Antibacterial resistance makes IC imperative

Study highlights potential dangers ahead

The world faces a crisis due to antibacterial drug resistance, and pharmaceutical companies and physicians have failed to stay far enough ahead of adaptable bacteria, according to a new study.1

About 2 million nosocomial infections occur each year in the United States, and more than two-thirds of the pathogenic microorganisms responsible for these infections are resistant to at least one antibiotic.1

"Looking into the future, we could have a population that dies from bacterial infections," says Arthur C. Croft, DC, MS, MPH, PhD-candidate, director of the Spine Research Institute of San Diego in Spring Valley, CA. Croft is the lead author of the study.

"Everyone is concerned right now with viruses, like bird flu," he says.

But the risk of one genetic mutation spelling disaster for large populations is not high, Croft adds.

"I think while everyone has been concerned about that risk, the simmering antibiotic resistance problem has been unattended," he says.

"When people go to the doctor and they're sick, the doctor says, 'This looks like a virus, but let's give antibiotics anyway.'" Croft explains. "The theory is that the virus will weaken them to a secondary antibiotic infection."

But this is part of the problem that has contributed to overuse of antibiotics in the United States, he says.

"In this country, the culture is that we want to fix a problem quickly and do it easily by taking a pill," Croft adds. "And we take a child to the pediatrician, and we think the child has an illness that needs to be treated with antibiotics, we expect to leave with a prescription in our hands, and we don't want to hear that it is just a virus — so don't worry about it."

Often, antibiotic prescriptions are handed out to placate parents and patients, Croft says.

Over time, excessive prescribing has contributed to the world's growing problem with antibiotic resistance, he adds.

Another contributing factor is an overreliance on agricultural antibiotics, Croft says.

"One problem is our practice of using antibiotics that are the same or similar to those used in humans in agricultural animals, such as pigs, cattle, sheep, and goats," Croft says. "The problem is that you can develop within that system-resistant strain of bacteria that is passed on directly or in other ways to human beings."

Farm animals are fed more than 40% of the antibiotics manufactured in the United States. High volume of antibiotics are given to the food animals both as prophylaxis and as growth promoters.1,2,3

Another problem is that local community outbreaks are increasing," Croft says. "Vancomycin resistance is an increasing problem because these strains are just spread around, often by people who are asymptomatic."

Hospital settings are susceptible to drug-resistant organisms, which is why hospitals are placing more emphasis on infection control, he notes.

At the same time that drug-resistant strains are spreading and that the newer drugs designed to defeat them are losing potency, there are very few new antibacterial agents in the drug development pipeline, Croft says.

"The pharmaceutical companies are not working on this problem in earnest because it's not very profitable," Croft says.

If a large pharmaceutical company decides to develop a new antibiotic to deal with drug-resistant strains, it could sink billions of dollars into development, and then six months after the drug is on the market, some bacterial strains may become resistant to it, rendering the drug less useful, Croft explains.

"So it's much more profitable to look at new antidepressants, analgesics, and erectile dysfunction drugs," he adds.

References

  1. Croft AC, D'Antoni AV, Terzulli SL. Update on the antibacterial resistance crisis. Med Sci Monit 2007; 13(6): RA103-RA118.
  2. Levi SB. The challenge of antibiotic resistance. Sci Am 1998; 278:46-53.
  3. McEwen SA, Fedorka-Cray PJ. Antimicrobial use and resistance in animals. Clin Infect Dis 2002; 54(Suppl3):D93-S106.