Dahlia Medical Communications

Five Signs That We Are Heading Towards the Post-Antibiotic Era 

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by

Rachael Hills
in

Several researchers have warned that the post-antibiotic era is approaching. In this era antibiotics become worthless or only the most toxic antibiotics work. Who or what is to blame for this issue? There are multiple causes: 1) overprescribing of antibiotics, 2) failure to de-escalate broad-spectrum antibiotics, 3) slow creation of novel antibiotic classes, 4) poor infection control, and 5) bacterial evolution.1 

Are researchers overreacting? Will antibiotics stop working? The following scenarios suggest that the post-antibiotic era may arrive sooner than expected.  

Pseudomonas Has the Tools to Resist Cefiderocol  

Cefiderocol is a new cephalosporin that covers Gram-negative bacteria.2 Cefiderocol enters bacteria by coupling with iron, which is essential for some bacteria. Cefiderocol is a boon to the antibiotic lexicon. It can treat carbapenem-resistant Gram-negative bacteria.2 

Yet, those pesky bacteria find a way to evade antibiotics. Researchers at Cedars-Sinai reviewed Pseudomonas aeruginosa’s genome to determine how it might resist cefiderocol. They identified 20 different genetic mutations that could confer resistance to cefiderocol. In one mutation, resistant bacteria “shield” their sensitive brethren from cefiderocol.3 

The researchers are not ending on that glum note. They are running mathematical models to find dosing regimens that may defer resistance and then plan to study those regimens.3 

Multidrug-Resistant Acinetobacter baumannii Is Spreading in Saudi Arabia4 

Acinetobacter baumannii is a beast. It can form biofilms and live on surfaces for 5 months. This makes infection control a nightmare. Carbapenems are a mainstay for treating multidrug-resistant Acinetobacter. Unfortunately, carbapenem resistance is growing.  

A recent review found that Acinetobacter resistance is rising in Saudi Arabian hospitals. The study found that even as far back as 2008, Acinetobacter resistance was alarming. From 2006-2008, a hospital in Riyadh had high rates of isolates resistant to meropenem (92.1%) and imipenem (79.1%).   

The Highly Pathogenic E. coli ST410 Strain Is Carbapenem-Resistant5 

Escherichia coli ST410 is a carbapenem-resistant strain that causes extraintestinal infections. E. coli’s pathogenicity tends to wane as its resistance grows. ST410’s pathogenicity has grown along with its resistance (ref5f). This strain is the culprit in two pediatric Chinese hospital outbreaks. Of greater note, a study found 11 isolates that also contained the colistin resistance gene mcr-1. 

Multidrug-Resistant and Carbapenemase-Producing Gram-Negative Bacteria Were Found in Two Ethiopian Hospitals6 

A recent study swabbed environmental samples from the ICUs and NICUs in two Ethiopian hospitals. The samples yielded 162 isolates: Klebsiella pneumoniae (48.8% of isolates), Acinetobacter species (31.5%), Escherichia coli (11.7%), and Pseudomonas aeruginosa (8%). Several of the isolates were multidrug-resistant or carbapenemase-producing. The table below breaks down the extent of resistance among the isolates.   

NICU incubators, baby bed sets, and baby exam tables harbored the largest number of resistant isolates. 

Table. Percent of Isolates with Multidrug-Resistance and Carbapenemase-Producers6 

 Percent Multidrug-Resistant Percent Carbapenemase-Producing 
Klebsiella pneumoniae 89.9% 31.6% 
Escherichia coli 89.5% 10.5% 
Acinetobacter species 62.7% 7.3% 
Pseudomonas aeruginosa 61.5% 30.8% 

The War in Ukraine Is Worsening Antimicrobial Resistance 

In Ukraine people can buy antibiotics over the counter. This practice has contributed to community antibiotic resistance.7 In 2019, the Ukrainian government established an antibiotic stewardship program, but the Russo-Ukrainian War has stalled progress.8 

War injuries are often messy and dirty. Physicians order broad-spectrum antibiotics to avoid sepsis. Then these patients are sometimes transferred to other hospitals.7 These transfers and refugee migration allow resistant microbes to travel faster. The drug misuse has led to 75% of Acinetobacter baumannii and 80% of Klebsiella pneumoniae isolates in Ukraine to be multidrug-resistant.8 

Closing Thoughts 

These stories represent the many factors that contribute to multidrug resistance: drug misuse, poor infection control, inadequate novel antibiotic creation, and bacterial evolution. These multinational scenarios show that antibiotic resistance is a global issue. If one country allows drug resistance to grow, then we are all at risk of entering the post-antibiotic era.  

References 

  1. Antimicrobial resistance. World Health Organization. November 21, 2023. Accessed March 8, 2024. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance#:~:text=AMR%20is%20a%20natural%20process,in%20humans%2C%20animals%20and%20plants. 
  1. Kufel WD, Steele JM, Riddell SW, et al. Cefiderocol for treatment of an empyema due to extensively drug-resistant Pseudomonas aeruginosa: clinical observations and susceptibility testing considerations. IDCases. June 3, 2020;21:e00863. doi: 10.1016/j.idcr.2020.e00863. 
  1. Cedars-Sinai. Study details how a common bacterium resists new antibiotic. Newswise. February 26, 2024. Accessed March 4, 2024. https://www.newswise.com/articles/study-details-how-a-common-bacterium-resists-new-antibiotic 
  1. Aldali JA. Acinetobacter baumannii: a multidrug-resistant pathogen, has emerged in Saudi Arabia. Saudi Med J. Aug 2023;44(8):732-744. doi: 10.15537/smj.2023.44.8.20230194. 
  1. Ba, X, Guo, Y, Moran R, et al. Global emergence of a hypervirulent carbapenem-resistant Escherichia coli ST410 clone. Nat Commun January 12, 2024;15(1):494. doi: 10.1038/s41467-023-43854-3.   
  1. Kindu M, Moges F, Ashagrie D, et al. Multidrug-resistant and carbapenemase-producing critical gram-negative bacteria isolated from the intensive care unit environment in Amhara region, Ethiopia. PLoS One. November 30, 2023;18(11):e0295286. doi: 10.1371/journal.pone.0295286. 
  1. Melwani M. How war is spreading drug resistant superbugs across Ukraine and beyond. BMJ. November 22, 2022;379:o2731. doi: 10.1136/bmj.o2731.   
  1. Loban’ G, Faustova M, Dobrovolska O, Tkachenko P. War in Ukraine: incursion of antimicrobial resistance. Ir J Med Sci. December 2023;192(6):2905-2907. doi: 10.1007/s11845-023-03401-x. Epub May 13, 2023. 

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