Resistance

Sometimes, especially in primary care practices, clinicians are sometimes under pressure to give in to patients’ demands for inappropriate treatment. For example, Mrs. Jones sees her doctor for what the doctor determines to be a common cold. When Mrs. Jones is told that antibiotics are not needed, she becomes indignant at what she deems to be “non-treatment.” Some practitioners, in order to placate the indignant patient, will prescribe antibiotics. This is known as overtreatment and is one of the causes of antimicrobial resistance. Antimicrobial resistance is the ability of germs to evade the treatment effects of antimicrobial drugs.

Antibiotics are important, often lifesaving medications, but their overuse has contributed to antimicrobial resistance, which is increasing globally. In the U.S., nearly three million people are diagnosed with antimicrobial-resistant infections every year. Risk factors for antimicrobial-resistant infections include a weakened immune system (due to cancer, organ transplant, HIV, or immunosuppressing medications), infants and people older than 65 years, and conditions such as diabetes, chronic kidney disease, and chronic lung disease. Prior treatment with antibiotics and long-term antibiotic use, prolonged hospital stays, and catheters are also associated with increased risk. Antimicrobial resistance can spread through inadequate handwashing, substandard hospital cleaning, overcrowding, poor sanitation, contaminated food or water, and travel to areas that have high rates of antimicrobial resistance.

Antimicrobial resistance makes it harder to treat infections such as pneumonia and urinary tract infections (UTIs), often leading to delayed treatment with effective therapy. Resistance can also make some infections untreatable, which markedly increases the risk of death. In 2021, more than one million people worldwide died of an infection caused by a resistant microbe, and that number is expected to rise to 40 million by 2050. The most common antibiotic-resistant bacteria are methicillin-resistant Staphylococcus aureus (MRSA), drug-resistant Streptococcus pneumoniae, and gram-negative bacteria such as Escherichia coli, Klebsiella, Pseudomonas aeruginosa, and Acinetobacter that are resistant to carbapenem antibiotics. MRSA may cause skin infections, pneumonia, and bloodstream infections. S pneumonia is a common cause of pneumonia, ear infections, and meningitis, particularly in children and older adults. Carbapenem-resistant gram-negative bacteria often cause UTIs, pneumonia, and bloodstream or inter-abdominal infections. Antimicrobial-resistant tuberculosis, malaria, and fungal infections (such as Aspergillus and Candida) are also increasing. Some viruses that can infect those with weakened immune systems (such as cytomegalovirus) can also become resistant to anti-viral drugs.

Unnecessary use of antimicrobials should be avoided. Many infections do not require treatment with antibiotics. When needed, these medications should not be taken for longer than prescribed. The spread of resistant organisms can be reduced by washing hands or cleaning them with sanitizer before meals, before preparing food, and after using the bathroom. Vaccination to protect against S pneumonia, Hemophilus influenza type b, and influenza decreases antimicrobial use and reduces a person’s risk of acquiring an antimicrobial-resistant infection.

For more information go to the website of the Centers for Disease Control and Prevention at www.cdc.gov

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