CADILLAC — When penicillin was patented for medical use in the 1940s, it was extremely effective in treating a large number of bacterial strains, including the sexually transmitted disease gonorrhea.
Within the course of a single lifetime, penicillin has become almost completely ineffective at treating many of the same bacteria that it previously eradicated with ease, including gonorrhea.
According to the Centers for Disease Control and Prevention, “Antimicrobial resistance in gonorrhea is of increasing concern, and successful treatment of gonorrhea is becoming more difficult.‘
Spectrum Health Infectious Disease Specialist Liam Sullivan said gonorrhea is an example of what is called a Gram-negative bacteria. In layman’s terms, this indicates that the bacteria have a propensity to quickly evolve and resist antibiotic medications — as opposed to Gram-positive bacteria, which don’t evolve as quickly.
Sometimes referred to as “superbugs,‘ such bacteria have become the focus of concern among some medical professionals, who worry the decreasing efficacy of antibacterial drugs could eventually cause a global health problem.
“At least 23,000 people die each year as a direct result of these antibiotic-resistant infections,‘ the CDC reported. “Many more die from other conditions that were complicated by an antibiotic-resistant infection.‘
Sullivan said a superbug is (about 99% of the time) a bacteria that has developed a resistance to multiple forms of antibiotics.
Examples of commonly seen superbugs include Methicillin-resistant Staphylococcus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and ESBL-producing Enterobacteriaceae.
These bacteria and others like them developed resistance to antibiotics as a result of being over-exposed to the medications, giving them an opportunity to evolve.
“Bacteria have been around for 4 billion years and they’ve learned some very ingenious ways of survival,‘ Sullivan said. This ability of some bacteria to quickly evolve has made antibiotic drugs unique from other kinds of drugs in the sense that the longer they’re around, the less effective they become, Sullivan said.
But the superbug problem isn’t just that bacteria are evolving; Sullivan said companies are less interested nowadays in investing in antibiotic drug research.
“In the 80s and 90s, 50 or 60 new antibiotics came out, and that’s a conservative estimate,‘ Sullivan said. “In the last 10 years, there’s probably been less than 10. As resistance developed (in the bacteria), the pipeline has slowed.‘
Researching and bringing new drugs into the marketplace can cost billions of dollars, so companies naturally want to recoup this investment but with antibiotics generally only used for a couple days or weeks at a time, Sullivan said the market isn’t there to justify spending that type of money unless the federal government provides some sort of subsidy.
To reduce the chances that bacteria will evolve even better defenses to the antibiotics currently available, medical professionals are being more careful about how they prescribe the medications.
In the past, Sullivan said antibiotics were prescribed almost out of habit and for symptoms that often had nothing to do with a bacterial infection.
Spectrum Health Infectious Disease Pharmacist Derek Vander Horst said prescribers used to think about antibiotics as “can’t hurt, might help drugs.‘
Today, health care professionals practice what is called “antimicrobial stewardship,‘ which is essentially the process of taking more time to determine what antibiotic medications to use and for how long they should be used.
Vander Horst said this process can be the source of frustration for patients, who have become accustomed to immediately being prescribed antibiotics.
“I don’t think the public really appreciates the problem we’re running up against,‘ Vander Horst said. “It’s largely the medical community’s fault because we’ve been giving people antibiotics for so many years.‘
Munson Healthcare Cadillac Hospital Vice President of Medical Affairs Joe Santangelo said anytime they treat some with a known superbug, they take precautions to mitigate against the bacteria spreading to another host. These precautions could include wearing gloves and a gown to reduce physical contact.
Sullivan, with Spectrum Health, said most superbug infections fall on the less contagious side of the spectrum when compared to influenza or other diseases that can be contracted from several feet away from a person coughing.
Some of the more dire predictions about the possible dangers of superbugs include the possibility they could surpass cancer and heart disease as the No. 1 killer of the elderly and those with compromised immune systems within the next several decades.
Sullivan isn’t convinced the problem will get that bad but he acknowledged that it’s an issue that needs to be taken very seriously.
District Health Department No. 10 Medical Director Jennifer Morse said she also wasn’t too worried at this point because the methods of combating superbugs are becoming more advanced every day.
Santangelo agreed, adding that the combination of vigilant antimicrobial stewardship, prescreening of patients to find and treat superbugs before they have a chance to spread, and improved sanitation habits among the public all will contribute to stopping the spread of these bacteria.
“The bacteria are constantly evolving but medicine is evolving, too,‘ Santangelo said. “I think we have a good game plan for how we’re going to tackle this issue. There’s not a guarantee that the bugs are going to win.‘