Her nightmare is one that doctors are seeing with growing frequency: antibiotic-resistant infections resulting from overuse of the drugs in humans and farm animals.
The problem is so threatening that it prompted a report last April by the Centers for Disease Control and Prevention. In the CDC's conservative estimates, more than 2 million Americans are struck by antibiotic-resistant infections each year; at least 23,000 die from their illnesses. From souped-up strep to drug-resistant staph, 17 different bacteria have been ID'd that can evade some of our strongest drugs. If you catch one of these superbugs, your doctor has limited meds that will work against it, making treatment tricky, hospitalization more likely, and, in rare cases, death a possibility.
While health officials have been sounding the alarm about antibiotic resistance for years, experts say we are now at a tipping point. "Some of these bacteria are at the cusp of being able to resist all of the antibiotics we have," says Steve Solomon, M.D., the director of the CDC's Office of Antimicrobial Resistance. "It's like being right at the edge of a cliff, and if we don't act with seriousness, we are going to go over it." If we do go over, we'll have to worry about more than hard-to-treat UTIs: "Things as common as strep throat or a. . .scratched knee could once again kill," warns Margaret Chan, M.D., director-general of the World Health Organization.
What Doesn't Kill Them Makes Them Stronger
In order to wrap your head around how puny microorganisms morphed into nightmare bacteria, a little biology primer is in order. Bacteria are hardwired to out-evolve other organisms that can annihilate themÃ¢â‚¬”a phenomenon that scientists took advantage of to create the first antibiotics. Penicillin, for example, was derived from a bacteria-killing fungus.
In other words, these drugs work so well because they harness bacteria's natural weapons of warfareÃ¢â‚¬”but that's also the reason that overusing them is causing them to fail. Every time we take an antibiotic, we give germs another chance to outsmart the drugÃ¢â‚¬”something they can do in a number of ways, says Michael Edmond, M.D., M.P.H., a hospital epidemiologist and professor of infectious diseases at Virginia Commonwealth University. For instance, in order to survive, bacteria can develop a protective shell so that antibiotics can't invade their cell wallsÃ¢â‚¬”or the drugs get pumped back out when they do. And when those now drug-resistant bacteria reproduce, they can pass that mutation down to the next generation, potentially creating new superbug strains.
More worrisome: Bacteria have the ability to acquire and share resistance genesÃ¢â‚¬”bits of DNA that make bacteria invulnerable to attack. Melissa's E. coli, for example, has a chunk of genetic material that produces an enzyme which simply breaks down many of even our strongest antibiotics. Even scarier, bacteria can not only pass these genes down to their offspring but also share them with bacteria in other speciesÃ¢â‚¬”so a germ that has never come into contact with a particular antibiotic can develop weapons against it. Bacteria can acquire these genes by picking up "free" DNA from the environment, or via viruses that pick up the genes from one bacterium and inject it into another. "Over the past decade, bacteria have evolved the ability to accumulate multidrug resistances," says Stuart Levy, M.D., a professor at Tufts University School of Medicine and president of the Alliance for Prudent Use of Antibiotics. That is, they transfer and exchange them like we do tidbits of juicy gossip.
Prescription For Trouble
While bacteria's ability to develop resistance to antibiotics is evolution in action, we've helped it along the way by overusing the drugs we have and failing to develop new ones, says Brad Spellberg, M.D., an infectious-disease specialist at Harbor-UCLA Medical Center. Despite decades of warnings from experts, overuse is rampant. Doctors write about 250 million prescriptions annuallyÃ¢â‚¬”often to appease patients begging for a pill to treat a runny nose or scratchy throat. "It's a societal problem," says Levy.
Up to half of all antibiotic scripts in the U.S. are unnecessary or inappropriate, according to the CDC. Some examples from a study published in JAMA Internal Medicine: While only about 10 percent of adults with a sore throat actually have a bacterial strep infection, they are prescribed antibiotics approximately 60 percent of the time; and though only about 10 percent of acute bronchitis cases are caused by bacteria, antibiotics are given to 73 percent of patients. The temptation to stuff ourselves full of meds just in case is understandable: Nobody wants to wait it out when there's the possibility of a quick fix.
But when we pop an antibiotic that we don't really need, or we don't finish the full course because we feel better in a few days, sensitive bacteria in our system are killed off--and we've just given resistant germs another chance to multiply.
Once these lethal pathogens are out there, they can spread from person to person or to groups of people through the environment. One recent study found that the Hudson River in New York contained bacteria that's resistant to two antibioticsÃ¢â‚¬”ampicillin and tetracycline; its presence was linked to sewage. Translation: People who are harboring resistant bacteria can pass them into the environment (via waterways, in this case) through their excrement. "One person's useÃ¢â‚¬”or abuseÃ¢â‚¬”of an antibiotic could be another person's demise," says Levy.
The problem isn't just in your doctor's officeÃ¢â‚¬”it's on your dinner table, too. Farmers add antibiotics to animal feed so they can keep their livestock healthy in close quarters and supersize their growth. A whopping 80 percent of all antibiotics sold in the U.S. are mixed into animal feedÃ¢â‚¬”a practice that the American Medical Association and the World Health Organization consider excessive and unsafe. "There is a clear scientific consensus that when we put antibiotics into livestock on this scale, it results in the spread of antibiotic-resistant bacteria to humans," says Spellberg. The deadly germs can migrate from the farm by leaking into the water we drink and inhabiting the soil in which our food grows.
And, more directly, they contaminate the meat and poultry we put in our grocery cart. In 2011, a joint program by the Food and Drug Administration, the CDC, and the Department of Agriculture found antibiotic-resistant bacteria on 81 percent of ground turkey sampled from supermarkets; 69 percent of pork chops; 55 percent of ground beef; and 39 percent of chicken breasts, wings, and thighs.
Which is gross, but also alarming. And recent research suggests that some strains of resistant E. coliÃ¢â‚¬”like the one that fueled Melissa's UTIÃ¢â‚¬”are originating in poultry. "If you eat chicken contaminated with resistant E. coli, the bacteria can colonize your gutÃ¢â‚¬”potentially without damaging it. But if it gets dragged from your rectum to your urethra during sex, it can cause a resistant infection," says Amee Manges, Ph.D., of the University of British Columbia.
Even vegetarians can't rest easy. "The fertilizer that's used to grow crops may have come from the intestines of animals that are fed antibiotics," says Spellberg. And even if you ate only organic meat and crops that were fertilized in alternative ways, people can spread these deadly germs amongst themselves with no outside assistance. "You can get them the same way you would catch a coldÃ¢â‚¬”through sneezing, coughing, and hand shaking," says Spellberg.
Battling the bulletproof bugs
Some of the promising research being done on antibiotic resistance:
- Researchers from Boston University and Harvard found that adding silver to some antibiotics made them more effective. The blinged-out meds even worked on bacteria that were previously resistant to the drugs.
- University of California at San Diego School of Medicine scientists have shown that tinkering with the chemical structures of some drugs (so bacteria can't recognize them) restored their effectiveness in animals.
- Scientists in the U.K. have isolated viruses that eat bacteria, called bacteriophages, to destroy Clostridium difficileÃ¢â‚¬”a pathogen that causes life-threatening diarrhea and kills 14,000 people every yearÃ¢â‚¬”without harming beneficial bacteria.
- Researchers at Oregon State University have shown that antibacterial agents created in a lab can be used to kill deadly germs in animals by targeting their genes, an approach that avoids the development of resistance.
If you're unlucky enough to catch one of these superbugs, treatment is tricky. While tests can identify some drug-resistant pathogens, others are identified only when multiple antibiotics fail to work. Because not enough new drugs have been created to replace the ones bacteria have become resistant to, doctors may have to resort to antibiotics that, while effective, can have toxic side effects. There are various treatments doctors can try, including cutting out infected tissue, "but the frightening truth is that some patients will die from multidrug-resistant infections," says Edmond.
To the rescue are scientists who are working hard at developing new technologies to outsmart these bacteria. "Medical advances will be extremely helpful, but antibiotics will continue to be our mainstay in our fight against bacteria and infectious diseases," says Solomon. In order to keep our ability to use them, a few things need to happen.
In addition to stepping up efforts to prevent infections, we need to develop new antibiotics. In an effort to re-prime the pump, President Obama recently signed legislation providing incentives to pharmaceutical companies to develop new medications, and the Department of Health and Human Services announced an agreement under which it will provide $40 million to GlaxoSmithKline to develop drugs to fight resistance.
Once new drugs are available, we need to stop abusing them, says Spellberg. That means the next time your doctor whips out a prescription pad, ask if the meds are really necessary for your condition. You may be able to manage the symptoms with OTC meds, or wait for a few days to see if you get better on your own. Doctors need to step up too. "We've got to figure out a way to reward physicians who are being judicious with these drugs," says Spellberg. There will be times when antibiotics are absolutely necessary, but if you want the drugs to continue working for youÃ¢â‚¬”and everyone elseÃ¢â‚¬”use them wisely.
We're already getting smarter about our food: The FDA issued a plan in December that will make it more difficult to use antibiotics to make animals grow larger, by asking drug companies to revise their labels so that using the drugs for any purpose other than treating sick animals would become illegal. But many say the government needs to ban the use of antibiotics in animal feed altogether. "This is a major step by the FDA," says Levy. "But recommending is not necessarily enforcing. This action is voluntary, with the hopes that industry and farmers will accept the ban."
Whenever these drugs are utilized, Solomon says, it must be done with discretion. "Antibiotic use in any setting affects a complex ecosystem," he says. "And misusing them threatens human health."
Melissa understands that all too well. Although the antibiotics she is taking now seem to be working, the drug-resistant strain of E. coli is living in her gut. She says, "My urologist says this is probably going to be with me for the rest of my life."
Your Best Defense
No oneÃ¢â‚¬”not even the healthiest among usÃ¢â‚¬”is immune from an antibiotic-resistant bacterial infection, but there are some (very easy!) things you can do to reduce your risk.
1. Wipe down the elliptical
Killer germs like staphylococcusÃ¢â‚¬”which causes skin infections and is ubiquitous in gymsÃ¢â‚¬”can live for weeks on exercise equipment, where lingering sweat provides a breeding ground for bacteria. Alcohol-based cleaners can eliminate them.
2. Turn up the heat
Cooking your meat thoroughly kills off most dangerous bacteria, such as E. coli. Be sure to heat ground meat (including pork) to 160Ã‚Â°F (165Ã‚Â°F for ground turkey and chicken); steaks, roasts, and chops to 145Ã‚Â°F; poultry to 165Ã‚Â°F; and fresh pork to 145Ã‚Â°F.
3. Wash your hands
It's a no-brainer, yes, but also the single most important thing you can do. KlebsiellaÃ¢â‚¬”which is found in healthy human intestines and stool, causing UTIs, pneumonia, and meningitisÃ¢â‚¬”is spread through the fecal-oral route (ew!).
4. But avoid Triclosan
This antibacterial agent, found in some soaps and sanitizers, has been found to contribute to drug resistance. According to the FDA, it has zero advantage over washing with soap and water.
5. Eat organic meat
A recent Maryland School of Public Health study found that organic poultry harbors significantly less antibiotic-resistant bacteria than meat from birds raised on conventional farms.
6. Be a pill snob
If you need an antibiotic, ask your doctor if you can take a narrow-spectrum drug for your condition. The broader the antibiotic, the more benign and beneficial bacteria are killed off, giving other germs a chance to become resistant.