Researchers are flagging a growing problem in the world of infectious disease and antimicrobials: superbugs are becoming increasingly resistant to the therapies and drugs that are used to fight them. In fact, the World Health Organization has warned that nearly one in six infection-causing microbes are resistant to antibiotic treatments. Furthermore, its report also indicates that between 2018 and 2023, "antibiotic resistance rose in over 40% of the pathogen-antibiotic combinations monitored, with an average annual increase of 5-15%." While the organization specifically highlighted South-East Asia and the Mediterranean regions as most vulnerable to this resistance, this is a global issue, especially given how rapidly microbial diseases can spread across borders.
The mechanism behind this is something that has been well studied for decades; a bacteria may be vulnerable to a certain drug, but over time, will learn how to defend itself against that drug and evolve to survive in harsher conditions. This then requires additional development around the drug to circumvent the bacteria's ability to dodge it; and so continues the vicious cycle. Take for example certain microbes such as Bacteroides, Enterococcus, Neisseria gonorrhoeae, and Staphylococcus; these species are notorious for producing Beta-lactamase enzymes which inactivate the beta-lactam ring of susceptible penicillins and cephalosporin medications. Therefore, although these drugs were once very effective against these species of bacteria, the bacteria have learned to adapt and destroy the bactericidal capabilities of the medication. Hence, scientists had to create Beta-lactamase inhibitors, which would inhibit the bacteria's enzyme to break down beta-lactam rings. This addition to many medications is now common; for example, amoxicillin can be augmented with clavulanate, a beta-lactamase inhibitor; ampicillin can be augmented with sulbactam, etc.
Nevertheless, increasing resistance to even the most advanced medications is inevitable, given that microbial creatures including bacteria, viruses and fungus have thrived on Earth for millennia and continue to find ways to adapt to their prey. One study found that by 2050, this growth in anti-microbial resistance could kill nearly 39 million people globally, indicating a surge of nearly 68% in deaths. This is also exacerbated by a growing sick population globally. Specifically, the rate of chronic health conditions, metabolic diseases and other long-term illnesses have increased significantly among the global population over the last two decades. These include conditions such as heart failure, metabolic syndrome, diabetes, hyperlipidemia and auto-immune conditions. While these contribute to direct mortality rates, they also often make individuals more susceptible to microbial infections; in combination with more drug-resistant pathogens, this fosters an extremely vulnerable environment for decades to come.
What can be done about this?
Unfortunately, this problem is not something that can be resolved overnight, but will take a concerted effort by the entire healthcare system, including patients, to make a significant impact. The most important aspect to slow the rate of resistance is improving antibiotic stewardship, which dictates how clinicians can better prescribe medications and how patients can be better stewards of properly taking medications when and how they are supposed to. The CDC explains its core elements of stewardship, including ways to prevent misuse and mitigate resistance across hospital, outpatient and home settings. Furthermore, education around this topic is crucial for patients as well, especially in understanding that the misuse and overuse of these medications for pathogens that do not require them will ultimately only cause more harm to society.