A report issued in November by the Centers for Disease Control and Prevention (CDC) revealed some bad news and some good news about infections caused by antibiotic-resistant microbes, or superbugs, in America. Superbugs are germs such a bacteria and fungi that can’t be destroyed by the medications currently available to fight them.

First, the bad news: In the report, the CDC noted that antibiotic-resistant superbugs have killed nearly twice as many people as previously believed. Also, the CDC announced it has identified two new, potentially deadly superbugs, bringing the total of most threatening superbugs to five.

One of the new superbugs,, a fungus called Candida auris, was a bit of a surprise to CDC officials. Five years ago, they weren’t even considering Candida auris as a serious threat. But it is now.

Among the superbugs we’ve known about, C difficle is a particularly nasty one. It is considered an urgent threat by health officials. C difficle alone caused nearly 250,000 infections in 2017, the most recent year for available data. It also caused at least 12,000 deaths that year.

The good news is that the total number of deaths from superbug infections has declined by 18 percent. The CDC estimates that 36,000 Americans died as a result of superbug infections in 2017. Compare that to 44,000 deaths in 2013. The decline is attributed, at least in part, to more judicious prescribing of antibiotics by physicians.

Antibiotic resistance is considered one of the world’s most pressing health problems. It happens when the germs find a way to survive the onslaught of death caused by the drugs. Bacteria are sneaky. They can alter antibiotics’ effect on them in several ways. I’ll describe a few of those ways soon.

Just to be clear, it’s the bacteria that become resistant to the medications. Individuals don’t become resistant. But resistant germs can be spread from person to person, and before you know it, an entire community is at risk.

So how do germs become resistant to antibiotics? The short answer is: They fight back!. They develop defense strategies called resistance mechanisms. Bacteria develop these mechanisms by altering the coded instructions found in their DNA. They can then share altered pieces of their DNA with other germs, making them resistant as well.

One of the resistance mechanisms bacteria use is to restrict the access of the antibiotics. Bacteria do this by changing or limiting the entryways for the antibiotics into their cells. That way, the drugs can’t get inside the bacteria to destroy them.

A second defense strategy of bacteria is to rid themselves of the antibiotic. They use pumps located in their cell walls to pump out any antibiotic that gets into the cells. A third strategy is to change or destroy the antibiotic using enzymes and proteins that break down the medication, rendering it useless.

Many antibiotics are designed to single out and destroy specific parts of a bacterium. These are the medications’ targets. One resistance mechanism is to bypass the effects of the antibiotics by developing new cell processes that avoid using the antibiotics’ targets.

Bacteria also develop resistance by changing the antibiotics’ targets. As a result, the antibiotics no longer fit and the drugs can’t do their job of destroying the bacteria.

The CDC and the World Health Organization continue to call on physicians to prescribe antibiotics only when they’re absolutely necessary and appropriate to treat patients’ infections. They ask us to take action as well to use antibiotics wisely. Here are a few suggestions for things you can do:

• Don’t pressure your doctor to prescribe an antibiotic for a viral infection such as a cold or the flu. Antibiotics aren’t effective on viruses. Ask your doctor about other ways to treat your viral infection.
• Don’t save antibiotics you didn’t use for the next time you get sick. Discard any medication that’s left over once you’ve completed your prescribed course of treatment.
• Take your antibiotics exactly as your doctor prescribes. Don’t skip doses, and be sure to take the medication until it’s gone. For it to be most effective, you must take the medication for the entire time of your treatment .You may start to feel better and think you don’t need the medication anymore, but take it for the full course anyway. Some germs may survive the antibiotics’ initial effect and re-infect you if you stop too soon.
• Don’t take someone else’s antibiotics. They may not be right drugs for your type of infection. Taking the wrong antibiotic can delay your treatment and allow the bacteria to multiply.

The world has a drug problem! It’s getting so bad that the United Nations held a special meeting last September to discuss it. It was only the fourth time ever the UN called a high-level meeting on a global health issue. This time, the delegates discussed antibiotic-resistant infections – superbugs impervious to our current arsenal of germ-fighting drugs.

Drug-resistant bacteria, as well as drug-resistant parasites, viruses and fungi, have been lurking for a while. One superbug has been popping up, even here in the US, that is resistant to our last-ditch antibiotic. Without medications that can fight these germs, there will be untreatable infections that will have devastating consequences across the globe.

Already, it’s estimated that more than 700,000 people worldwide die each year from drug-resistant infections. And that’s a lowball figure because tens of thousands of deaths from these infections are not reported or are attributed to other causes. One review on antimicrobial resistance suggests that by 2050, 10 million people around the world will die each year from these infections!

Drug resistance happens naturally over time, usually through genetic changes. However, the overuse and misuse of antibiotics and other drugs developed to treat microbial infections accelerated this process. Using antibiotics for every little illness, especially for viral infections such as colds and flu, and to promote growth in livestock, are examples of this misuse. After years of doing this, we now have a resistance problem.

One superbug that’s got everybody scrambling is a bacterium that can’t be killed by the drug of last resort, Colistin. Infections with this bacteria had been seen in animals and humans in China and Europe, but have been discovered in the US as well. Fortunately in those cases, the infections responded to other antibiotics, but the bacteria’s resistance to Colistin is significant.

Why? Without getting too technical, the genetic change that makes this bacteria resistant to Colistin can be spread to other strains of bacteria. That includes strains that are already resistant to all other antibiotics. That would create bacteria that are totally untreatable with any drug we currently have available.

With superbugs like these, routine medical procedures such as C-sections, hip replacements and chemotherapy become extremely high risk. Without effective antibiotics to treat them, minor infections could become life-threatening crises. Little, if anything, could be done to treat common conditions such as gonorrhea and pneumonia.

What can be done? At the UN meeting in September, World Health Organization director general Margaret Chan stressed that it is imperative for consumers and medical providers to rely less on antibiotics for disease treatment. She also appealed for more progress in antibiotic development. After all, only two new classes of antibiotics have reached the market in the past half-century.

As they brought the meeting to a close, the UN delegates signed a declaration committing to encouraging innovation in antibiotic development and increasing public awareness of the growing threat of drug-resistant infections. They also agreed to develop surveillance and regulatory systems on the sales and use of antimicrobial medicines for humans and animals.

Facing a new kind of drug problem, the world is poised to take on the challenge.