Episode 9 – Antibiotic resistance: what’s the deal?

Aleena was recently offered antibiotics by a doctor, for a situation where antibiotics were completely inappropriate. She immediately called Janine and it was settled; they just had to do an episode on this massive issue. Meanwhile, Aleena has been partnering with her cat and doing some citizen science experiments, while Janine is stuck in another research rabbit hole: this time about counterfeit fruit and fruit piracy (of course!).

Mastering of this episode, plus intro and outro music, by the ever-talented Dr Adrian Diery.

Janine got her hands on a comprehensive narrative review about antibiotic resistance. It looked at the nature of the problem and what needs to be done about it. So what did she learn?

Antibiotics – a total game changer

The first antibiotic was discovered by Alexander Fleming in 1928. He identified that the penicillin fungus had an inherent ability to kill or slow down bacteria. Antibiotics have since become lifesaving medications, providing an effective treatment for bacterial infections that previously could have been life and death situations.

So what’s the issue then?

Fast forward to today and, while we still have antibiotics, and they are still lifesaving, sadly a new threat has emerged: antibiotic resistance. This is a situation where the bacterial organisms responsible for some infections stop responding to antibiotic treatment because they have become resistant or immune to it.

How does antibiotic resistance happen?

All organisms change over time due to random evolutionary change, such as mutation and natural selection. If any organism develops a beneficial mutation, this organism may survive more so than its neighbours and go on to reproduce more. Since bacteria reproduce incredibly quickly, evolutionary change is rapid and antibiotic resistance can develop fast.

What does antibiotic resistance lead to?

Antibiotic resistance is already leading to longer lasting infections, longer hospital stays and higher risk of death from bacterial infection. A report on tackling antibiotic resistance globally emphasised that it could lead to 10 million deaths by 2050 if urgent action isn’t taken, and that the costs of tasking action are $4 billion, but the costs of inaction are closer to $100 trillion.

Why is the resistance developing so fast?

It’s crucial to understand that antibiotics only kill bacteria. They do not work on fungal infections or viral infections or any other type of infection. And this gets at one of the reasons resistance is evolving so fast: prescribing antibiotics in situations where it is inappropriate. This is because every time bacteria are exposed to antibiotics, we give them a chance to evolve resistance in response. Other key factors include dosages that are too high, taking antibiotics too frequently or for too long, sub-standard hygiene, slow diagnostic testing, antibiotic use in meat production industry, and patients requesting antibiotics from their doctors when antibiotics are not appropriate.

What needs to be done?

“Antibiotic de-escalation” is the key to tackling this the problem. What does this look like? Wherever possible prescribe only when appropriate; use diagnostic tests to confirm the nature of infections; use “narrow spectrum” (less full on) agents first; reduce duration of treatment; and instigate overarching “antibiotic stewardship programs” from local through to global levels.

Giacomini, E., Perrone, V., Alessandrini, D., Paoli, D., Nappi, C., & Degli Esposti, L. (2021). Evidence of Antibiotic Resistance from Population-Based Studies: A Narrative Review. Infection and Drug Resistance, 14, 849.

Your gut bacteria are at risk too!

Every time you take antibiotics, the diversity of bacteria in your gut is dramatically reduced and it can take up to 4 years to get back to what was normal to you! Yikes! There is solid evidence behind the importance of gut bacterial diversity for the digestive and immune systems, but also emerging research on the links between gut bacteria, mood and mental health.

Jakobsson, H. E., Jernberg, C., Andersson, A. F., Sjölund-Karlsson, M., Jansson, J. K., & Engstrand, L. (2010). Short-term antibiotic treatment has differing long-term impacts on the human throat and gut microbiome. PloS one, 5(3), e9836.

What do healthcare workers think about antibiotics and antibiotic resistance?

Aleena gets pretty excited to tell us about this BIG international study across 30 counties in Europe (that takes a whole lot of work, by the way!). Over 18,000 healthcare workers did a survey testing their knowledge on antibiotics and attitudes about using antibiotics and the problem of antibiotic resistance. Their knowledge was pretty good overall (yay!), but it varied a lot across different countries and different types of healthcare workers. Those who prescribe medicines were very aware of the threat of antibiotic resistance, but they still sometimes prescribe antibiotics even when they would prefer not to. Mainly they’re worried that their patients might not get better without antibiotics, but they also feel they don’t have time to explain when antibiotics aren’t needed, they’re not sure what the infection is, and they don’t want to disappoint patients who really want antibiotics.

The bottom line? We all have a role to play in stopping antibiotic resistance!!!

Check out this TED talk by the lead author of the study, Professor Diane Ashiru-Oredope.

Ashiru-Oredope, D., et al. (2021). Healthcare workers’ knowledge, attitudes and behaviours with respect to antibiotics, antibiotic use and antibiotic resistance across 30 EU/EEA countries in 2019. Eurosurveillance, 26(12), 1900633.

What brought out our inner square?

Did you see it? The cats sitting on the square shapes?! Check it out here if not (also, where were you?) It’s all too familiar to Aleena and fellow cat people. Cats can’t resist plonking themselves on/in an enclosed space. Well it turns out they’re even compelled to sit in ILLUSORY enclosed spaces. WE KNOW – WOW! After this study by Gabriella Smith (@Explanimals) was published, nerdy cat lovers took to twitter in fascination and delight. Aleena’s cat Myshka has since participated in a few home experiments, including a few variations on the test. Myshka, good girl. Aleena, you giant square (get it?).

A recent ABC news story really piqued Janine’s interest. A man from China who has gotten his hands on some golden kiwi cuttings and taken them back to China. He’s since been accused of cultivating “counterfeit plants”. Zespri is the company that technically owns the rights to this variety. They hired private investigators to check out the kiwi orchard in China. This guy, the kiwifruit pirate, has been found guilty and had to pay $15 million in damages. But 5000+ hectares of these kiwis are already growing in China… so this of course brought out Janine’s inner square and the ensuing deep dive into kiwifruit history and fruit law! One article from Time Magazine suggests there is no definitive record of how the fruit got to NZ initially, but consensus is that a NZ school principal brought them back to NZ in 1904. But Janine remains worried: she often has random plants popping up in the compost heap and wondered if she could be accused of being an unintentional plant pirate too?! And isn’t NZ the original pirate as they took it from its native China? So many questions, but so few answers…

Photo by Patrick Tomasso on Unsplash

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