Monday, November 21, 2022

How Do Antibiotics Become Resistant

Historical Timeline Of Antibiotics

What causes antibiotic resistance? – Kevin Wu
  • Louis Pasteur unknowingly described the first antibiotic in 1877 when he observed that certain bacteria release substances that kill other bacteria
  • In 1909, Paul Ehrlich discovered arsphenamine , an arsenic compound that kills Treponema palladium, the bacterium causing the sexually transmitted disease, syphilis.
  • In 1928 Alexander Fleming discovered that a mold inhibited the growth of staphylococcal bacteria and named the substance it produced “penicillin” .
  • It was not until 1940 that Howard Florey and Ernst Chain isolated the active ingredient in Fleming’s mold.
  • With wide-scale production of penicillin, the use of antibiotics increased, leading to an average eight-year increase in human life span between 1944 and 1972. Unfortunately, many bacterial species continued to survive penicillin treatment due to their resistance mechanisms.

How Bad Is The Problem

The Centers for Disease Control and Prevention estimates that each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections. We are approaching a time when once easily-treated infections are no longer easy to treat or may be untreatable because of antibiotic resistance. As Dr. Thomas Frieden, head of the CDC, puts it, “The medicine cabinet is empty for some patients. It is the end of the road for antibiotics unless we act urgently.”

Improving Access To Microbiology

Another crucial part of our strategy is expanding access to laboratories that can accurately diagnose a patients infection and test the underlying pathogen for resistance. This is challenging in most settings where we work, where there’s often a scarcity of well-equipped microbiology labs with skilled staff who can conduct the necessary tests and correctly interpret the results.

To meet this need, our first step is to look for an existing lab accessible to a given project. If we find one that meets our quality standards and can work with us, we use it, sometimes after helping to build up equipment, supplies, skills, or capacity. In settings without labs and where the need is great, we may build our own and train local staff to run it, and then provide external support as needed. This has succeeded even in some extremely difficult contextsfor example at our trauma hospital in Aden, in war-torn Yemen, a country where the health system is in ruins. As of mid-2019, we have established microbiology labs at six projects, with four more planned in the near future.

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Reinforcing Infection Prevention And Control

While most patients diagnosed with ABR infections developed them before seeking treatment, resistant bacteria can also spread within healthcare facilities. This is a significant problem even in high-income countries, but safeguards against transmission in hospitals and clinicsincluding basic handwashing and thorough disinfection of all surfaces and medical devicesare more often lacking in under-resourced facilities with high patient loads.

Establishing these safeguards at our projects requires well-planned protocols and trained staff. For example, patients at our specialized burn unit in Drouillard Hospital in Port-au-Prince, Haiti must have their bandages changed every other day until the burns are fully healed. Since these changes can take up to two hoursample time for bacteria to invade a woundthe procedure must be done in a sterile operating room by staff covered in protective garments. Another less obvious but crucial safeguard is finding space to isolate patients with ABR infections to prevent transmission. These measures can be especially challenging to maintain in emergencies when hospitals receive many wounded or sick patients in a very short time, often requiring a constant and difficult balancing act for our teams.

Protect Yourself And Your Family

Morning Sign Out  Antibiotics: What You Need to Know
  • When preparing food, follow the four steps to food safety:
  • Clean.Wash your hands before and after touching uncooked eggs or raw meat, poultry , seafood, or their juices. Wash your work surfaces, cutting boards, utensils, and dishes before, during, and after cooking.
  • Germs from raw meat, poultry, seafood, and eggs can spread to fruits, vegetables, and other ready-to-eat foods unless you keep them separate. Use one cutting board to prepare raw meats and another for foods that will not be cooked before theyre eaten. Dont put cooked meat on a plate that had raw meat on it.
  • Cook. Use a food thermometer to ensure that foods are cooked to a safe internal temperature: 145°F for whole cuts of beef, pork, lamb, and veal 160°F for ground red meats and egg dishes and 165°F for poultry, including ground chicken and turkey. Get safe cooking temperaturesexternal icon for other foods.
  • Chill. Keep your refrigerator at 40°F or below and refrigerate foods within 2 hours of cooking. Refrigerate within 1 hour if food is exposed to temperatures above 90°F .
  • When around pets and other animals:
  • Wash your hands after touching them, their food, water, poop, belongings , or habitats .
  • Review CDCs Travelers Health recommendations when preparing for international travel.
  • To help slow the spread of antibiotic resistance, take antibiotics only when needed, and take them exactly as prescribed by your healthcare provider.

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    What Is Antibiotic Resistance

    Antibiotic resistance happens when the germs no longer respond to the antibiotics designed to kill them. That means the germs are not killed and continue to grow. It does not mean our body is resistant to antibiotics.

    Bacteria and fungi are constantly finding new ways to avoid the effects of the antibiotics used to treat the infections they cause.

    Infections caused by antibiotic-resistant germs are difficult, and sometimes impossible, to treat. In many cases, antibiotic-resistant infections require extended hospital stays, additional follow-up doctor visits, and costly and toxic alternatives.

    Spread Of Germs & Resistance Mechanisms

    To survive, germs can develop defense strategies against antibiotics and antifungals called resistance mechanisms. DNA tells the germ how to make specific proteins, which determine the germs resistance mechanisms. Bacteria and fungi can carry genes for many types of resistance.

    When already hard-to-treat germs have the right combination of resistance mechanisms, it can make all antibiotics or antifungals ineffective, resulting in untreatable infections. Alarmingly, antimicrobial-resistant germs can share their resistance mechanisms with other germs that have not been exposed to antibiotics or antifungals.

    This table gives a few examples of defense strategies used to resist the effects of antibiotics or antifungals.

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    Antibiotic Resistance Food And Food Animals

    The American food supply is among the safest in the world, but people can still get food poisoning by eating contaminated foods. Some food poisoning is caused by antibiotic-resistant bacteria. Symptoms of infection with antibiotic-resistant bacteria are like other food poisoning symptoms, which can be mild to life-threatening and include diarrhea, nausea, and vomiting.

    Antibiotics are medicines that kill or stop the growth of bacteria. Antibiotic resistance happens when bacteria develop the ability to survive or grow despite being exposed to antibiotics designed to kill them.

    Antibiotics save lives, but any time antibiotics are used, they can contribute to the development and spread of antibiotic resistance. Antibiotic resistance spreads to bacteria through people, animals, and the environment. Improving antibiotic use, including reducing unnecessary use, can help stop resistance from spreading.

    Learn what CDC is doing to help stop antibiotic-resistant infections from food and animals, and how you can protect yourself and your family.

    Bacteria Resistant To Antibiotics

    How do bacteria become antibiotic resistant?

    Some bacteria have developed resistance to antibiotics that were once commonly used to treat them. For example, Staphylococcus aureus and Neisseria gonorrhoeae are now almost always resistant to benzyl penicillin. In the past, these infections were usually controlled by penicillin.The most serious concern with antibiotic resistance is that some bacteria have become resistant to almost all of the easily available antibiotics. These bacteria are able to cause serious disease and this is a major public health problem. Important examples are:

    • methicillin-resistant Staphylococcus aureus
    • carbapenem-resistant Enterobacteriaceae gut bacteria

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    How Antibiotic Use Affects Resistance

    Antibiotics save lives but their use can contribute to the development of resistant germs. Antibiotic resistance is accelerated when the presence of antibiotics pressure bacteria and fungi to adapt.

    Antibiotics and antifungals kill some germs that cause infections, but they also kill helpful germs that protect our body from infection. The antibiotic-resistant germs survive and multiply. These surviving germs have resistance traits in their DNA that can spread to other germs.

    What Is An Antibiotic

    Antibiotics, also known as antimicrobial drugs, are drugs that fight infections caused by bacteria. Alexander Fleming discovered the first antibiotic, penicillin, in 1927. After the first use of antibiotics in the 1940s, they transformed medical care and dramatically reduced illness and death from infectious diseases.

    The term âantibioticâ originally referred to a natural compound produced by a fungus or another microorganism that kills bacteria which cause disease in humans or animals. Some antibiotics may be synthetic compounds that can also kill or inhibit the growth of microbes. Technically, the term âantimicrobial agentâ refers to both natural and synthetic compounds however, many people use the word âantibioticâ to refer to both. Although antibiotics have many beneficial effects, their use has contributed to the problem of antibiotic resistance.

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    Transmission Of Antibiotic Resistant Bacteria In Hospitals

    The common ways in which bacteria can be passed from person to person include:

    • contact with contaminated hands of hospital staff
    • contact with contaminated surfaces such as door handles, over-bed tables and call bells
    • contact with contaminated equipment, such as stethoscopes and blood pressure cuffs.

    How Bacteria Resist Antibiotics

    Superbugs antibiotic resistant bacteria @science_pupil

    What methods do Bacteria use to resist antibiotics?

    There are a few different methods that bacteria use to actively resist antibiotics. These natural defences are what cause the problem when treating patients for infections. If a patient is infected with bacteria that have these defences, then antibiotics are likely to be less effective because the bacteria have now become resistant to antibiotics. Here are three of the most common ways bacteria counter their antibiotic attackers:

    Efflux Pump

    This is a pump in the wall of the bacteria cell that simply ejects the antibiotics out of the cell, meaning that the antibiotics cant kill the bacteria.

    Neutralisation

    Enzymes in the bacteria breakdown the antibiotic compounds so they dont work properly to kill the bacteria.

    Modification

    Rather than destroy or breakdown the antibiotics, this method sees enzymes in the bacteria cell attach to the antibiotics to change their structure and make them ineffective against the bacteria.

    What can we do?

    Bacteria are constantly evolving and we can never stop bacteria from resisting antibiotics. The aim for the Longitude Prize is to produce a diagnostic to help us all use fewer antibiotics and slow down the rate at which bacteria evolve.

    Were calling on people from all areas of innovation and from across the world to take part in the Longitude Prize and to come up with a solution to this problem. If resistance is slowed, antibiotics will have a fighting chance.

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    Causes Of Antimicrobial Resistance

    Microbes, such as bacteria, viruses, fungi, and parasites, are living organisms that evolve over time. Their primary function is to reproduce, thrive, and spread quickly and efficiently. Therefore, microbes adapt to their environments and change in ways that ensure their survival. If something stops their ability to grow, such as an antimicrobial, genetic changes can occur that enable the microbe to survive. There are several ways this happens.

    What Does Antibiotic Resistance Mean For You Your Family And The Community

    Antibiotic resistance is a major concern because it means some infections will become more difficult, and sometimes impossible, to treat. If you or someone in your family develop an antibiotic-resistant infection:

    • you may have the infection for longer
    • you may be more likely to have complications from the infection
    • you could remain infectious for longer and pass your infection to other people.

    Infections caused by antibiotic-resistant bacteria are harder to treat, usually last longer, often result is longer stays in hospital and are associated with more complications. In serious cases they can cause death. Doctors have to use to less conventional antibiotics or a combination of different antibiotics to treat these infections. These are usually more costly and can have more-serious side effects. In New Zealand, the occurrence of antibiotic-resistant bacteria is increasing. Examples of antibiotic-resistant bacteria include:

    • Methicillin-resistant Staphylococcus aureus a group of bacteria that are resistant to commonly used penicillin-like antibiotics
    • Extended spectrum beta-lactamases chemicals produced by some bacteria that prevent certain antibiotics from working.
    • Vancomycin-resistant enterococci a group of bacteria that are resistant to the antibiotic vancomycin.

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    What Causes Abr Infections

    Bacteria can become resistant to an antibiotic when they are exposed to it repeatedly, or to incomplete or sub-optimal doses. This can lead to the growth of mutant bacteria which the drug can no longer kill. Resistance occurs in a wide range of disease-causing bacteria and can also be transmitted from one type of bacteria to another.

    ABR infections are especially common in settings where off-the-shelf or counterfeit antibiotics are widely available, or where antibiotics are often overused or misused. Without access to proper laboratory diagnostics, health care providers often do not know whether a patients symptoms are caused by a bacterial infection, and if so, which type of bacteria is involved. This can lead to unnecessary or incorrect prescriptions for antibiotics. Resistant bacteria can also spread in hospitals with poor sanitation or inadequate infection control, infecting especially vulnerable patients who are already sick or have unhealed wounds.

    How Msf Responds To Antibiotic Resistance

    How do antibiotics kill bacteria – and how do superbugs become so resistant?

    The rise in ABR infections worldwide, combined with MSFs increased engagement in Middle Eastern countries at war, has made antibiotic resistance a slow-motion emergency facing many of our teams.

    For example, in our reconstructive surgery program in Amman, Jordan, about half of all war-wounded patients from Iraq, Syria and Yemen arrive with serious infections, up to 60% of which are ABR. The same holds true for Yemen, where war has destroyed an already fragile healthcare system, and with it the capacity for proper sterilization, hygiene, and care for patients with open fractures or other severe injuries highly susceptible to infection. Rampant overuse and misuse of antibiotics also helps drive the development and spread of resistant infections in settings like these.

    In response, we have developed a comprehensive strategy to detect, treat, and prevent antibiotic-resistant infections. Our strategy focuses on a few key pillars:

    • Ensuring stringent hygiene in our hospitals and clinics to prevent transmission of infection between patients
    • Expanding access to microbiology-based diagnosis
    • Providing good quality of care aimed at saving lives and limbs of people with resistant infections, while ensuring that antibiotics are prescribed and used appropriately
    • Building local capacity to implement our package of care.

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    World Antimicrobial Awareness Week

    Held annually since 2015, WAAW is a global campaign that aims to increase awareness of antimicrobial resistance worldwide and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of drug-resistant infections. Antimicrobials are critical tools in helping to fight diseases in humans, animals and plants. They include antibiotics, antivirals, antifungals and antiprotozoa. WAAW takes place every year from 18 to 24 November. The slogan has previously been, Antibiotics: Handle with Care but changed to Antimicrobials: Handle with Care in 2020 to reflect the broadening scope of drug resistant infections.

    Why You Should Care

    Antibiotic resistance has spread around the world, and it’s making some diseases, such as meningitis or pneumonia, more difficult to treat. You might need stronger, more expensive drugs. Or you might need to take them longer. You also might not get well as quickly, or you could develop other health issues.

    Each year, an estimated 2.8 million people in the U.S. develop infections that are resistant to antibiotics, resulting in deaths of more than 35,000 people.

    Resistance also makes it more difficult to care for people with chronic diseases. Some people need medical treatments like chemotherapy, surgery, or dialysis, and they sometimes take antibiotics to help reduce the risk of infection.

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    Leading Factors Facilitating The Spread Of Antibiotic Resistance

    • Lack of awareness about the issue, among the general public, prescribers, politicians, and the media.
    • Inadequate waste management and poor water sanitation.
    • Poor infection prevention and control practices .
    • Insufficient diagnostic tools for the rapid and reliable detection of resistance.
    • Lack of vaccines for some important infections.
    • Lack of antibiotics to treat infections caused by multi-drug resistant bacteria.
    • Weak or absent antibiotic resistance surveillance programs to track the number and type of antibiotic-resistant infections in a given area, city, country or global region.
    • Lack of a comprehensive, uniform and coordinated response among all countries.

    Most efficient ways to prevent the spread of antibiotic resistance

    • Treatment failure leading to chronic problems
    • Increased morbidity and mortality
    • Adverse effects of alternative treatments
    • Relapse of the infection after treatment
    • Increased spread of antibiotic-resistant bacteria and their associated community- and healthcare-acquired infections
    • Increased use of antibiotics
    • Lack of availability of clinically effective antibiotics
    • Longer and more complicated stays in hospital
    • Excess healthcare costs

    How Can Taking Antibiotics Contribute To Antibiotic Resistance

    Antibiotic Resistance in Acne Treatment

    Anytime antibiotics are used, they can contribute to antibiotic resistance. This is because increases in antibiotic resistance are driven by a combination of germs exposed to antibiotics, and the spread of those germs and their mechanisms of resistance. When antibiotics are needed, the benefits usually outweigh the risks of antibiotic resistance. However, too many antibiotics are being used unnecessarily and misused, which threatens the usefulness of these important drugs.

    For example, too many antibiotics are being prescribed unnecessarily to humans in the United States. CDC estimates about 47 million antibiotic courses are prescribed for infections that dont need antibiotics, like for colds and the flu, in U.S. doctors offices and emergency departments each year. Thats about 28% of all antibiotics prescribed in these settings.

    Everyone has a role to play in improving antibiotic use. Appropriate antibiotic use helps fight antibiotic resistance and ensures these lifesaving drugs will be available for future generations.

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