Antibiotic resistance: The hidden healthcare crisis

One of the greatest contributions to medicine was Alexander Fleming’s 1928 discovery of the first antibiotic. Penicillin became another great contribution when it was made readily available in 1945, saving the lives of countless soldiers who would have otherwise died from infected wounds during World War II. After more than 75 years of widespread use, however, the bacteria penicillin once so effectively killed have learned how to fight back, and resistant bacteria can be found worldwide in alarming numbers.

According to a comprehensive global study published in The Lancet, there were 1.27 million deaths attributable to antibiotic resistance in 2019, with the U.S. reporting 35,000 fatalities, according to the Centers for Disease Control and Prevention. However, public awareness of this threat to population health remains very low.

“Most people only know about the phenomenon when they are personally affected, or when a family member is battling an antibiotic-resistant infection and they read up on the issue,” says Oladele Ogunseitan, UC Presidential Chair and UCI professor of population health and disease prevention. “But, like the COVID-19 pandemic, this is a shared societal problem. The more we use excess or unnecessary antibiotics in clinical settings or in agriculture, the more likely it is that resistance will spread among bacteria that we need antibiotics to control.”

How it happens

Antibiotic production and resistance are natural processes. Bacteria are microscopic organisms that live in a variety of environments, including soil, oceans, plants and animals, as well as humans. Some, such as probiotics, aid in digestion and help balance bacteria in our intestines, while others, called pathogens, cause disease. Most antibiotics are created as defense mechanisms. Evolution by natural or environmental selection of random mutations occurring in genetic material is common to all organisms. As some microorganisms get better at producing increasingly potent antibiotics, the bacteria generate strains that are more fit for survival and are not killed. Antibiotics will no longer be effective against these resistant strains, known as superbugs.

Overprescription of antibiotics, overuse of them in animal food farming and not completing required courses of antibiotics are the primary culprits in creating superbugs. The more bacteria are exposed to antibiotics, the more opportunities they have to learn how to become resistant. If pathogens survive inadequate or incomplete doses, they can reinforce and spread resistance.

Improper disposal of expired or unused antibiotics by flushing them down the toilet can contaminate lakes, streams and oceans, harming fish and wildlife, and they may wind up in our drinking water. Throwing them in the trash can contaminate the soil and groundwater. The safest disposal method is through a drug takeback program or drop-off site.

What can be done

“The most important thing is to prevent infection, and there are very simple hygiene practices that can help,” Ogunseitan says. “These include washing hands with soap and water after using the toilet or touching dirty items, covering our faces when we cough or sneeze, and not eating food that has fallen on the ground. These are all good practices that parents can follow and teach their children at an early age.”

He also advises parents not to pressure healthcare providers to prescribe antibiotics for themselves or their children when they’re not indicated, as they only work on bacterial infections, not viruses such as the common flu. In addition, adults can join in the knowledge and advocacy movement to become better “antibiotic stewards” by learning more and sharing accurate information about appropriate use, as well as promoting no use of antibiotics in farming when animals are not sick.

“We all have a role to play in helping to educate our communities about disease prevention and hygiene,” Ogunseitan says. “At UCI, we are recruiting antibiotic stewards who pledge to increase their own knowledge and share it with others. There is a strong group of faculty and students working on antibiotic resistance on campus, and through our efforts, we hope to strengthen the research, education and translational science framework for combating it regionally and globally.”

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