Antibiotic Resistance: One of Modern Medicine’s Greatest Challenges

By Alfred DeLuca, MD

It sounds like the plot of a latest science fiction novel: Bacteria are becoming increasingly resistant to antibiotics, creating a concerning combination of potent “superbugs” and a lack of new antibiotics to treat them. Unfortunately, this is not a work of fiction.

Adequately treating resistant bacterial infections is one of modern medicine’s greatest challenges. While bacteria have been around longer than we have, we still don’t have a full understanding of how they work. They are sophisticated and capable of multiplying rapidly, trading genetic information and morphing into antibiotic-resistant species. If you take an antibiotic for a viral infection, your microbiome – the community of good bacteria – is adversely affected. This can decrease your ability to fight infection naturally and cause antibiotic resistance to increase. Other complications of antibiotic misuse include allergies to antibiotics and a severe form of colitis known as Clostridium difficile.

What is Antibiotic Resistance?

We are exposed to bacteria from birth, and our body decides which are “good” bacteria, such as the cells in the gut that help us digest food, and which are “bad.” Unfortunately, we’ve spent more than 50 years fighting bad bacteria with antibiotics that were too strong or the wrong dosage, or by prescribing antibiotics for too long. As a result, bacteria have evolved mechanisms to defeat the antibiotic designed to kill them.

When antibiotics are prescribed, they kill the bacteria causing the illness and the good bacteria protecting the body. This allows drug-resistant bacteria in the body to grow and multiply, and as they multiply, they pass on their drug-resistance to the next generation of bacteria. I’m seeing more patients with persistent, life-threatening infections that require stronger and stronger classes of antibiotics. In fact, entire classes of drugs have become useless against resistant strains of bacteria. For example, penicillin is now ineffective against staph infections. Very few new antibiotic medications have been developed in the last 15 years, and those that have are very costly and often not covered by insurance.

I recently treated a patient who was admitted to the hospital for the first time in his adult life. He was suffering from a kidney infection and sepsis, but had no history of kidney disease and hadn’t traveled to a location where he could’ve been exposed to an exotic infection. The bacteria in his body began producing extended spectrum beta-lactamases, enzymes that break down and destroy most antibiotics. Looking for answers, we performed a nuclear scan, which revealed which kidney was the source of the infection. Even on the correct antibiotic his health didn’t improve. Ultimately, the infected kidney had to be surgically removed, curing the infection.

We’re facing a serious public health challenge. Antibiotic misuse has led to an extremely drug-resistant form of tuberculosis in the United States, a nearly untreatable strain of gonorrhea in Southeast Asia and many other persistent “superbugs.” It’s estimated that antibiotic resistance causes 23,000 deaths each year. There are no new antibiotics in the pharmaceutical pipeline, so we need to reset our bodies and promote our immune system’s ability to fight infection. This includes handwashing, using infection control isolation procedures, getting vaccinated and, of course, appropriate antibiotic use for bacterial infections.

Dr. Alfred DeLuca is the medical director of the Antibiotic Stewardship Program and chairman of the Infection Control Committee at CentraState Medical Center. He is board-certified in internal medicine and infectious diseases, and can be reached by calling 866-CENTRA7.