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Antibiotic Overuse and Resistance

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Antibiotic Overuse and Resistance

The deadly cost of inadequate antibiotic therapy

According to the World Health Organization (WHO), antibiotic resistance is rising to dangerously high levels in all parts of the world as new resistance mechanisms are emerging and spreading globally.1 With antibiotics becoming less effective, it has grown increasingly difficult, and in some cases impossible, to treat patients for even common infectious diseases like pneumonia.

Patient care is also becoming more costly as first-line antibiotics are being replaced by more expensive medications. A longer duration of illness and treatment, often in hospitals, increases healthcare costs as well as the economic burden on patients and societies.1

Learn from an expert, Prof. Evangelos J. Giamarellos-Bourboulis, Chairman of the European Sepsis Alliance: Antibiotic resistance, the microbiome, and B·R·A·H·M·S PCT 

Learn from an expert, Prof. Evangelos J. Giamarellos-Bourboulis, Chairman of the European Sepsis Alliance: Antibiotic resistance, the microbiome, and B·R·A·H·M·S PCT 

Watch: What is “microbiome”?
Watch: Antibiotics are useful, right?
Watch: What is “antibiotic resistance”?
Watch: How can we limit antibiotic exposure and their side effects on microbiome?

Yet the true cost of antibiotic resistance is measured in lives and infection rates: inadequate antibiotic therapy can lead to increased mortality and morbidity, as well as a higher rate of infections such as Clostridioides difficile (C. diff).2

Hospitals can no longer afford to ignore the crisis of antibiotic resistant bacteria. Based on scenarios of rising drug resistance for six pathogens, The Review on Antimicrobial Resistance estimates that unless action is taken, the global burden of deaths from antibiotic resistance could balloon to 10 million lives each year by 2050, at a cumulative global economic output cost of $100 trillion USD.6

Estimates of related infections in the U.S. and Europe | Antibiotic overuse and resistance
It has been estimated that by 2050, 10 million worldwide deaths could result from antibiotic resistance, making it deadlier than cancer.6

What are the causes of antibiotic resistance?

Antibiotic resistance is a complex process that occurs as bacteria adapt to the continuous presence of antibiotics.8 Once bacteria become resistant against antibiotics, it becomes much more difficult to get an infection under control. Patients experiencing infection with resistant bacteria often face prolonged hospital stays and higher mortality risks. These patients’ more extensive care also leads to increased costs.

 

1. Antibiotics fight bacteria, but bacteria fights back

The defensive strategies bacteria use against antibiotics are called resistance mechanisms.7 Bacteria develop these mechanisms using instructions carried in their DNA. Often, resistance genes are found within plasmids, small pieces of DNA that carry genetic instructions from one germ to another. This means that some bacteria can share their DNA and make other bacteria resistant.7 

How does antibiotic resistance develop?
Development process of different bacteria | Antibiotic overuse and resistance
2. Antibiotic overuse leads to resistance.

The overuse and misuse of antibiotics accelerates the natural process of antibiotic resistance.7 Resistant bacteria are then spread via healthcare-acquired infections, which hospitals and clinics struggle to prevent and control. It’s a treacherous cycle that has led to increased resistance to life-saving antibiotics around the world, greatly reducing treatment options. Some bacterial strains have even become resistant to both first- and second-line antibiotics. These multidrug-resistant (MDR) strains can only be treated with last-resort antibiotics, if they can be treated at all.

For example, among antibiotic-resistant pathogens, one of the most concerning is Klebsiella pneumoniae (K. pneumoniae). It accounts for about one third of all Gram-negative infections, including urinary tract infections, cystitis, pneumonia, surgical wound infections, endocarditis and sepsis.8  

K. pneumoniae has a high resistance against the four major antibiotic classes: the third-generation cephalosporins, aminoglycosides, fluoroquinolones and carbapenems.9-11 This resistance is resulting in a growing, worldwide problem in which clinicians have fewer effective antibiotic treatment options for hospital-acquired infections.12

Antibiotic resistance of Klebsiella pneumonia in certain countries | Antibiotic overuse and resistance
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The fight to end antibiotic resistance starts now

The need for more effective antibiotics is greater than ever, yet few new antibiotics are in the development pipeline. Moreover, new antibiotics have demonstrated only limited effectiveness against resistant strains. Therefore, it is critical to limit antibiotic resistance so that antibiotics remain a potent treatment option against infections, today and in the future.   

As a clinician, you can play a key role in reducing antibiotic resistance by practicing antibiotic stewardship. This means not prescribing antibiotics for patients who are unlikely to suffer from bacterial infection, while ensuring that patients who do require antibiotic treatment receive the appropriate antibiotics, at the correct dose and for the proper duration.

It is possible to end the antibiotic resistance crisis—if hospitals and clinicians take action now.

Impact of antibiotic stewardship11
Effect and impact of stewardship | Antibiotic overuse and resistance

Discover how PCT can be an aid to reduce antibiotic overuse and exposure

PCT Perspectives: Antibiotic Stewardship
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References
  1. World Health Organization. Antibiotic Resistance [Internet]. Geneva (CH). 2020 Jul 31. [cited 2020 Dec 16]. Available here.
  2. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2019 [Internet]. Atlanta (GA). 2019 Dec. [cited 2020 Dec 11]. Available here.
  3. Khanna S, Pardi DS. The growing incidence and severity of Clostridium difficile infection in inpatient and outpatient settings. Expert review of gastroenterology & hepatology. 2010 Aug 1;4(4):409-16.
  4. European Center for disease Prevention and Control. Antimicrobial resistance in the EU/EEA (EARS-Net) - Annual Epidemiological Report for 2019, 2020 [Internet] Available here.
  5. European Centre for Disease Prevention and Control (EU body or agency), Kinross, Sutens. European surveillance of clostridium difficile infections: Surveillance protocol version 2.2. [Internet]. Publications Office of the European Union. Publications Office of the European Union; 2016 [cited 2021Mar31]. Available here.
  6. Review on antimicrobial resistance. Tackling drug-resistant infections globally: Final report and recommendations [Internet]. London (UK). 2016 May. Available here.
  7. Centers for Disease Control and Prevention. How antibiotic resistance happens [Internet]. Atlanta (GA). 2020 Feb 10. Available here.
  8. Navon-Venezia S, Kondratyeva K, Carattoli A. Klebsiella pneumoniae: A major worldwide source and shuttle for antibiotic resistance. FEMS Microbiol Rev. 2017;41(3):252–75.
  9. Fair RJ and Tor Y.  Antibiotics and bacterial resistance in the 21st Century. Perspect Med Chem. 2014;6, 25–64. 
  10. Dsouza R, Pinto NA, Hwang I, Cho Y, Yong D, Choi J, et al. Panel strain of Klebsiella pneumoniae for beta-lactam antibiotic evaluation: Their phenotypic and genotypic characterization. PeerJ Prepr. 2017 Jan 19;5:e2896.
  11. Healthcare-associated infections in acute care hospitals [Internet]. European Centre for Disease Prevention and Control. 2021 [cited 2021Mar31]. Available here.
  12. Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev. 2010 Sep 1;74(3):417-33.
  13. The Center for Disease Dynamics, Economics & Policy. Resistance map: Antibiotic resistance [Internet]. Washington (DC). 2020. [cited 2020 Dec 11]. Available here.
  14. Dik JW, Hendrix R, Poelman R, Niesters HG, Postma MJ, Sinha B, et al. Measuring the impact of antimicrobial stewardship programs. Expert Rev Anti Infect Ther. 2016 Jun 2;14(6):569-75. 
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