Why humans are losing the race against superbugs

MRSA is a staph bacteria that resists treatment by many common antibiotics and is depicted above in yellow and surrounded by cellular debris. The image is from a microscope. MRSA stands for methicillin-resistant Staphylococcus aureus.

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Drug-resistantbacteria, also known as superbugs, are killing more people each year than either HIV/AIDS or Malaria. The rise in antibiotic resistant infections is hitting low- and middle-income countries the hardest.

Chris Murray, the director of the Institute for Health Metrics and Evaluation, says that resistance is one of the leading causes of death. A new study published in the medical journal The Lancet shows that in the year of 2019, drug resistant infections directly killed 1.2 million people and played a role in 5 million more deaths. Murray and his colleagues set out to quantify how much of a problem antibiotic resistance is globally and they found thatbacteria are mutating to evade antibiotics at a pace far faster than many researchers had previously forecast.

These deadly new strains ofbacteria are causing many diseases, including fatal pneumonia, gangrenous wounds, and terminal cases of sepsis.

The failure of antibiotics used to be thought of as a First World problem. Murray says the study shows it happening all over the world.

He says that in the past, people thought that they had to be rich enough to use a lot of antibiotics. That's not the case.

In sub-Saharan Africa, deaths caused by antibiotic resistance are the highest in the world, with 24 deaths per 100,000 population, compared to 13 deaths per 100,000 in high income countries. Australia has a mortality rate of 6 deaths per 100,000.

Latin America is in the middle. Being in the middle is still bad according to Dr. Fiorella Krapp Lopez.

Krapp says that there is a high incidence of resistance to different types of antibiotics. The problem has been increasing.

She says antibiotic resistance is affecting health care.

I think it's everywhere. She says that they are seeing it in the community with infections that used to be very simple to treat. Minor wounds that used to only need a bandage are now turning into multi-drug resistant infections. In very sick patients with bloodstream infections or very severe pneumonia, we see it. It's a full spectrum of infectious diseases right now.

Dozens of researchers around the world contributed to the new report. She gave data on drug resistance.

There are many reasons why this problem is harder to address in low- and middle-income countries.

Antibiotics are readily available to anyone without a prescription. Misuse of these fuels leads to more resistance.

The systems to flag and test for drug resistant infections are not as strong as in wealthier countries.

Third, low- and middle-income countries have higher rates of hospital infections than high income countries, and those infections are more likely to be drug resistant.

Lower-income countries are still dependent on older, cheaper, and less effective drugs despite some new more powerful antibiotics being developed.

Krapp says the COVID crisis made the problems worse. It's too early to tell, but she's worried about the increase in drug resistance.

She says there was a lot of antibiotic use. Many people who contracted the virus self-medicated at home because they didn't want to go to the overcrowded hospitals.

She says it's still easy to get antibiotics without a prescription. More than 70% of the patients that arrived to the hospital were already using antibiotics at home. They thought the drugs would help their recovery. Antibiotics wouldn't help against a coronaviruses.

This scenario may be one of the reasons that Peru has had the highest per capita death rate in the world. Hospitals and clinics were overwhelmed with patients at times.

"We believe that a lot of the high COVID mortality that we had in Peru was due to secondary infections acquired in the hospitals rather than just by COVID 19," she says. It's hard to say whether or not that happened. Monitoring for resistance to antibiotics in lower income countries is limited during the best of times but not always.

Hospitals were over capacity during the Pandemic. Many patients went into the understaffed intensive care units. It was the perfect storm to have a high transmission of drug-resistant pathogens.

It's not clear if that was happening because health care workers were just trying to keep patients breathing, and testing samples for resistance fell low on the priority list.

Kapp is concerned that the world's most powerful drugs are no longer effective against common bacterial infections, and that they are learning how to evade them.

She says that we are in a race and thebacteria are moving faster than we are. Humans are able to create new antibiotics and make them accessible to the most vulnerable populations, but they are becoming resistant much faster.