Jan. 22, 2022 -- Even before the COVID-19 pandemic, we've all been there. You wake up feeling lousy -- headache, scratchy throat, coughing -- and you find the energy to go see your doctor. What you really want is validation -- yes, something is going around -- and a prescription that will knock the illness out of you in a day or 2, tops.
Then the doctor uses the “V” word. They tell you the rapid strep test came back negative, so you likely have a virus. Instead of a strong antibiotic, you need rest, fluids, and time for your body to fight off the infection.
You head home dejected -- why couldn't I get an antibiotic, just in case? What's the harm?
More than 1.2 million deaths around the world in just 2019 alone: That's the grave estimate in the largest study to date looking at the growing public health challenge of antibiotic-resistant bacteria.
Researchers from UCLA, the University of Washington, and other leading institutions worked together on an ambitious study to look at the death toll from bacterial antimicrobial resistance (AMR) worldwide.
In the past, bacteria would die off and an infection would clear up because antibiotics worked like a bacterial killing machine. Unfortunately, because of overuse of antibiotics and other things, these machines are faltering.
Now, many common antibiotics no longer work as well against some of the most common -- and, in some cases, the most serious -- bacterial infections.
"If left unchecked, the spread of AMR could make many bacterial pathogens much more lethal in the future than they are today," the researchers note in the study, published online Thursday in The Lancet.
Making matters worse, there is no financial incentive for pharmaceutical companies to develop new antibiotics to take their place. Many antibiotics have been on the market so long, you can get them as inexpensive generics. That means companies are likely to lose money, not make money, on new drugs.
How can the average American make a difference? Don't insist on an antibiotic in a doctor’s office when it's not recommended. Choose antibiotic-free meat at the grocery store. Practice good hand hygiene to help avoid getting sick in the first place. And realize that even if we make inroads against AMR in the U.S., the challenge is even greater in lower- and middle-income countries.
Millions of Lives Already Lost
The experts studied antibacterial resistance in 204 countries and territories around the world and estimated that 1.27 million deaths could have been prevented in 2019.
Even more deaths could have been prevented that year if these resistant infections were changed to no infections. The research shows almost 5 million people around the world could still be alive.
Based on the numbers in this study, AMR is now a leading cause of death worldwide. For example, antimicrobial resistance killed more people that either HIV or malaria in 2019.
Western sub-Saharan Africa had the highest death rates in the study. In contrast, the region that includes Australia and New Zealand had the fewest deaths.
Fighting the Resistance Will Take Work
For a study about millions of deaths, it wasn't all doom and gloom. The experts suggested five strategies that could make the situation better.
For example, it is going to take a continued effort on the part of doctors to avoid prescribing unnecessary antibiotics; agricultural companies need to minimize antibiotic use in chicken, beef, and other livestock; and drug companies need something to make it worth their time and effort to develop new medications.
Governments and private organizations also will need to increase funding for research into novel antibiotics and another “V” word -- vaccines, said study researcher Kevin Ikuta, MD, a health sciences assistant clinical professor of medicine at UCLA.
Of the six most worrisome bacteria, only one -- Streptococcus pneumoniae -- has a vaccine available to prevent getting the infection in the first place.
More vaccines are in the works, but for now, people remain vulnerable to the other five main culprits: Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. The study reveals that each of these bacteria is responsible for more than 250,000 AMR-associated deaths.
Prefer to narrow down your anxiety to the most threatening antibiotic-and-resistant bacteria pair out of the 88 combinations the researchers studied? They identified methicillin-resistant S. aureus (MRSA) as the one causing the most AMR deaths -- more than 100,000 deaths in 2019 alone.
How Does COVID-19 Figure In?
In an editorial in The Lancet published at the same time as the study, Ramanan Laxminarayan, PhD, called antimicrobial resistance an “overlooked pandemic.”
"As COVID-19 rages on, the pandemic of antimicrobial resistance continues in the shadows. The toll taken by AMR on patients and their families is largely invisible but is reflected in prolonged bacterial infections that extend hospital stays and cause needless deaths," wrote Laxminarayan, an economist and epidemiologist with the Global Antibiotic Research and Development Partnership in Geneva, Switzerland.
There is a direct relationship between COVID-19 and AMR, Vance Fowler, MD, said when asked to comment on the study. When someone with COVID-19 is hospitalized for an extended time, for example, they are more likely to get a resistant bacterial infection as well.
Experts call these “super infections.”
The Lancet report is likely "to bring more attention to AMR, especially since so many people have been distracted by COVID, and rightly so. The world has had its hands full with COVID," said Fowler, a professor of medicine at Duke University School of Medicine in Durham, NC.
The deaths linked to AMR show that there is more work to be done on infection control and prevention, he said. Tracking hot spots around the world will allow resources to be directed better.
Asked if there are any reasons for hope or optimism at this point, Ikuta said, "Definitely. We know what needs to be done to combat the spread of resistance. COVID-19 has demonstrated the importance of global commitment to infection control measures, such as hand-washing and surveillance, and rapid investments in treatments, which can all be applied to antimicrobial resistance."