Antimicrobial drug resistance

Many diseases are caused by pathogenic bacteria and other microbes. These diseases include various epidemic illnesses and also tuberculosis, pneumonia, blood infection (sepsis), leprosy and syphilis. Antibiotics are chemicals toxic to such microbes. Antimicrobial drug resistance results from the rapid ability of microbes to reproduce and so evolve strains resistant to antibiotics. The use of antibiotics actually speeds up the process of adaptation; therefore, microbial drug resistance is not a passing trend but likely a permanent feature in the fight against infectious diseases.  This is particularly true in settings where antibiotics are used as a substitute for sanitation and hygiene.

Across the world, people are dying as result of infections which do not respond to any of the 160 different antibiotics on the market. "Pan-drug resistant bacteria" have been found on every continent on earth. Bacteria have developed resistance to every antibiotic in our arsenal. Acute infectious diseases are re-emerging as a serious threat to health in advanced industrialized countries due to the growing resistance of microbes to antibiotic drugs. 

Antibiotics are drugs that disable or kill bacteria; more accurately they should be called antibacterials.  Antimicrobials cover the larger group of pathogenic organisms, including fungi and viruses.  But the terms are often used interchangeably.

The first American known to be infected with such bacteria was a 49-year-old Pennsylvania woman who sought treatment for a urinary tract infection in April 2016.

Resistance to antibiotics is carried by a small circle of DNA called a plasmid, which is separate form the rest of the genes in the bacterium and can move freely to another bacterium.  Bacteria are capable of passing their antibiotic-resistant genes to other bacteria by a process known as horizontal gene transfer.  In December 2015, scientists discovered "pan-resistant" bacteria that carry a gene that allows them to resist all the world's antibiotics.

By 2050, annual deaths due to antibiotic resistance are expected to reach: 317,000 in North America; 390,000 in Europe; 4.15 Million in Africa; 4.73 Million in Asia

Each year, in the United States alone, at least 23,000 people are dying of antibiotic-resistant infections and related complications (2018).  According to the CDC, at least 2,049,442 people already become ill with antibiotic resistant infections in the U.S. each year.

80% of the antibacterial drugs sold in the US were used on animals, primarily for agricultural production.  An April 2016 study found that antibiotic-resistance has likely become "the norm, rather than the exception" in commercial meat production facilities.

In March 2015, the White House issued their National Action Plan for Combating Antibiotic-Resistant Bacteria. The plan calls for the end of antibiotic misuse and over-use in healthcare and food production. Initial findings indicate that nearly 1 in 3 antibiotic prescriptions written in the U.S. is inappropriate or unnecessary.

Drug resistance is regarded as the key driver of the increased sales of antibiotics, following a slump in the 1980s. The worldwide market for antibiotics was worth $20 billion in 1991, 12% up on 1990. Estimates of the total cost of antibiotic resistance in the USA range up to $30 billion a year.

Organisms in which resistance is a serious problem include Streptococci spp, Staphylococci spp, Enterococci spp, Pseudomonas spp, and Mycobacterium tuberculosis. Staphylococcus aureus has become legendary for its ability to collect resistance traits against antibacterial agents and strains have become endemic in hospitals that are resistant to vancomycin, the antibiotic of last resort. About 8% of the enterococci encountered in American hospitals (1993) are resistant to vancomycin, 20 times the rate of 4 years previously; consequently, 19,000 patients a year have untreatable infections. VRE, a form of Enterococcus faecium, which causes wound and urinary tract infections, is also resistant to vancomycin.

Diseases that are re-emerging due to antibiotic-resistant strains include penicillin-resistant gonorrhoea, vancomycin-resistant enterococcus, E. coli  0157 food poisoning, antibiotic-resistant influenza, multiply drug-resistant tuberculosis, Lyme disease, and dengue haemorrhagic fever. There are probably many more such drug-resistant diseases; experts say that deaths and contagious outbreaks are not being diagnosed correctly or reported due to underfunded regional medical services. In 1993, an epidemic of yellow fever in Kenya was given full rein as a consequence of a regional laboratory's failure to diagnose the cause of the outbreak correctly.

Drug-resistant strains of tuberculosis have appeared in many places in the past few decades. In Russia in 1997, drug-resistant tubercular cases spread into the population at large after some of Russia's 1 million prisoners were released from overcrowded jails - where the official toll is 2481 cases per 100,000 prisoners; unofficially the incidence is 50%. The incidence of TB in the Russian non-prison population tripled to 70 cases per 100,000. In Azerbaijan there are officially 4667 TB cases per 100,000 prisoners, of whom one quarter die. 56,000 prisoners were released in 1996, many of whom were known to be suffering from drug-resistant TB. In Russia and Azerbaijan the prevalence of TB is also rising to the levels of the 1970's. This epidemic, poverty due to economic upheaval, and a lack of medical services, have contributed to Russia's mortality rate, now the highest in Europe. (In the USA there are 8.7 TB cases per 100,000 people.)