Health & Fit Antibiotic-resistant bacteria are killing us. Here's how we can defeat these 'superbugs.'

By some estimates, antibiotic-resistant bacteria are already killing more Americans than car accidents and even opioid overdoses.And the situation is getting worse. 

© William Fowle, Northeastern University Researchers say Teixobactin is a promising new antibiotic able to kill some superbugs.

In a report this month, the Centers for Disease Control and Prevention estimates that more than 35,000 Americans die from drug-resistant infections each year. Yet for a variety of reasons — including that hospitals often report cause of death as the illness that first brought a patient to the hospital rather than the resistant bacteria they acquired there — the CDC’s estimate is likely still too conservative. Other estimates place the number of annual deaths in the U.S. at 100,000 or more.

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Most of modern hospital medicine relies heavily on effective antibiotics, and drug-resistant infections are rampant in these settings. Particularly susceptible are people with compromised immune systems such as premature babies, transplant patients and people getting cancer chemotherapy. Also at risk are those with implanted devices, people with diabetic foot ulcers and anyone having surgery.

Heed the lessons of evolution 

Yet solutions — simple in principle — are possible. And they don’t require spending exorbitant amounts of money on new drugs that will fail in the manner of their predecessors. Instead, we can apply what we know about evolution to stop resistance.

E. coli superbug spread by poor toilet hygiene

People failing to wash their hands after going to the toilet, rather than undercooked meat or other food, is behind the spread of antibiotic-resistant E. coli, according to new research. © Shutterstock Washing your hands is the best way to prevent the spread of antibiotic-resistant E. coli. Humans and animals carry E. coli bacteria in the gut. It is usually harmless, but some strains cause food poisoning, others cause urinary tract infections (UTIs), and the most dangerous lead to bloodstream infections.

Antibiotic resistance arises when genetic changes in their DNA enable some bacteria to survive drug exposure. With their drug-sensitive competitors killed off by the antibiotics, the resistant bacteria can flourish and go on to cause illness despite the antibiotic. And, just like any other germs, these resistant bacteria can spread to other people. This process is textbook Darwinian evolution by natural selection.

A guiding principle should be to avoid, whenever possible, taking actions that will further drive the evolution of resistance. But there is an urgent need to figure out how best to do that. More research is needed to test potential solutions.

For example, rather than expecting drugs to do all the work, we could examine, for those with healthy immune systems, using just enough drug to knock bacterial populations down so our immune systems can gain the upper hand and finish the job. The medical orthodoxy that pushes patients to complete drug courses even when they no longer feel sick can promote the very evolution it is intended to prevent. That’s because longer drug courses can kill off the beneficial bacteria that could otherwise outcompete resistant ones.

E. Coli Superbug: Best Way To Stop It From Spreading

According to new research, E. coli is more commonly spread by failing to wash hands rather than eating uncooked food.Humans and animals actually carry some strains in their gut that are usually harmless. When it becomes dangerous, however, it can easily cause food poisoning (believed to be caused by consuming food and meat that is undercooked or isn’t prepared properly), and is easily the most dangerous that leads to infections in the bloodstream.

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Another approach is to use combinations of antibiotics to treat infections. Combinations can halt the evolution of resistance simply due to the sheer unlikelihood that a single bacterium will develop resistance mutations to numerous drugs at once. The strategy is well-established in diseases such as HIV, tuberculosis and cancer.

Vaccines offer yet another solution. They’re much more evolution-proof than antibiotics, in some cases providing sustained disease control for many decades.

We must preserve precious antibiotics

A few years ago, a physician at a hospital in Michigan asked for my advice. His patient had an Enterobacter infection, and he’d tried antibiotic after antibiotic to treat her—without success. With only two drugs left, I suggested he use both simultaneously. My thinking was that since the drugs had different modes of action more mutations would be required for the bacteria to generate resistance to both drugs.

Drug-resistant superbugs kill someone every 15 minutes in the US, new CDC report reveals

Every 15 minutes, someone in the United States dies of a superbug that has learned to outsmart even our most sophisticated antibiotics, according to a new report from the US Centers for Disease Control and Prevention. © Centers for Disease Control Clostridioides difficile or C. Diff is a bacteria that causes diarrhea and inflammation of the colon. Every year there 223,900 cases of infection and 12,800 deaths from the bacteria. The pathogen is listed as one of the CDC's five urgent threats to antibiotic resistance. © Courtesy the Lillis family Peggy Liliis and her sons, Christian and Liam.

At the time, however, there wasn’t enough justification to go with my theory. So the physician went with best practice — try one antibiotic until it fails, then switch to the other. The patient died, not from the heart failure that brought her into the hospital in the first place, but from the evolution of drug resistance among the bacteria in her body.

Could we have staved off that evolution for longer? More laboratory studies are needed to better understand how to manage the evolution of potentially dangerous bacteria. Then we need to apply what we learn to humans, carefully. It's likely that no one generic solution will emerge, but I am confident we can do much better if we go after the evolution.

If scientists, the medical community, and funders don’t act now to address the problem of antibiotic resistance, we will all suffer serious consequences. But I am optimistic that so long as we apply the lessons of almost two centuries of research about how evolution works, we can effectively steward our precious antibiotic resources and save countless lives.

Andrew Read is Fellow of the Royal Society of London, director of the Huck Institutes of the Life Sciences, Evan Pugh Professor of Biology and Entomology, and Eberly Professor of Biotechnology at Penn State.

This article originally appeared on USA TODAY: Antibiotic-resistant bacteria are killing us. Here's how we can defeat these 'superbugs.'

Super germ kill more than 30 000 Europeans every year

© picture alliance / dpa MRSA germs are responsible for many deaths.

• Deaths from antibiotic-resistant bacteria are on the rise, as shown by a new evaluation by the European Agency for Disease Prevention (ECDC).

• A total of 670,000 such infections are reported annually, most of them in clinics and practices.

• Patients can also help curb development.

They've been given a name that resonates with fear and awe: Super germs are those bacteria that are increasingly eluding the weapons of medicine. When a patient becomes infected with these microbes, doctors have to try one antibiotic at a time. Sometimes the second or third helps, sometimes there is none at all. Physicians have to watch helplessly as their patients die.

More than 33,000 Europeans lose their lives this way each year. The number had risen considerably since 2007, according to scientists of the EU disease protection authority ECDC in the journal Lancet Infectious Diseases. So far, the organization has assumed that resistant bacteria require about 25,000 lives each year.

In Germany, the data die after nearly 2400 people every year from an infection with a super germ. Most deaths were recorded in Italy (11 000) and France (5500). Overall, the resistant bacteria cost almost as many healthy years of life as the flu, AIDS and tuberculosis taken together.

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in Germany Escherichia coli strains proved to be particularly devastating, against which even the last available antibiotic failed. Almost 10,000 deaths a year are attributable to her. Infections with multi-resistant Staphylococcus aureus (MRSA) killed more than 7,000 people over the same period. Both germs are widespread and mostly harmless for healthy people. But if they get into the bodies of seriously ill or newborn babies, they can cause deadly infections. Such transfers happen primarily in clinics. The study authors estimate that about two-thirds of the total of 670 000 super-germ infections occur in hospitals or medical practices.

"The figures are about what we expected," said Petra Gastmeier, director of the Institute for Hygiene and Environmental Medicine at the Berlin Charité: "The researchers have calculated this solidly and carefully, but in principle such models are of course subject to some imponderables . " Thus, the reporting systems in different countries have different degrees of reliability. The scientists had focused on eight bacterial species that were registered with the ECDC in 2015.

It is certain, however, that the development would be partially avoidable. "Above all, we need even more attention in terms of the number of antibiotics prescriptions, which is still too high," said the doctor further. This applies to both latches and the general practitioners. Even with many patients, it has not yet arrived how important it is to limit the use of antibiotics to the really necessary cases. In Germany, according to an evaluation of the health insurance DAK 30 percent of the prescriptions at least questionable.

This includes the practice of prescribing antibiotics even for simple colds. Some patients are pushing their doctors to do this nonsensical action. The drugs do not help against the common cold virus. But their constant use gives bacteria the chance to develop resistance.

Likewise, the antibiotics used in large numbers in the animal fattening fire the formation of resistance. From livestock, the resistant germs can enter the organism of farmers, in the environment or in the food of consumers. Reliable figures on the problem of animal housing are rare.

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