Antibiotics are drugs used to prevent or cure illnesses caused by bacterial infections. Antibiotic resistance occurs when bacteria change in response to treatment by these drugs. These changes make the bacteria more resistant to these drugs, and therefore, it becomes hard to treat diseases caused by bacterial infection. There has been a dramatic increase in the emergence of antibiotic-resistant bacterial strains, making the choices for antibiotic treatment limited and expensive.
Antibiotics have made a significant impact on medicine, including improving orthopedic surgical and implant outcomes, and has transformed human health in many other useful ways. Before the evolution of antibiotics, Staphylococcus aureus had high fatality rates; however, the introduction of antibiotics improved the fate of infected patients. Antibiotics reduced the number of incidences of infection, reduced childhood mortality, led to an increase in life expectancy and also saved many lives. Penicillin was the first antibiotic to be discovered, which led to the development of a variety of new antibiotics. Currently, Cephalosporins, aminoglycosides, glycopeptide antibiotics, and quinolones are used to treat infections.
These great discoveries have led to the misuse of antibiotics leading to the rapid development of antibiotic bacteria strains. The discovery and development of new antibiotics to curb these resistant strains have declined rapidly due to various factors. The decline is due to decreasing antibiotic research and investments by pharmaceutical companies; ultimately, this is due to government regulations that affect the pace of translational exploitation.
Currently, the most antibiotic-resistant bacteria is Staphylococcus aureus others include Enterococcus faecium, S. aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species also referred to as 'ESKAPE' which have caused significant morbidity and mortality. The Center for Disease Control has classified multidrug-resistant (MDR) microorganisms, which include S.aureus, Acinetobacter, and Pseudomonas aeruginosa. These bacteria resistance has a negative effect on treatment and prevention of the infections leading to substantial financial burdens for patients and public health systems.
Several molecular mechanisms employed by the microorganisms lead to antibiotic resistance. They include intrinsic and acquired mechanisms. Microbes intrinsically resist certain antibiotics as a result of inherent structural characteristics; for example, antibiotics may be unable to penetrate the bacterial outer membrane or is removed by efflux pumps. Acquired mechanisms are as a result of mutations. Mutations in these microorganisms are obtained through chromosomal mutations or by acquiring antibiotic resistance genes from another bacterium through plasmids and transposons, which act as the vector systems for gene transfer.
Antibiotic resistance is primarily acquired through four different pathways that are, transformation, transduction, conjugation, and mutation and expressed through, prevention of cell penetration, antibiotic expulsion through efflux pumps, antibiotic inactivating proteins (enzymes), and modification of the target. Biofilm formation is the primary means of antibiotic resistance in orthopedic implant-associated infections. Certain antibiotics fail to penetrate the biofilm leading antibiotic resistance. Mutations are attributed to human activities like the use of antibiotics in agriculture, antibiotics present during waste disposal and also the failure of patients to complete prescribed antibiotic dosage.
Medical implications of antibiotic resistance
Antibiotic resistance compromises the safety and efficacy of surgical procedures like implantations and transplantations that require antibiotic protection. Secondly, patients with infections arising from multidrug-resistant microorganisms are at a higher risk of worse clinical outcomes, which might lead to death. These patients also consume more healthcare resources as compared to infections caused by antibiotic-susceptible strains. According to the CDC, U.S. alone, antibiotic-resistant bacteria lead to at least 2 million infections and 23,000 deaths in a year, resulting in a $55-70 billion economic impact.
Due to the increasing challenges in antibiotic resistance, several opportunities are presented and obligations to alleviate the crisis Obligations to establish resistance surveillance and monitoring, development of international guidelines on the use of antibiotics, and the establishment and following of strict hygiene measures to lower transmission of resistant microorganisms have been presented.
On the other hand, a couple of opportunities are presented, for example, the development of advanced diagnostic methods which are quick and accurate, research into new antibiotic targets with a broad spectrum of activity, and further examination of mechanisms of antibiotic resistance to tackle the origin of the resistance.
Orthopedic implant-associated infections are often treated with systemic and local antibiotic treatment. S. aureus and S. epidermidis are the most prevalent causative microorganisms involved in orthopedic implant-associated infections, and this bacteria strain has exhibited high levels of antibiotic resistance; hence, a significant problem in the public health sector. It is also evident that antibiotic resistance bacteria contribute to worse clinical outcomes, shown where patients infected with Methicillin-susceptible and resistant strains of bacteria had more extended hospital stays, significantly high risk of treatment failure, more co-morbidities as compared to those infected with methicillin-susceptible S. aureus.
Insight into the study
The article has presented well the various mechanism through which bacteria antibiotic resistance occur and the different ways through which resistance is expressed. It has given me a deeper understanding of how bacteria mutation, leads to antibiotic resistance. It is also clear that antibiotic resistance genes can survive for thousands of years, which leads to the rapid change of the resistant strains and the need for new research to examine the occurrence of antibiotic resistance.
Bacteria antibiotic resistance is a major global health problem. The problem poses a great threat to the public health sector. Much conventional medicine used in the treatment has been rendered inefficient the alarming rate of generation of antibiotic-resistant bacterial strains. There is, therefore, a need for more research into new potential antibiotics potent against these multidrug-resistant microorganisms. It is, however, quite unfortunate that governments have enacted strict regulations for new antibiotics research and development thereby slowing the pace of research and also decline in the investment of pharmaceutical companies into new antibiotic development.
Various factors contribute to the existence of antibiotic-resistant bacteria and resistance genes in the environment. Human activities are one of the major contributing factors to this. I have learned that agricultural activities lead to the development of antibiotic resistance. Therefore to curb this, organic farming and consumption of organic food products is the right way of maintaining personal health as they don't contain antibiotics used in inorganic agriculture.
Proper disposal of antibiotics has also been presented as a human activity that contributes to the existence of antibiotic-resistant bacteria and genes in the environment. Practicing sound waste disposal will lead to a reduction in the rising occurrences of antibiotic resistance. Finally, antibiotic misuse is the factor that contributes to the development of antibiotic-resistant, therefore, usage of antibiotics should be as directed by the doctor and to full dose completion.
Li, Bingyun, and Thomas J Webster. "Bacteria antibiotic resistance: New challenges and opportunities for implant-associated orthopedic infections." Journal of orthopedic research: official publication of the Orthopaedic Research Society vol. 36,1 (2018): 22-32. doi:10.1002/jor.23656
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