Samya Sen
In September 1928, a man named Alexander Fleming changed the course of human history by gifting humanity with the idea of antibiosis. He worked as a bacteriologist at St. Mary’s hospital in London and had returned from summer vacation to his lab. While discarding old Petri dishes, he found that some of them had been contaminated by a fungus which had caused the lysis of the bacterial cells in its vicinity. What followed was scientific scrutiny and curiosity at its very best. The fungus Penicillium notatum (or sometimes claimed as P. chrysogenum) had been successful in killing a dreaded bacterial pathogen that was being studied by Fleming, Staphylococcus aureus.
Nearly a hundred years have passed since that day. A hundred years where we have witnessed the discovery of a plethora of natural and synthetic antimicrobials, right from the beta-lactams to the most lethal carbapenems. Unfortunately, while making multiple breakthroughs in antibiotic discovery in the last century, we thought that ultimately humans will triumph over the tiniest of living organisms living on this planet, the bacteria. What we failed to understand was the millions of years of natural selection that the bacteria have gone through, which has made them nearly invincible. In the struggle for existence, the bacteria have acquired defenses against the most potent of antimicrobials along with the near-superhuman ability to adapt to nearly any situation and environment. Thus the concept of antimicrobial resistance emerged and now we have acknowledged the fact that all antimicrobials that we throw at the bacteria will eventually be rendered ineffective by them. It is thus the need of the hour to protect the antibiotics that we have at hand.
Fast-forwarding to 2016, a woman in Nevada, USA died of an infection caused by a ‘superbug’ that resisted all antibiotics available for treatment including the last line of defense, the carbapenems. Although a rare case, similar events are increasing day by day worldwide forcing us into believing that we are already living in a post-antibiotic era. If the current trend is allowed to carry on, we could lose 10 million citizens of this world by 2050 due to superbug infections. It is very important to understand that our best antibiotics are failing and the rate of discovery of novel antimicrobials is too slow when compared with the emergence of antibiotic resistance. But as students of science, we must not panic as scientists must look at the light at the end of the tunnel, even if there is a faint one.
To counter the phenomena of antibiotic resistance we must first understand the phenomena itself. Antibiosis means the preservation of one’s life by finishing another. Simply put, bacteria compete in the harshest of microenvironments for nutrition and space against millions of other competitors. It thus becomes a necessity for the elimination of some bacteria to make space for the others. This is where the antibiotics come in. They are produced by a definite group of organisms to kill/inhibit their competitor species. Interestingly, the antibiotic only kills members of other species and not the producers. This immunity towards their antibiotics is rendered by antibiotic resistance genes and mutations that they possess. These genes protect any organism that harbors them, rendering multiple antibiotics useless. Now let’s imagine a scenario where a human being suffering from a bacterial infection is being treated with a specific antibiotic. The antibiotic will work if the infection-causing bacteria do not possess the resistant gene against the prescribed antibiotic. Unfortunately, some members of a specific bacterial population randomly carry these genes. It thus becomes extremely important for the patient to finish the prescribed course of the antibiotic which kills nearly all bacteria causing the infection, even the ones carrying the resistance genes, as the antibiotic dosage overwhelms their resistive capabilities. If the patient decides to stop the course midway, there is a very high probability that the antibiotic-resistant members of the population will survive and cause a second antibiotic-resistant infection. Pathogens of the highest order like Escherichia coli, Klebsiella pneumoniae, Helicobacter pylori, Staphylococcus aureus, and many others collect these resistant genes in their genomic library to give rise to entities that can resist multiple antibiotics and thus are correctly termed ‘superbugs’. Once infected by such a superbug, treatment options go down drastically with the rise in treatment costs, which in turn gives rise to increased morbidity and mortality of the patient. Thus, we must follow a few key steps in life to tackle the problem:
- We must never stop a course of antibiotics midway as the selection of resistant bacteria is a high probability.
- We must always visit the doctor and take the prescribed antibiotics. The doctor also assesses the condition of the patient to suggest the proper antibiotic dosage which is a vital parameter to prevent resistance.
Sometimes people take antibiotics for the common cold which is funny as the common cold is caused by a virus that remains unaffected. On the contrary, the normal bacterial population living inside our body gets killed disrupting vital physiological processes like digestion. Interestingly, sometimes the good bacteria in our body suppress the growth of bad bacteria. When this balance is affected, there is a high chance that the bad bacteria may dominate giving rise to various health complications.
- Governmental and Non-governmental bodies must reach to the urban as well as the rural masses to make them aware of the consequences of antibiotic misuse and overuse. Many animal farms all over the world feed antibiotic supplements to the animals for enhanced growth and meat production which is a major reason for the emergence of antibiotic resistance.
In conclusion, yes the post-antibiotic era is indeed inevitable. But at the same time, humanity is entering the phase where survival is at stake. This should ensure rigorous antimicrobial research which is something to be excited about. COVID has diverted the attention of scientists to a great extent where antiviral research is being facilitated by most nations. We, at any cost, must not forget our old enemies, the bacteria, and the threats they present. Novel antimicrobials based on phytochemicals and nanotechnology are already being reported from different areas of the world. It is necessary to channel requisite funds into these research areas by the governments, ensuring rapid clinical trials and approvals, making the role of the pharma companies ever so important. In a nutshell, the threat of antibiotic resistance has to be fought by a united front comprising of every citizen and country on this planet. Perhaps this will eventually become the key to our survival as bacteria will most probably be there when our sun explodes. It is their planet and we must play our part to survive on it.
References:
- Zucca M, Savoia D. The post-antibiotic era: promising developments in the therapy of infectious diseases. Int J Biomed Sci. 2010;6(2):77-86.
- https://longitudeprize.org/blog-post/what-does-post-antibiotic-era-actually-mean
- https://www.nature.com/news/who-warns-against-post-antibiotic-era-1.15135
- https://www.vox.com/future-perfect/2019/11/14/20963824/drug-resistance-antibiotics-cdc-report
About the author:
Samya Sen is a doctoral candidate who has submitted his Ph.D. thesis from the Department of Microbiology, University of Kalyani. His research interests include antimicrobial resistance biology and nanomedicine.
Email: samya.microbio@gmail.com
