Understanding the Global Crisis of Antibiotic Resistance

Each year in the United States, about 2 million people get infected by a bacteria that resists antibiotics, and at last 23 thousandths die. And in Asia, one child dies every two minutes because of the same reason.

The reason for antibiotic resistance

Antibiotic resistance happens because of the irrational use of antibiotics, even for humans, animals, or in agriculture, for example, the usage of huge amounts without a physician's prescription or using animal manure containing antibiotic residues.

All of these make the bacteria acquire antibiotic resistance genes (ARGs) through mutations, and they become a fixed part of their genome.

Even some bacteria don't have antibiotic resistance genes, but they can be transmitted to them by horizontal gene transfer (HGT).

What is horizontal gene transfer?

Horizontal gene transfer (HGT), the movement of antibiotic resistance genes from environmental bacteria to pathogenic bacteria, is a critical factor that has fueled the antibiotic resistance pandemic.

How Does Horizontal Gene Transfer Occur?

There are several mechanisms through which horizontal gene transfer takes place:

1. Conjugation: This process involves the transfer of DNA from a donor cell to a recipient cell through direct cell-to-cell contact, often facilitated by structures called pili.

2. Transformation: In transformation, bacteria take up "naked" DNA directly from their external environment.

3. Transduction: This mechanism involves the transfer of bacterial DNA via bacteriophages (viruses that infect bacteria). Bacterial DNA is packaged into the bacteriophage head and then transferred to neighboring bacterial cells.

4. Gene Transfer Agents (GTAs): GTAs are phage-like particles that carry fragments of bacterial DNA. These particles are released from cells during lysis (breakdown) and can then spread to neighboring bacterial cells.

What would a future without a solution be like?

Failure to take immediate action will lead to dire consequences soon, including a shift to second- or third-line antibiotics—which are often more expensive and more dangerous—the inability to save the lives of infected children in developing countries, deteriorating public health, and the risk of losing important advances in modern medicine such as organ transplants and certain types of cancer treatments. That's why we need a global effort to resolve this current crisis.

What are the challenges facing the finding of solutions to antibiotic resistance?

Among the challenges facing the problem of antibiotic resistance are the current shortage of effective drugs, the lack of successful preventative measures, and the lack of new antibiotics. Only two new antibiotics have been introduced to the market since 1960.

There are several reasons why pharmaceutical companies are shying away from scientific research aimed at developing new antibiotics, including:

1. The increasing cost of research and trials

2. The difficult and complex approval requirements for new drugs

3. The lack of economic returns from this research.

Therefore, instead of relying solely on the discovery of novel antibiotics, efforts should be directed towards discovering new therapeutic alternatives to mitigate this problem.

Current and Future Solutions to the Problem of Antibiotic Resistance

1. It is important to educate doctors, pharmacists, and the community about the dangers of antibiotic resistance and to alert patients that their adherence to prescriptions is not only essential for complete recovery, but also to reduce bacterial resistance.

2. It is essential to have specific regulations regarding the prescribing, dispensing, and use of antibiotics in human and veterinary medicine, as well as in agriculture—such as laws restricting the sale of antibiotics without a prescription—and to monitor their implementation and punish violators.

3. Use of antimicrobials. Unlike antibiotics, which directly kill bacteria, antimicrobials interact with the body's innate immunity and have indirect effects to improve the elimination of bacteria.

4. One of the solutions scientists are focusing on is killing antibiotic-resistant bacteria without the need to develop new antibiotics. This includes disrupting the SOS response, a natural defense mechanism in bacteria, making antibiotics more effective and lethal. This also includes the use of compounds that produce hydrogen sulfide (H2S), which is lethal to many bacteria and reverses resistance in bacteria that do not produce H2S.

Finally, antibiotic resistance remains a troubling global problem that requires urgent intervention. Everyone must start with themselves.

References

1. Akova, M. (2016). Epidemiology of antimicrobial resistance in bloodstream infections. Virulence, 7(3), 252–266.

2. Cars, O., & Högberg, L. (2008). Innovating for antibacterial resistance. ESCMID News, 2(23), 22-24.‏

3. Frieri, M., Kumar, K., & Boutin, A. (2017). Antibiotic resistance. Journal of infection and public health, 10(4), 369-378.‏

4. Ilić, K., Jakovljević, E., & Škodrić-Trifunović, V. (2012). Social-economic factors and irrational antibiotic use as reasons for antibiotic resistance of bacteria causing common childhood infections in primary healthcare. European journal of pediatrics, 171, 767-777.‏

5. Von Wintersdorff, C. J., Penders, J., Van Niekerk, J. M., Mills, N. D., Majumder, S., Van Alphen, L. B., ... & Wolffs, P. F. (2016). Dissemination of antimicrobial resistance in microbial ecosystems through horizontal gene transfer. Frontiers in microbiology, 7, 173.‏

6. Chinemerem Nwobodo, D., Ugwu, M. C., Oliseloke Anie, C., Al‐Ouqaili, M. T., Chinedu Ikem, J., Victor Chigozie, U., & Saki, M. (2022). Antibiotic resistance: The challenges and some emerging strategies for tackling a global menace. Journal of clinical laboratory analysis, 36(9), e24655.

   Assessed and Endorsed by the MedReport Medical Review Board

   ‏