pet store. The Campylobacter bacteria isolated from the samples are resistant to commonly recommended, first-line antibiotics, which makes it more difficult to treat. Candida auris has also reported as the new superbug and it is now one of the world’s most terrifying hospital microbes. C. auris, the yeast that causes infections in human, live on the human skin without causing any problem, but they cause infection when they get into the wrong place such as the bloodstream or lungs. The majority of the C. auris strains found in the patients are resistant to a common antifungal drug such as fluconazole. Hence, it presents a threat to the intensive care units at the hospitals as it can survive normal efforts at decontamination and almost everywhere in the air. As of July 2017, 20 separate NHS trusts and independent hospitals in the United Kingdom had detected C. auris, more than 35 hospitals have had patients known to be colonized with C. auris transferred to them. Three hospitals had large outbreaks that are difficult to control, despite the intensive infection prevention and control measures.

It is found that thousands of bereaved families are not being told that their loved one died after contracting a superbug as the doctor are fear of being blamed. There are 165 new antibiotics resistant infections being detected every day, according to the Public Health England data, the most severe resistant infections which have already reached the bloodstream increased by 32% in a five-year review. In fact, even the seagull all over Australia are found to carry the superbugs resistant to antibiotics.  More than 20% of the silver gulls nationwide carrying bacteria such as E.coli which cause urinary tract and blood infections and it is believed that the birds contracted the superbugs from scavenging in rubbish and sewage. The study showed that the feces of the silver gulls are resistant to common antibiotic medications such as cephalosporin and fluoroquinolone. In 2017, a 70-year-old woman are killed by a superbug that could not be treated with 26 different antibiotics. The woman are found to have the Klebsiella pneumoniae infection in her bone after breaking her right leg, her immune system was going into overdrive in an attempt to fight the infection and caused the inflammation throughout her body. In the end, her condition worsened and she died from septic shock.

High-Risk Microbes With Antibiotics Resistance

  1. Clostridium difficile
    • Threat level (urgent)
    • Causes life-threatening diarrhea
    • Often occur in hospitalized or recently hospitalized patients
    • 14,000 deaths per year
    • This bacteria strain is resistant to fluoroquinolone antibiotics
  2. Carbapenem-resistant Enterobacteriaceae
    • Threat level (urgent)
    • Resistant to all or nearly all the antibiotics
    • Almost half of the patients who get bloodstream infections from CRE bacteria die
    • More than 9000 drug-resistant infections per year
    • Approximately 600 deaths result from infections by two common CRE, carbapenem-resistant Klebsiella spp. and carbapenem-resistant E.coli
    • Deaths from carbapenem-resistant Klebsiella pneumoniae increased from 341 in 2007 to 2094 in 2015 at Europe
    • Drug-resistant K.pneumoniae can continue to spread or pass its resistance to other species of bacteria
  3. Neisseria Gonorrhoeae
    • Threat level (urgent)
    • Causes gonorrhea, a sexually transmitted disease that results in discharge and inflammation at urethra, cervix, pharynx, or rectum
    • Resistance to antibiotics included cefixime, ceftriaxone, azithromycin, tetracycline
    • Easily transmitted
    • More than 800,000 cases annually in the United States
  4. Multidrug-resistant Acinetobacter
    • Threat level (serious)
    • Cause pneumonia or bloodstream infections among critically ill patients
    • Some Acinetobacter strains are resistant to nearly all or all antibiotics
    • At least 12,000 infections occur in the United States per year
    • At least three classes of antibiotics no longer can cure resistant Acinetobacter infections
  5. Drug-Resistant Campylobacter
    • Threat level (serious)
    • usually cause bloody diarrhea, fever, abdominal cramps
    • Resistant to ciprofloxacin and azithromycin
    • Approximately 1.3 million infections, 13,000 hospitalizations and 120 deaths per year
  6. Vancomycin-resistant Enterococcus (VRE)
    • Threat level (serious)
    • Cause infections among very sick patients in hospitals and other healthcare settings
    • Cause bloodstream infections, surgical site infections, and urinary tract infections
    • Among 20,000 (30%) of Enterococcus infections are vancomycin-resistant
    • Approximately 1300 deaths per year
  7. Multidrug-resistant Pseudomonas aeruginosa
    • Threat level (serious)
    • Cause pneumonia, bloodstream infections, urinary tract infections, and surgical site infections
    • Some strains of Pseudomonas aeruginosa are found to resistant to nearly all or all antibiotics including aminoglycosides, cephalosporins, fluoroquinolones and carbapenems
    • About 51,000 Pseudomonas infections per year, more than 6000 are multidrug-resistant
  8. Drug-resistant Non-Typhoidal Salmonella
    • Threat level (serious)
    • Resistant infections are more severe and have higher hospitalization rates
    • Resistance to ceftriaxone, ciprofloxacin, multiple classes of drugs
    • Causes approximately 1.2 million illnesses, 23,000 hospitalizations and 450 deaths per year
  9. Drug-resistant Shigella
    • Threat level (serious)
    • Can cause fever, abdominal pain, reactive arthritis
    • High-risk groups included young children, people with inadequate handwashing and hygiene habits
    • Resistance to first-line drugs such as ampicillin and trimethoprim-sulfamethoxazole, ciprofloxacin
    • Causes 500,000 infections, 5500 hospitalizations and 40 deaths per year
  10. Methicillin-resistant Staphylococcus aureus (MRSA)
    • Threat level (serious)
    • Cause a range of illnesses, from the skin and wound infections to pneumonia and bloodstream infections
    • Estimated of 80,461 MRSA infections and 11,285 deaths in 2011
  11. Drug-resistant Streptococcus Pneumoniae
    • Threat level (serious)
    • Leading cause of bacterial pneumonia and meningitis, bloodstream infections, ear and sinus infections
    • Resistance to penicillin and erythromycin groups
    • About 1200,000 infections, 19000 hospitalizations and 7000 deaths per year
    • Pneumococcal ear infections (otitis media) are common pneumococcal disease among children
  12. Drug-resistant Tuberculosis
    • Threat level (serious)
    • Drug-resistant TB more challenging to treat as it requires more time and more expensive drugs that often have side effects
    • Resistance to isoniazid, rifampicin
    • Total of 10,528 cases reported in 2011
    • Frequent causes of death worldwide
  13. Erythromycin-resistant Group A Streptococcus
    • Threat level (concerning)
    • Causes pharyngitis (strep throat), streptococcal toxic shock syndrome, necrotizing fasciitis (flesh-eating disease), scarlet fever, rheumatic fever, and skin infections
    • Resistance to clindamycin and macrolides drugs, tetracycline
    • 1-2.6 million of strep throat infections per year

Fighting Against Antibiotics Resistant

According to the Betsi Cadwaladr health board, reducing the number of antibiotics prescription has led to a fall in superbug cases. The health board said that compared to 2017-18, the cases of patients developing C. difficile reduced from 271 to 166 cases in 2018-19. In September 2018, the researchers found that Listeria bacteria that were once shown to be resistant to the antibiotic fosfomycin may be susceptible to be treated again. Listeria infection is also known as listeriosis is the most lethal foodborne disease known and is often fatal. It is normally caused by eating contaminated foods such as soft cheese, smoked salmon, pates, meats, and salads. Listeria infection is deadly for those with weak immune systems especially older people and newborns.

A team at London has developed a microneedle sensor that can constantly monitor the patients’reaction to the antibiotics and other drugs. The sensor had the potential to produce the results more quickly than the current existing practices. Besides, the needles are many times thinner than the human hair and hence they are small enough to slip between the skin cell to sample for the body fluids. The array of needle sample fluids 200 times within a second and can detect tiny changes that showing how the patients react after being injected with the antibiotics. The development of this microneedle sensor definitely helps seriously ill patients to recover more quickly. The hospitals in the United Kingdom have become very good at catching outbreaks of MRSA and the way they tackled MRSA and other superbugs helps to cut down the number of people infected. The researchers worked out the samples that were closely related by sequencing the genetic code, and they found 173, ranging from outbreaks affecting two patients up to 44. This detective work makes their infection control to be much more targeted, efficient and effective. The superbugs-related deaths have also hit their lowest levels in Wales for at least 15 years while the number of deaths involving MRSA hit 22 years low.

In 2017, the Australian scientists have mapped the molecular structure of a protein that shields superbugs from antibiotics. The protein known as EptA allows some strains to shrug off colistin, an antibiotic used when all other treatments fail. This protein can help to develop new drugs for antibiotic-resistant bacteria strains and fight for the superbugs. Last year, a man named Tom Patterson was infected with an antibiotic-resistant superbug after traveled to Egypt during his holiday. The deadly superbug rampaged through his bloodstream and the doctors told him the superbug is resistant to all the antibiotics they had to offer. He started to vomit at first, and after the CT scan, it is found that he had an abscess in his gut which known as a pseudocyst. And then, Tom falls into a coma. The doctors after that discovered that the infection in his gut is the infection that has closed down hospitals in Germany- Acinetobacter baumannii. In the end, his wife chose to approach the Food and Drug Administration to approve an experimental treatment. They have to find the phage that is able to kill the Acinetobacter bacterium that Tom was infected with, and after three weeks Tom was injected with cocktails of four phages. He is now three-quarters of the way through a predicted four-year recovery period and he had to relearn to swallow, talk, stand and walk. Tom was the first person in North America to receive intravenous phage therapy for superbug infection. This proved that phage therapy somehow works to combat the bacteria that have developed resistance to antibiotics or other drugs.

Prevention of Antibiotic Resistance: Your Role

  • Antibiotics should be the last line of defense but not the first
  • Only take antibiotics prescribed by a doctor and you need to have a little knowledge and understanding about antibiotics
  • Do not use other people’s antibiotics or leftover antibiotics as the antibiotics are specific for certain infections
  • Antibiotics are not needed for viral infections

Solutions for Antibiotic Resistance

  1. Combination Therapy
    • Double antibiotic therapy
  2. Exact Concentration of Antimicrobials
    • Used in concentrations strong enough to kill the most insensitive microorganisms present
  3. New Effective Drugs
    • Development of genetic probes to look for resistance genes in the microorganisms
    • Develop new antimicrobial vaccines
  4. Better diagnostics
    • Several biomarkers being evaluated for more accurate diagnostic purpose
    • Some similar symptoms make it difficult to determine whether it is a bacterial or viral infection
  5. Improves doctor-patient-drug relationship
    • Over-prescription of antibiotics that are not required
    • Patients who feel better and stop using antimicrobial drugs make the problem worse

References

  1. https://www.medicalnewstoday.com/articles/327093.php#antibiotic-resistance
  2. https://www.cdc.gov/campylobacter/outbreaks/puppies-12-19/index.html
  3. https://www.bbc.com/news/health-49170866
  4. https://www.mirror.co.uk/news/uk-news/winter-superbug-viruses-killing-patients-21279845
  5. https://newsinhealth.nih.gov/2014/02/stop-spread-superbugs
  6. https://www.bbc.com/news/world-australia-48916923
  7. https://www.mphonline.org/superbugs/
  8. https://www.webmd.com/a-to-z-guides/news/20150417/superbugs-what-they-are#1
  9. https://www.aftermath.com/content/superbug-infection-bacteria/
  10. https://www.bbc.com/news/uk-wales-49388802
  11. https://www.bbc.com/news/health-38609553
  12. https://www.bbc.com/news/stories-50221375?fbclid=IwAR3scjsnsG9hMYacSqug-n2EIuPFWqR1ARoVm4GQehdTRNuOiKuPqYvysww

Internet Sources

  • 2% – https://www.cdc.gov/campylobacter/outbreaks/puppies-12-19/index.html
  • 1% – https://www.theguardian.com/uk-news/2018/oct/26/girl-6-died-of-sepsis-after-hospital-failed-to-treat-her
  • 1% – https://www.mirror.co.uk/news/uk-news/winter-superbug-viruses-killing-patients-21279845
  • 1% – https://www.iflscience.com/health-and-medicine/antibiotic-resistance-has-doubled-in-the-last-20-years-new-research-finds/
  • 1% – https://www.gov.uk/government/publications/candida-auris-emergence-in-england/candida-auris-within-the-united-kingdom-updated-guidance-published
  • 1% – https://www.ecowatch.com/antibiotic-resistance-2641061326.html
  • 1% – https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf
  • 1% – https://www.bbc.com/news/health-49170866
  • 1% – https://www.bbc.co.uk/news/uk-wales-49388802
  • 1% – https://www.bbc.co.uk/news/health-38609553
  • 1% – https://truemedian.com/2019/11/03/my-husband-squeezed-my-hand-to-say-he-wanted-to-live-then-i-found-a-way-to-save-him-bbc-news/
  • 1% – https://infactly.com/2019/07/10/australian-seagulls-carry-antibiotic-resistant-superbugs/
  • 1% – https://bendedreality.com/new-research-finds-antibiotic-resistance-has-doubled-in-the-last-20-years/
  • 1% – http://www.sanondaf.co.uk/news/superbug-sleuthing-finds-secret-outbreaks/
  • 1% – http://theheraldghana.com/superbug-sleuthing-finds-secret-outbreaks/
  • 1% – http://josefshomperlennews.com/my-husband-squeezed-my-hand-to-say-he-wanted-to-live-then-i-found-a-way-to-save-him/
  • 1% – http://img.medscape.com/images/870/265/870265-slides.pdf

Superbugs as Global Crisis

2 thoughts on “Superbugs as Global Crisis”

  1. Very informative. Good article. NB: Combination theyapy can be two or more antimicrobials because of the XMDR bacteria and Superbugs.

    Reply

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