Since the discovery of penicillin in 1928, we have used antibiotics against a host of infections. But now, doctors are finding that more and more bacteria are resistant to even the strongest antibiotics available.
In 2015, the World Health Organization warned that we are heading toward a "post-antibiotic era," when more people will die from common infections. If that happens, medical practice as we know it will change drastically.
Antibiotic resistance and reducing hospital infections are Dr. Michael Bell's specialties at the U.S. Centers for Disease Control and Prevention.
"Many of the things that we take for granted in modern medicine, the ability to do surgery for example, requires antibiotics in many cases. If I get hit by a car, talented emergency medicine doctors can help me, the surgeons can put me back together but the bacteria that get into the wound will cause an infection, and if we can’t treat that infection, I can’t really be saved," he said.
If we lose effective antibiotics, Bell said it would affect everything from joint replacement surgery to cancer care.
"In India alone, there is an estimated 58,000 infants who have died because of a single resistant infection in just one year," he said.
About 23,000 deaths from antimicrobial resistance also occurred in the U.S., as well as another 23,000 in the European Union in 2014, according to the CDC and the World Health Organization.
Bell said the problem is partly one of our own making.
"For the longest time we’ve had a number of different antibiotics in the pipeline at any given time, so whenever we ran out of the ability to use one, we would move to the next one," he said. "Unfortunately, right now the number of antibiotics in the pipeline is essentially zero, maybe one, if we’re lucky. The time between now and when that’s available could be on the order of five to 10 years."
Bacteria are constantly evolving, which is normal, and those that survive the drugs designed to kill them reproduce. What you end up with is a microbe, commonly called a "germ," that no longer responds to antibiotics.
Bell says that's why it's so important to save the antibiotics that are still effective. Improper use is one of the key drivers for the development of antibiotic-resistant germs.
A CDC study published in 2014 found U.S. hospitals were prescribing stronger antibiotics and more of them than necessary. The CDC has since asked hospital practitioners to monitor antibiotic use so they are using the right antibiotics for the right time and for the right duration.
"Antibiotic resistance is being generated by not only using too many antibiotics," Bell told VOA, "but also, by spread of infection by lack of hygiene, from unintended contact with soiled surfaces, so the infection control side is equally important."
For example, the most common complication for patients in a hospital is infection, including antibiotic resistant infections such as MRSA (methicillin resistant Staphylococcus aureus).
A study by the University of Maryland Medical Center found that health care workers who wore gowns and gloves in intensive care units where the sickest patients stay reduced MRSA infections by 40 percent. The researchers also found that health care workers who followed this protocol, also washed their hands more frequently after leaving patients' rooms. Frequent hand-washing also reduces the spread of infection.
Bell said patients can get involved in their own care during hospital stays.
"People can control their hygiene, they can ask about their medications, and they need to be ready to speak up in hospital settings," he said. "If you are in the hospital for any reason, you need to be ready to ask someone to wash their hands before they touch you, you need to be ready to ask what is being done to keep you safe from an antibiotic resistant infection or C-difficile (Clostridium difficile, an antibiotic resistant severe inflammation of the colon). Speaking up is hard and sometimes you need a friend. Bringing a family member may be the best way to do it, but speaking up is key."
The CDC has advice for patients, as well. On its website, the CDC tells people to take all antibiotics as prescribed and to finish the course of the drugs, even if they feel better. It also tells patients not to take antibiotics left over from a previous infection.
The World Health Organization says public awareness of the problem is low in all regions of the world, and that many people think antibiotics, which work against bacteria only, can treat viral infections like the flu or a cold.
The WHO also says the sale of antibiotics without a prescription remains widespread in many countries. What this means is that antibiotics are being used too often and when they may not be needed.
Scientists are working on developing new drugs. But until then, doctors, pharmacies and patients need to take urgent action on a global level to prevent the catastrophe that a post-antibiotic era would cause.