Nietzsche was right, though “that which does not kill bacteria makes them stronger” may have been more accurate. Seventy years ago, the advent of antibiotics presented humans with an unparalleled improvement in health outcomes and life expectancy. Simple bacterial infections no longer indicated the death sentence they used to. Yet, with ever increasing levels of antibiotic consumption and misuse, bacteria are becoming smarter and stronger than the drugs used to kill them. This is known as antibiotic resistance – the bacteria’s ability to withstand attack by previously effective medicines, rendering these standard or basic treatments useless. To raise awareness about one of the world’s most pressing public health threats, earlier this month the CDC announced that November 12 - 18 was “Get Smart About Antibiotics Week”.
Resistance is an unfortunate byproduct of antibiotic use, both appropriate and inappropriate. The ideal bacteria are those that have never been exposed to any antibiotics, and therefore have not had the chance to build up any defenses. Unfortunately, due to the widespread availability, prescription, and use of drugs, these “antibiotic virgins” are rare, and bacteria are growing stronger. This has led to the development of bacterial strains that require stronger and meaner drugs that are often more toxic and consequently cause more side effects.
Antibiotic overuse and misuse occurs most often in the healthcare setting and in food production. According to the CDC, nearly 50 percent of antimicrobial use in hospitals is unnecessary or inappropriate. This has lead to a staggering increase in antibiotic resistant infections, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The risk of infection, especially among already immune-compromised patients, is raised significantly. MRSA, for example, can be passed between patients, between healthcare providers and their patient, as well as from bed linens, bed rails, bathroom fixtures, and medical equipment. Infection with VRE occurs almost exclusively in healthcare facilities, and is also transmitted through direct contact with the microbe. Further, this strain of enterococci has developed the clever ability to pass its resistance to vancomycin on to other, unrelated bacteria – such as MRSA.
It is estimated that approximately 80 percent of the antibiotics sold in the U.S. are used in animal food production, for both growth promotion and to maintain animal health. Small quantities of antibiotics are often fed to animals throughout their lifetime, a practice that facilitates and promotes the development of drug resistant bacterial strains. These bacteria can persist in animal meat and infect consumers. The rampant use of antibiotics in animal agriculture has lead to outbreaks of drug resistant Salmonella and E.coli, for example.
At the end of 2011, 19 people became ill with a multi-drug resistant strain of Salmonella Typhimurium after consuming contaminated ground beef bought at Hannaford Supermarkets. Cases were reported all over the United States, from Hawaii to Massachusetts. Seven patients were hospitalized and laboratory results showed they were resistant to up to eight different antibiotics, including amoxicillin, and sensitive to three commonly used antibiotics, such as ciprofloxacin.
What can be done?
Rational use and prescription of antibiotics is key in preventing the development of drug resistant bacterial strains. This involves educating both healthcare providers and patients on the illnesses antibiotics are supposed to treat, the prescription of proper doses, and the importance of completing the full prescription.
Striving towards more judicious use of antibiotics in the food industry would also be an effective strategy to minimize the development of drug resistant bacteria. Further, the FDA must continue to vigilantly monitor antibiotic use in food animals and track antibiotic resistance in foodborne bacteria. Consumers can also protect themselves by being aware of foodborne outbreaks and recalls, and by avoiding potentially contaminated foods.