By Dr. Samer Koutoubi, M.D., Ph.D.
Department Chair and Faculty Member, Public Health
Antimicrobial resistance occurs when bacteria or fungi invade the body and beat the drugs that are designed to kill them. This invasion may lead to more infections that are very hard to treat.
There are also a growing number of fatalities. The CDC notes that five million people have died worldwide because the infections in their bodies were resistant to antibiotics.
According to the Centers for Disease Control and Prevention’s (CDC’s) 2019 Antibiotic Resistance (AR) Threats Report, more than 2.8 million antimicrobial-resistant infections happen every year in the United States and have resulted in 35,000 deaths. Also, a recent report by the United Nations indicated that the annual toll is expected to increase to 10 million by 2050 if steps are not taken to stop the spread of antimicrobial resistance.
The CDC Issues a Health Advisory about a Drug-Resistant Disease
On Feb. 24, 2023, the CDC issued a health advisory to the public regarding an increase in extensively drug-resistant shigellosis in the United States. Shigellosis results from a germ called shigella.
According to the CDC, shigellosis symptoms can appear one to two days after exposure, but some people will not have any symptoms. The symptoms of shigellosis include:
- Prolonged and bloody diarrhea
- Abdominal pain
- Tenesmus (the feeling that you need to pass stools, even though your bowels are already empty)
Shigella germs can be spread by a fecal-oral route, according to the CDC. For instance, someone can acquire a shigella infection by eating food or drinking water contaminated with the germ or having contact with poop during sexual contact with someone who has or recently had diarrhea.
The CDC states that antimicrobial resistance can affect people of all ages and occurs in any profession, including healthcare workers. It is one of the world’s most urgent global public health problems and can lead to:
- A longer duration of shigellosis
- Longer hospital stays
- Longer treatment, including more expensive medications
- Higher medical costs, which lead to more of an economic burden on families
- An increase in mortality
Antimicrobial Resistance and COVID-19
According to the CDC’s COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022, the United States lost much of its progress in combating antimicrobial resistance in 2020 due to the COVID-19 pandemic. The CDC notes that more than 29,400 people died from antimicrobial-resistant infections during the first year of the pandemic. Of these, nearly 40% of the people got the infection while they were in a hospital.
How Antimicrobial Resistance Happens
According to the World Health Organization (WHO), antimicrobial resistance occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective. For instance, healthcare providers often prescribe antibiotics to treat patients’ bacterial infections, and those medications are not effective enough to kill the germs causing the infection.
Microorganisms develop new resistance mechanisms every day. As a result, the CDC says that it becomes harder to treat and control common diseases such as pneumonia, tuberculosis, sexually transmitted diseases such as gonorrhea, and foodborne diseases such as shigella and salmonella.
Antibiotics and antifungal medications have been used for many years and have saved many lives. But the overuse of antibiotics and antifungal medications can lead to the development of resistant germs.
When they kill germs, antibiotics and antifungal medications do not differentiate between the good germs that protect our body from infection and bad germs that cause infections. The antimicrobial-resistant germs can survive and multiply over time. These surviving germs have resistance traits in their DNA that can spread to other germs.
Creating an Antimicrobial Resistance Monitoring System
To standardize antimicrobial resistance surveillance, the WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) on Oct. 22, 2015. GLASS was created to support the second objective of the Global Action Plan to tackle the antimicrobial resistance initiative to “strengthen knowledge through surveillance and research.” GLASS is also intended to fill in knowledge gaps and inform strategies at all levels.
According to WHO, the GLASS surveillance system “provides a standardized approachto the collection, analysis, interpretation and sharing of data by countries and seeks to actively support capacity building and monitor the status of existing and new national surveillance systems. Furthermore, GLASS promotes a shift from surveillance approaches based solely on laboratory data to a system that includes epidemiological, clinical, and population-level data.”
Creating Treatments to Combat Drug-Resistant Infections
The Global Antibiotic Research and Development Partnership (GARDP) is a core element of the WHO’s Global Action Plan on Antimicrobial Resistance. The WHO says that GARDP is a “not-for-profit organization developing new treatments for drug-resistant infections that pose the greatest threat to health.” It was established in 2016 to accelerate the development and access of treatments for drug-resistant infections.
Together with private, public and non-profit partners, GARDP works to preserve the power of antibiotics for generations to come. GARDP notes that its “5 by 25” initiative “aims to deliver five new treatments by 2025 for bacterial infections that pose the greatest threat to human health.” GARDP says that it works “with governments, the pharmaceutical and biotech industry, academia, and members from civil society around the world to revitalize the antibiotic development.”
CDC Methods for Mitigating Antimicrobial Resistance
The CDC is also taking action to share its expertise and reduce antimicrobial resistance. For instance, the CDC “deploys experts to investigate and contain resistance outbreaks, and assists other countries as they:
- Implement infection prevention and control programs, and antibiotic stewardship programs in healthcare settings
- Establish or strengthen national tracking systems to respond rapidly to outbreaks, identify emerging pathogens, and track trends
- Enhance laboratory capacity to detect and report resistance
- Develop and implement national action plans to address the threat of antibiotic resistance”
Antimicrobial resistance is likely to remain a significant health problem for years to come. But through hard work and collaboration, it may be possible to mitigate this public health threat.
About the Author
Dr. Samer Koutoubi is the Department Chair of Public Health. He earned his Ph.D. in Dietetics and Nutrition from Florida International University in 2001. Dr. Koutoubi earned his M.D. degree in 1988 from Iuliu Hațieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania. His research focuses on coronary heart disease among tri-ethnic groups, including African-Americans, Caucasians and Hispanics. His interest is in disease prevention and wellness, epidemiological research, cardiovascular disease and nutrition, homocysteine metabolism, lipoprotein metabolism, and cultural food and health.
Dr. Koutoubi has also authored several articles in peer-reviewed journals and wrote a book review. He served as the Editor-in-Chief for The Internet Journal of Alternative Medicine and reviewed manuscripts for The Journal of Alternative and Complementary Medicine, Ethnicity and Disease Journal, European Journal of Clinical Nutrition, and The Journal of The National Medical Association. Dr. Koutoubi has also been quoted in national magazines and newspapers, including Natural Health Magazine, Energy Time, Well Being Journal, Northwest Prime Time, and Natural Food Merchandiser.