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This article is from the In-Depth Report The Crisis of Antibiotic Resistance

Antibiotic Resistance Is Taking Out "Last-Resort" Drugs Used to Combat Worrisome Category of Germs

How to tell the bad news from the really bad news
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© iStockphoto.com / Henrik Larsson

There are so many news stories about antibiotic resistance these days that you may be tempted to ignore them all just to preserve your sanity. But there is a kind of hierarchy of danger when it comes to figuring out which stories are most deserving of your attention.

Anytime you hear that a particular bacterium has become resistant to a "drug of last resort," that is bad. Drugs of last resort—such as vancomycin for Staphylococcus infections—are usually the last line of safe, dependable defense for certain kinds of infections. Drug companies can try to come up with new medications to replace the outpaced meds, but that takes time and does not bring in a lot of money, so we are fast running out of drugs of last resort.

Another category of bad news to pay attention to is when serious antibiotic resistance has developed in the so-called Gram-negative bacteria. (All bacteria are divided into two groups: Gram-positive and Gram-negative based on how they react to a stain invented by a Danish bacteriologist named Hans Christian Joachim Gram.) As Maryn McKenna explains in "The Enemy Within," antibiotic resistance in the gram-negative bacteria is particularly worrisome because Gram-negative germs are more likely than Gram-positive ones to share the genes responsible for drug resistance across species. Her story is doubly alarming because it provides a detailed look at how resistance has developed in the U.S. against drugs of last resort (really bad) in Gram-negative bacteria (really, really bad).

As if that were not bad enough, clinicians are now starting to see drug resistance in whole new categories of pathogens—such as fungi.

Perhaps the worst news of all, however, is that even if antibiotics are used correctly, they may be contributing to the drug-resistance problem. Because even proper use of antibiotics creates an environment in which microbes with resistance genes are favored to survive.

The good news, however, is that changing our habits can lead to lower levels of drug resistance. Even something as simple as making sure that doctors and nurses wash their hands between treating patients in the hospital can make a difference. The U.S. Centers for Disease Control and Prevention, the National Institutes of Health and the World Health Organization have all launched initiatives designed to help preserve the utility of antibiotics. See their respective summaries of the situation here, here and here. It will certainly take time and effort and the cooperation of a lot of people, but it is not impossible to keep antibiotics effective. As with so many issues in life, we know what to do. The question is whether or not we will follow through.

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