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A superbug may be bacteria, viruses, parasites or fungi. Superbugs can't be stopped by medicines that are the first choice for treating diseases these germs cause. Superbug infections can lead to higher rates of death from otherwise treatable diseases.
But if the germ changes so that it survives the medicine, that germ is called drug resistant. It's also referred to as antimicrobial resistant. A germ's resistance to treatment makes it a superbug. It happens naturally, and while resistance can be slowed, it can't be stopped. Once a germ is resistant to the first-choice medicine, other medicines have to be used. These can cause worse side effects, not work as well or be more expensive than the first choice.
When you do get an infection, use prescription medicine as directed. Complete the full treatment course, even if you feel better. Don't share your medicines. And don't use any leftover prescription later.
Superbugs are strains of bacteria that are resistant to several types of antibiotics. Each year these drug-resistant bacteria infect more than 2 million people nationwide and kill at least 23,000, according to the U.S. Centers for Disease Control and Prevention (CDC). Drug-resistant forms of tuberculosis, gonorrhea, and staph infections are just a few of the dangers we now face.
Over time, if more and more people take antibiotics when not necessary, drug-resistant bacteria can continue to thrive and spread. They may even share their drug-resistant traits with other bacteria. Drugs may become less effective or not work at all against certain disease-causing bacteria.
NIH researchers have been looking at whether antibiotics are effective for treating certain conditions in the first place. One recent study showed that antibiotics may be less effective than previously thought for treating a common type of sinus infection. This kind of research can help prevent the misuse and overuse of antibiotics.
A MRSA skin infection can appear as one or more pimples or boils that are swollen, painful, or hot to the touch. The infection can spread through even a tiny cut or scrape that comes into contact with these bacteria. Many people recover from MRSA infections, but some cases can be life-threatening. The CDC estimates that more than 80,000 aggressive MRSA infections and 11,000 related deaths occur each year in the United States.
When antibiotics are needed, doctors usually prescribe a mild one before trying something more aggressive like vancomycin. Such newer antibiotics can be more toxic and more expensive than older ones. Eventually, bacteria will develop resistance to even the new drugs. In recent years, some superbugs, such as vancomycin-resistant Enterococci bacteria, remain unaffected by even this antibiotic of last resort.
Ideally, doctors would be able to quickly identify the right antibiotic to treat a particular infection. But labs need days or even weeks to test and identify the bacteria strain. Until the lab results come in, antibiotic treatment is often an educated guess.
Genetic studies by NIH-supported researchers such as Segre and Fowler are also helping us understand the unique characteristics of antibiotic-resistant bacteria. Their findings could point the way to innovative new treatments.
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Staphylococcus aureus is a common cause of infection in both hospitals and the community, and it is becoming increasingly virulent and resistant to antibiotics. The recent sequencing of seven strains of S. aureus provides unprecedented information about its genome diversity. Subtle differences in core (stable) regions of the genome have been exploited by multi-locus sequence typing (MLST) to understand S. aureus population structure. Dramatic differences in the carriage and spread of accessory genes, including those involved in virulence and resistance, contribute to the emergence of new strains with healthcare implications. Understanding the differences between S. aureus genomes and the controls that govern these changes is helping to improve our knowledge of S. aureus pathogenicity and to predict the evolution of super-superbugs.
There has been some debate about the disease-invoking potential of Staphylococcus aureus strains and whether invasive disease is associated with particularly virulent genotypes, or "superbugs." A study in this issue of the JCI describes the genotyping of a large collection of nonclinical, commensal S. aureus strains from healthy individuals in a Dutch population. Extensive study of their genetic relatedness by amplified restriction fragment typing and comparison with strains that are associated with different types of infections revealed that the S. aureus population is clonal and that some strains have enhanced virulence. This is discussed in the context of growing interest in the mechanisms of bacterial colonization, antibiotic resistance, and novel vaccines.
"People keep asking me, how close are we to going off the cliff," says Dr. James Johnson, professor of infectious diseases medicine at the University of Minnesota. The cliffside free fall he is talking about is the day that drug-resistant bacteria will be able to outfox the world's entire arsenal of antibiotics. Common infections would then become untreatable.
His declaration came in response to a report of a woman in Nevada who died of an incurable infection, resistant to all 26 antibiotics available in the U.S. to treat infection. Her death was reported in the Jan. 13 Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention. That kind of bacterium is known as a "superbug," which belongs to a family of bacteria resistant to antibiotics. In cases like the Nevada woman, who was infected with Klebsiella pneumoniae, the term "nightmare superbug" has been coined because this particular specimen was even resistant to antibiotics developed as a last resort against bacterial infection.
People in the U.S. have died from so-called superbug infections before. The CDC estimates that 23,000 die every year from multidrug-resistant infections. A British report, The Review on Antimicrobial Resistance, estimates that globally, 700,000 people die each year from infections that are drug-resistant. In many of those cases, the infection's resistance was discovered too late, perhaps before a last-line, effective drug was finally initiated. In poor countries, those newer, more expensive antibiotics often are not available.
The Nevada case is different in that resistance was discovered early in treatment, but even the drugs seen as the last line of defense didn't work. "This one is the poster child because of resistance across the board," Johnson says.
The woman's most recent hospitalization for infection in India had been in June 2016. She was admitted to a hospital in Reno in August, and state health department officials were notified that she had CRE. "Lab results showed she was resistant to all 14 drugs we tested," says Chen. Further tests at the CDC lab showed resistance to 26 antibiotics. She died in September of multiple organ failure and sepsis. "This was my first time to see such a resistant pattern," says Chen.
CRE infections are rare in the U.S. The CDC does not require that hospitals report CRE cases but estimates that some 175 cases have been reported in the states as of January 2017. "The majority of [CRE] cases still respond to one or two classes of antibiotics," says Chen.
CRE infections are more common in India and Southeast Asia. The reasons aren't clear, but all infections spread more easily in parts of the world with inadequate sanitary facilities. Then, as people cross borders and board airplanes, the bacteria spread in the same way that brought CRE to Reno. That's why Dr. Randall Todd, director of epidemiology and public health preparedness at the Washoe County Health District, says all hospitals should double down on preventive efforts, including a travel history. "It's important that health care providers and hospitals keep in mind that our world is ever shrinking," he says. "When someone comes in, it's important to know where in the world they've been."
Then, if CRE or other resistant infections are diagnosed, the hospital can set up appropriate precautions, like isolating the patient, and immediately start lab tests to try to find an effective antibiotic.
But in this case, there was no effective antibiotic. "And we're going to see more of these, from a drip, drip, drip of cases to a steady drizzle to a rainstorm," predicts Johnson. "It's scary, but it's good to get scared if that motivates action."
The action needed is to use antibiotics wisely, in people and in animals, so strains of bacteria don't get a chance to develop resistance, says Johnson. And to continue research into development of new antibiotics. "We do have some new drugs coming along, so there's hope," he says. But as new antibiotics become available, "we have to use them selectively, not willy-nilly."
Antibiotic-resistant superbugs are a serious threat. The CDC estimates that each year, antibiotic-resistant bacteria and fungi cause 2.8 million infections in the US, and more than 35,000 people die as a result.1
In the report, Antibiotic Resistant Threats in the United States (2019), the CDC compiled information about pathogens it considers urgent, serious, or concerning. Here are some of the dangerous superbugs the CDC and the healthcare industry are most worried about. 1
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