While the world’s attention remains focused on battling COVID-19, another global health crisis is intensifying — and it’s one that could change the way we treat simple infections, like strep throat, or go about doing routine surgeries, such as joint replacements.
What is a superbug?
A superbug is any microbe — bacteria, virus, parasite or fungus — that has grown resistant to most of the medications commonly used to treat the infections it causes.
Source: Mayo Clinic
It’s antibiotic resistance, and it’s “rising to dangerously high levels,” the World Health Organization (WHO) says. In the U.S. alone, more than 35,000 people die from antibiotic-resistant infections each year, according to the latest data from the Centers for Disease Control and Prevention (CDC). Globally, that number is at least 700,000, and by 2050, it could be 10 million, experts predict.
“People are calling it the silent pandemic,” says David Weiss, director of the Antibiotic Resistance Center at Emory University’s School of Medicine. “It's more like a slow-developing chronic [issue], but it could definitely get to pretty epidemic proportions.”
Yet despite the danger it poses, antibiotic resistance is widely misunderstood, global research shows. Here are six myths about antibiotic resistance, plus tips on how you can protect yourself from a superbug infection.
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Myth 1: Antibiotic resistance is when people become resistant to antibiotics
Fact: Antibiotic resistance is when bacteria become resistant to the drugs designed to kill them. It does not mean that people develop a resistance to antibiotics. “The simplest way to understand it is that the bacteria are just trying to survive,” Weiss says, and they do that by mutating, or changing their genetic material, in order to escape the lethal effects of the drugs. Those that succeed continue to grow and spread.
Fungi can also morph into drug-resistant germs, as can viruses. “And what is happening is we're seeing that this is becoming more and more frequent,” says Matthew McCarthy, M.D., an associate professor of medicine at Weill Cornell Medicine and author of Superbugs: The Race to Stop an Epidemic. “And that means we're running out of treatment options.”
Having a smaller arsenal of effective drugs makes treating infections caused by drug-resistant bugs more difficult — sometimes impossible. In many cases, antibiotic-resistant infections require extended hospital stays and expensive and toxic treatment alternatives, the CDC says.
Several types of bacteria that cause common ailments — like urinary tract infections and pneumonia — have become resistant to antibiotics, the U.S. Food and Drug Administration reports. Bacteria that cause skin infections and meningitis also make the list.
Myth 2: Antibiotic resistance is a new phenomenon
Fact: Germs have been outsmarting drugs for decades. In fact, shortly after the first antibiotic was introduced in 1941, researchers identified a bacteria that was resistant to it. But it never became the problem it is today because science was always one step ahead.
“As soon as bacteria would become resistant, we would have another antibiotic that we could use to treat [an infection],” Weiss says. “What's happened now is that the bacteria got ahead. And in some cases, we actually don't have the next antibiotic.”
Do you need an antibiotic?
That depends on what’s causing your illness.
Antibiotics treat only certain infections caused by bacteria, including:
- Strep throat
- Whooping Cough
- Urinary tract infections (UTI)
They won’t work against illnesses caused by viruses, like:
- Colds and runny noses
- Most sore throats (except strep throat)
- Most cases of chest colds (bronchitis)
One reason: Many drug companies have abandoned efforts to produce new antibiotics. “It's a very expensive process to discover and develop a new drug, and most companies lose money when they try to invest in a new antibiotic,” McCarthy says, which is why incentive programs could help usher in a new era of medicines.
In 2019, WHO identified 32 antibiotics in development that work against some of the world’s biggest bacterial threats, and only a handful are drastically different from existing antibiotics. “I'm still using antibiotics that were discovered decades ago. We need newer treatment options to meet the needs of the 21st century,” McCarthy says.
Misuse of antibiotics has also fueled resistance. Anytime an antibiotic is used, it gives the germs it targets an opportunity to mutate into a resistant form and spread elsewhere. That’s why health experts say it’s critical to take antibiotics only when they’re needed — when the benefits usually outweigh the risks of resistance — and only for bacterial infections. Still, about 47 million antibiotic courses are prescribed each year for infections they can’t cure, like colds and the flu, the CDC estimates.
Myth 3: You’re unlikely to encounter a superbug
Fact: Superbugs are all around us. “It used to be something that we thought only existed in hospitals or nursing homes, but superbugs can be in your home,” McCarthy says.
They can also “live with us happily” in the gut and on the skin, Weiss adds. “The problem occurs when something happens and they start causing disease, and then you try to treat them and it's untreatable because of antibiotic resistance.”
That said, one of the biggest risks for getting an antibiotic-resistant infection is staying in a hospital or health care setting where antibiotics are used often. “The [bacteria] that are remaining there are going to be more resistant,” Weiss explains.
Myth 4: Superbugs don’t affect healthy people
Fact: Nearly half (44 percent) of respondents in a multi-country WHO survey thought antibiotic resistance is a problem only for people who take antibiotics regularly. The fact is, anyone, “at any stage of life,” can get an antibiotic-resistant infection, the CDC says.
However, some people are more at risk for getting infections than others, like people with chronic illnesses and individuals with weakened immune systems, including older adults, who have a tougher time fighting off disease. About one-third of deaths from antibiotic-resistant pathogens have occurred in people 65 and older, according to research published by The Pew Charitable Trusts.
“When you have a medical condition that causes your immune system to weaken and you come into contact with a superbug, it can cause a problem. And the problem is when you end up in the emergency room with an infection that's resistant to all of the different antibiotics that a doctor like me was hoping to use,” McCarthy says.
Many of the same prevention efforts that can reduce the risk of any infection can also reduce the risk of a superbug infection: Washing your hands, staying up to date on recommended vaccines, preparing and storing your food safely, and avoiding close contact with people who are sick.
Other things you can do: Take antibiotics only when prescribed and follow your doctor’s instructions. Abandoning the treatment too early, even if you’re feeling better, gives any remaining bacteria an opportunity to change and become resistant to the medication.
Also, talk to your doctor about your individual risks. “So many patients don't realize that they are taking medications that weaken their immune system,” McCarthy says.
Myth 5: Drug-resistant germs are no threat to modern medicine
Fact: Medical care as we know it could look very different if we run out of effective antibiotics and new drugs or alternative therapies go undiscovered.
Common infections are already getting harder to treat at home. For example, the bacteria that causes most urinary tract infections is becoming increasingly resistant to a routinely prescribed antibiotic pill. “And there are a couple of other oral options we have right now, but it's starting to become resistant to those, too,” McCarthy says.
“And it's possible that five years from now, you may need to be in the hospital to get an intravenous antibiotic for what has now become a superbug infection. You're going to survive, but it's a lot more inconvenient for you and it's a lot more expensive for the health care system to treat you in the hospital for something that was once treatable as an outpatient,” he adds.
Everyday surgeries could also become more dangerous, and minor injuries could be life-threatening. “We could really get to that point if we don't pay attention to this,” Weiss says.
Myth 6: COVID-19 has curtailed the superbug crisis
Fact: Superbugs were a global health threat before the pandemic, and COVID-19 could only make the problem worse, experts say.
An “overwhelming number” of people have been hospitalized because of COVID-19, McCarthy says, “and a hospital is a place where you can pick up a superbug infection.” Plus, one of the common treatments for hospitalized COVID-19 patients is a steroid that weakens the immune system, “so people can get infected with superbugs more easily,” he adds. The CDC notes that it has responded to several outbreaks in COVID-19 units caused by drug-resistant pathogens.
Many health care facilities have also experienced staffing shortages, which can lead to lapses in infection-control practices. What’s more, antibiotic use in hospitals among COVID-19 patients has been high. Studies show that a majority of hospitalized COVID-19 patients in the U.S. received antibiotics upon admission for a coronavirus infection, even though few actually had a suspected or confirmed bacterial infection.
“So it's sort of this confluence of factors that have allowed superbugs to become more prominent during this pandemic,” McCarthy says.
Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.