# data[].attributes.body
“How Is Antibiotic Immunity Acquired?” Scientific American, www.scientificamerican.com/article/how-is-antibiotic-immunit/.

Leung, Rebecca. “Super-Resistant Superbugs.” CBS News, CBS Interactive, 2 May 2004, www.cbsnews.com/news/super-resistant-superbugs/.

“Stop the Spread of Superbugs.” National Institutes of Health, U.S. Department of Health and Human Services, 14 July 2017, newsinhealth.nih.gov/2014/02/stop-spread-superbugs.

# data[].attributes.headline
The Virus That Kills Drug-Resistant Superbugs

# data[].attributes.subject
The Virus That Kills Drug-Resistant Superbugs

# data[].attributes.attachment_link.title
The Virus That Kills Drug-Resistant Superbugs

# data[].attributes.attachment_link.title
Antibiotic Resistance and the Rise of Superbugs

# data[].attributes.headline
The Antibiotic Apocalypse Explained (Video)

# data[].attributes.subject
The Antibiotic Apocalypse Explained (Video)

# data[].attributes.attachment_link.readable_text
It's been 60 years since Dr. Alexander Fleming discovered a drug called penicillin, the first antibiotic.

Since then, doctors have prescribed the drugs to cure everything from pneumonia to scarlet fever.

But now, scientists are sounding the alarm that we have been overusing antibiotics - and that the germs have figured out ways to become resistant to them. Correspondent Lesley Stahl reports.

Infections we thought we had conquered once and for all are coming back because of a new breed of germs that doctors call "superbugs" -- bacteria that are resistant to almost all antibiotics.

The latest culprit is called MRSA, a staph bacteria that triggers infections so virulent they can - and have - turned deadly within days.

The first doctor in the country to identify MRSA in patients that weren't already very sick in the hospital was Dr. Robert Daum, head of infectious diseases at the University of Chicago Children's Hospital.

"What we noticed that was so different was we were seeing perfectly healthy children come in with serious, severe infections and they were this kind of resistant staph," says Daum. "And we said, 'What's going on here?'"

Apparently, this new "superbug," MRSA, was suddenly causing pneumonias and serious bone and skin infections so toxic that children were dying because of a lack of an effective antibiotic.

Daum says that if you had brought your child to the doctor with any of those infections two years ago, an antibiotic that belonged to the penicillin group of antibiotics would be prescribed. We can't do that anymore. We've abandoned that approach," says Daum. "All of these cillins, cephalosporin antibiotics - gone."

Daum says it isn't hopeless, that MRSA may not be resistant to every single antibiotic out there, but "we're needing to resort to unusual and often very, very expensive, hard-to-find, new treatments."

This new MRSA seems to be hitting people who are in close physical contact: children in day care centers, prisoners in jails, and athletes on sports teams.

Two of the NFL's Miami Dolphins were hospitalized with MRSA last season. "A lot of athletes are playing with cuts in their skin. Or on Astroturf, which is like a rug and can burn, abrade your skin," says Daum. "Staph love it when we have a break in our skin. They just love. They say, "This is just what I need to get inside."

And he says it's all over the country now, and all over the world: "I think it's kind of an epidemic."

But even with estimates of more than 10,000 cases so far, doctors in many communities aren't recognizing MRSA. That's what happened with 13-year-old Nicholas Johnson of Stafford, Texas. After he was injured at football practice, his parents, Janet and Dale Johnson, took him to the pediatrician.

The Johnsons said Nicholas was diagnosed with a bad shoulder sprain, had his arm put in a sling and advised to take ibuprofen for pain. That was on Thursday. By Friday night, Nicholas was in the emergency room at Texas Children's Hospital. His temperature had spiked to 104.6 degrees.

Nicholas was given antibiotics and some pain medication, and his parents took him home. But the antibiotics didn't work. On Monday, when his elbows and knees swelled up, Nicholas was back to the hospital. His mother said he was in respiratory failure and needed to be put on a ventilator.

But after being given multiple antibiotics, Nicholas was able to fight off the MRSA infection that had spread through his whole body. The hospital report says: "It's a miracle he survived."

Now, Nicholas says can run as well as he used to. And he's also lost all of the hearing in his left ear. But otherwise, he's in great shape and loves to show off the scars from his three operations.

One of the lifesaving drugs that Nicholas got was a powerful antibiotic called vancomycin, which for years hospitals reserved as the drug of last resort. But now, vancomycin use is skyrocketing.

To explain why that's frightening, Daum showed Stahl petri dishes with different strains of staph. Various antibiotics killed the staph germs, except for the dish that contained MRSA. The only antibiotic that would kill these germs was vancomycin.

"So this strain is resistant to everything except the antibiotic of last resort," says Daum.

But as vancomycin becomes the antibiotic of first choice, the bugs are learning to defeat it.

Two cases of vancomycin-resistant MRSA have been reported, and Daum says there would be a major medical crisis if that strain were to spread.

Meanwhile, other bacterial diseases like tuberculosis, gonorrhea and pneumonia are emerging in more dangerous, drug-resistant forms. And, childhood ear infections are far more difficult to treat.

While we can't stop the bacteria from trying to outwit antibiotics, health officials say a dramatic cut in their use could help reverse the tide. That means doctors will have to stop writing, and patients will have to stop demanding, the 130 million prescriptions for antibiotics that are given out each year. Half of them are given to treat illnesses like the common cold that the drugs have no effect on.

The U.S. government started a public education campaign last fall, with a recommendation for pediatricians and parents: No antibiotics for most childhood ear infections. But even though most of those infections go away on their own, parents may not stand for that.

Dr. William Schaffner, head of preventive medicine at Vanderbilt Medical Center in Nashville, says it may be hard to persuade doctors to be tougher with patients who want antibiotics: "It's easier to say than it is to do -- particularly when for a long time, you really thought that there would be a new antibiotic down the pike, and if this one doesn't work, we'll just use the next one."

But Schaffner says the next antibiotic may not be just down the pike. A majority of the major pharmaceutical companies are cutting back on antibiotic research or withdrawing altogether.

"For example, in the year 2002, something like 400 new pharmaceutical agents were licensed by the FDA," says Schaffner. "In that year, there were no genuinely new antibiotics among them. I mean, that's a striking thing. Last year, there were one or two."

Why is this happening? Well, one reason is that antibiotics are usually taken for just about two weeks, and therefore are not nearly as profitable as drugs people take for years, like Lipitor for cholesterol or Viagra.

"If I were the CEO of a pharmaceutical firm, I would point out that our research is benefiting the health of the public," says Schaffner. "A lipid-lowering drug reduces heart attacks. But how can I responsibly invest my shareholders' money -- $900 million to create a new antibiotic? ... Those are the estimates. That's not fair to the shareholders."

It takes almost a billion dollars these days to research and test a new drug for FDA approval. The world's largest pharmaceutical company, Pfizer, maker of Lipitor and Viagra, is one of the companies still working to come up with new antibiotics.

Dr. Martin MacKay is Pfizer's head of drug research: "Of 100 ideas that we think of in our laboratories, only one will make it into medicine, so it's a huge risk."

The company's latest antibiotic, Zyvox, was developed specifically for the treatment of MRSA. But just four years after its release, resistance is emerging.

How long is it likely to take before the medication will be available for use? "When we have an idea for a new medicine, just to get into humans could take five years," says MacKay. "And then, the clinical trials after that can be another 10 years. So this is a 15-year process."

So don't hold your breath for a stream of new antibiotics in the near future, even from companies like Pfizer.

But are these companies obligated to produce more? "I don't think there's any more obligation that the companies have to produce new antibiotics than Ford does to produce a small car that's gas efficient," says Schaffner. "I mean, we would need to think outside the box."

Thinking outside the box, however, could cost the U.S. taxpayer, and there are suggestions that the government may actually pay the drug companies to develop new antibiotics.

Dr. Anthony Fauci, head of the government's Institute of Allergy and Infectious Diseases, says that idea is being taken seriously. But it's going to be difficult to convince the public to help the pharmaceutical companies. "It is no question going to be hard to sell," says Fauci.

One idea is to extend the patents on billion-dollar drugs like Zoloft or Zithromax, if those extra profits are ploughed back into antibiotic research. But the medical community prefers another solution, one similar to President Bush's proposal called Bioshield, which would give the drug companies $6 billion outright to come up with new anti-toxins in case of a bio-terror attack.

"If the Bioshield concept is developing incentives for companies to get involved, we definitely should do it," says Fauci. "We are engaging them right now."

In fact, they've been engaged in discussions with the drug companies for the past four years about developing new antibiotics. So far, no solution has emerged, and infectious disease doctors say we're running out of time.

"The antibiotic era is really only 60 years old, but as we get more and more resistance going on, it acts more and more like the pre-antibiotic era," says Daum. "It's a little bit of a doomsday and over-dramatic message to say, 'Well, we're going back to that.' But in many ways, we are."

# data[].attributes.attachment_link.description
It's been 60 years since Dr. Alexander Fleming discovered a drug called penicillin, the first antibiotic. Since then, doctors have prescribed the drugs to cure everything from pneumonia to scarlet fever. But now, scientists are sounding the alarm that we have been overusing antibiotics - and that the germs have figured out ways to become resistant to them.

# data[].attributes.attachment_link.readable_text
Tony Mazzulli, an associate professor at the University of Toronto medical school and deputy chief microbiologist and infectious diseases specialist at Mount Sinai Hospital in Toronto, explains.

The concept of antibiotic immunity is a misnomer that can lead people to believe that they may become "immune" or "resistant" to an antibiotic if they take it too frequently or inappropriately. This notion stems from a misunderstanding in the general public of the concept of antibiotic resistance.

It is not people who become immune or resistant to an antibiotic. Rather it is the bacteria responsible for infections that become resistant. The purpose of an antibiotic is to kill--or at least inhibit the growth of--bacteria to quell an infection. Bacteria have been around for thousands of years and have had to survive in hostile environments. As a result, they are able to adapt and have a number of mechanisms for survival, one of which is the development of resistance to antibiotics.

Misuse or overuse of antibiotics selects for resistant bacteria. In a bacterial infection, billions of bacteria are present. Taking an antibiotic will kill or inhibit those bacteria that are susceptible to its effects and leave behind a subpopulation of bacteria that are resistant to the antibiotic. These remaining bacteria can survive and continue to grow. If they then spread from person to person, they may become the norm, and all future infections caused by these resistant bacteria will withstand the original antibiotic, rendering it useless for treatment. For many infections, patients often begin to feel better before all the bacteria have been eliminated. But it is important to complete a full course of antibiotics, even if ones symptoms have improved, to ensure that as many bacteria as possible are destroyed.

Bacteria have a variety of mechanisms by which they become resistant to antibiotics, depending on the particular antibiotic (or class of antibiotic) and the type of bacteria involved. Because antibiotics work differently to attack an essential function of bacteria, it is necessary to consider both the phenotypic mechanism of resistance and the underlying genotypic mechanism of resistance.

From a physical or biochemical perspective, there are a number of factors that contribute to antiobiotic resistance. First, the cell wall of a bacterium can be altered so that an antibiotic cannot penetrate it. Second, some bacteria produce enzymes that can destroy antibiotics before they can work. Third, certain bacteria have developed mechanisms known as efflux pumps, which are able to "eject" antibiotics from the bacterial cell before they have a chance to exert any effect. Finally, the antibiotic target site within the bacteria can be altered. In this situation, when an antibiotic enters the bacterial cell it must bind to its intended target in order to have an effect on the bacteria. If the target within the bacteria has been changed to make this binding impossible, the bacteria will be resistant to the medicines effects.

Underlying the phenotypic mechanisms of antibiotic resistance are the genetics of antibiotic resistance. Bacteria, like other living organisms, possess DNA that codes for the proteins and enzymes it requires for survival. Changes to the DNA can result in alterations in the final proteins or enzymes, which in turn can lead to antibiotic resistance. A common genetic mechanism for the development of antibiotic resistance is the acquisition of tiny fragments of DNA known as plasmids or transposons. Transposons may code for a specific antibiotic-inactivating enzyme, which, when produced by the bacteria, destroys an incoming antibiotic before it has an opportunity to work. These tiny fragments may be passed directly from one bacterium to another by a process known as conjugation. Alternatively, small viruses may attack certain bacteria and inject DNA fragments by a process known as transduction.

Another genetic mechanism of antibiotic resistance is the acquisition and accumulation of resistance genes from neighboring bacteria through a process known as transformation. A good example of this is the pneumococcus bacterium, which is a common cause of pneumonia, bacterial sinusitis, middle ear infections and even meningitis. When penicillin first became available for clinical use in the 1940s, the pneumococcus bacterium was 100 percent susceptible to penicillin. After decades of use, a portion of pneumococcal bacteria have accumulated small pieces of genetic material that they have scavenged from other bacteria, rendering them resistant to the effects of penicillin. Finally, a fourth genetic mechanism by which bacteria can develop antibiotic resistance is through mutations in their DNA. Every time a bacterium multiplies and grows, it may develop a mutation in its DNA. If the mutation occurs in a part of the DNA that codes for a protein or substance that is the target of an antibiotic, the bacteria may become resistant to that drug.

There is nothing stopping a bacterium from becoming resistant to more than one antibiotic. In fact, for some bacteria and antibiotics, cross resistance is common, which creates a new problem. The more drugs a bacterium is resistant to, the more difficult it becomes to treat an infection. Although many alternative antibiotics are currently available for use and new ones continue to be developed, there is a concern that doctors may run out of options for treating some highly resistant bacterial infections. Newer antibiotics may also be more costly than older ones and could come with side effects that make them more difficult to take. Ultimately the biggest concern with antibiotic resistance is that a patient will be treated for a potentially life threatening infection such as meningitis with an antibiotic to which the underlying bacteria is resistant. By the time the resistance is recognized through laboratory testing the patient may have suffered severe consequences.

The hope is that with more appropriate use of antibiotics and thus a reduction in antibiotic selection pressure, we can stem the tide of resistance and maintain a useful armamentarium of antibiotics for treating all types of bacterial infections. Patients should thus avoid taking antibiotics for things such as the common cold (which is caused by viruses and not bacteria), complete their courses of antibiotics as prescribed and not share their antibiotics with others.

# data[].attributes.attachment_link.description
Tony Mazzulli, an associate professor at the University of Toronto medical school and deputy chief microbiologist and infectious diseases specialist at Mount Sinai Hospital in Toronto, explains. The concept of antibiotic immunity is a misnomer that can lead people to believe that they may become "immune" or "resistant" to an antibiotic if they take it too frequently or inappropriately.

# data[].attributes.attachment_link.description
Create a new document and edit with others at the same time -- from your computer, phone or tablet. Get stuff done with or without an internet connection. Use Docs to edit Word files. Free from Google.

# data[].attributes.headline
Articles and Resources for More Information

# data[].attributes.subject
Articles and Resources for More Information

# data[].attributes.attachment_link.readable_text
Help Fight Drug-Resistant Bacteria

For nearly a century, bacteria-fighting drugs known as antibiotics have helped to control and destroy many of the harmful bacteria that can make us sick. But in recent decades, antibiotics have been losing their punch against some types of bacteria. In fact, certain bacteria are now unbeatable with today's medicines. Sadly, the way we've been using antibiotics is helping to create new drug-resistant "superbugs."

Superbugs are strains of bacteria that are resistant to several types of antibiotics. Each year these drug-resistant bacteria infect more than 2 million people nationwide and kill at least 23,000, according to the U.S. Centers for Disease Control and Prevention (CDC). Drug-resistant forms of tuberculosis, gonorrhea, and staph infections are just a few of the dangers we now face.

Antibiotics are among the most commonly prescribed drugs for people. They're also given to livestock to prevent disease and promote growth. Antibiotics are effective against bacterial infections, such as strep throat and some types of pneumonia, diarrheal diseases, and ear infections. But these drugs don't work at all against viruses, such as those that cause colds or flu.

Unfortunately, many antibiotics prescribed to people and to animals are unnecessary. And the overuse and misuse of antibiotics helps to create drug-resistant bacteria.

Here's how that might happen. When used properly, antibiotics can help destroy disease-causing bacteria. But if you take an antibiotic when you have a viral infection like the flu, the drug won't affect the viruses making you sick. Instead, it'll destroy a wide variety of bacteria in your body, including some of the "good" bacteria that help you digest food, fight infection, and stay healthy. Bacteria that are tough enough to survive the drug will have a chance to grow and quickly multiply. These drug-resistant strains may even spread to other people.

Over time, if more and more people take antibiotics when not necessary, drug-resistant bacteria can continue to thrive and spread. They may even share their drug-resistant traits with other bacteria. Drugs may become less effective or not work at all against certain disease-causing bacteria.

"Bacterial infections that were treatable for decades are no longer responding to antibiotics, even the newer ones," says Dr. Dennis Dixon, an NIH expert in bacterial and fungal diseases. Scientists have been trying to keep ahead of newly emerging drug-resistant bacteria by developing new drugs, but it's a tough task.

"We need to make the best use of the drugs we have, as there aren't many in the antibiotic development pipeline," says Dr. Jane Knisely, who oversees studies of drug-resistant bacteria at NIH. "It's important to understand the best way to use these drugs to increase their effectiveness and decrease the chances of resistance to emerge."

You can help slow the spread of drug-resistant bacteria by taking antibiotics properly and only when needed. Don't insist on an antibiotic if your health care provider advises otherwise. For example, many parents expect doctors to prescribe antibiotics for a child's ear infection. But experts recommend delaying for a time in certain situations, as many ear infections get better without antibiotics.

NIH researchers have been looking at whether antibiotics are effective for treating certain conditions in the first place. One recent study showed that antibiotics may be less effective than previously thought for treating a common type of sinus infection. This kind of research can help prevent the misuse and overuse of antibiotics.

"Treating infections with antibiotics is something we want to preserve for generations to come, so we shouldn't misuse them," says Dr. Julie Segre, a senior investigator at NIH.

In the past, some of the most dangerous superbugs have been confined to health care settings. That's because people who are sick or in a weakened state are more susceptible to picking up infections. But superbug infections aren't limited to hospitals. Some strains are out in the community and anyone, even healthy people, can become infected.

One common superbug increasingly seen outside hospitals is methicillin-resistant Staphylococcus aureus (MRSA). These bacteria don't respond to methicillin and related antibiotics. MRSA can cause skin infections and, in more serious cases, pneumonia or bloodstream infections.

A MRSA skin infection can appear as one or more pimples or boils that are swollen, painful, or hot to the touch. The infection can spread through even a tiny cut or scrape that comes into contact with these bacteria. Many people recover from MRSA infections, but some cases can be life-threatening. The CDC estimates that more than 80,000 aggressive MRSA infections and 11,000 related deaths occur each year in the United States.

When antibiotics are needed, doctors usually prescribe a mild one before trying something more aggressive like vancomycin. Such newer antibiotics can be more toxic and more expensive than older ones. Eventually, bacteria will develop resistance to even the new drugs. In recent years, some superbugs, such as vancomycin-resistant Enterococci bacteria, remain unaffected by even this antibiotic of last resort.

"We rely on antibiotics to deliver modern health care," Segre says. But with the rise of drug-resistant bacteria, "we're running out of new antibiotics to treat bacterial infections," and some of the more potent ones aren't working as well.

Ideally, doctors would be able to quickly identify the right antibiotic to treat a particular infection. But labs need days or even weeks to test and identify the bacteria strain. Until the lab results come in, antibiotic treatment is often an educated guess.

"We need to know how to treat for a favorable outcome, but knowledge about the infection can be several days away," explains Dr. Vance Fowler, an infectious disease expert at Duke University School of Medicine.

Fowler says faster diagnostic testing offers one of the best hopes for treating infectious diseases. Technology is catching up, he says, and new research in this area looks promising.

Genetic studies by NIH-supported researchers such as Segre and Fowler are also helping us understand the unique characteristics of antibiotic-resistant bacteria. Their findings could point the way to innovative new treatments.

While scientists search for ways to beat back these stubborn bacteria, you can help by preventing the spread of germs so we depend less on antibiotics in the first place.

The best way to prevent bacterial infections is by washing your hands frequently with soap and water. It's also a good idea not to share personal items such as towels or razors. And use antibiotics only as directed. We can all do our part to fight drug-resistant bacteria.

# data[].attributes.attachment_link.description
Antibiotics can destroy many types of bacteria that can make us sick. Sadly, our overuse of antibiotics is helping to create new drug-resistant "superbugs" that are difficult to defeat.

# data[].attributes.body
Superbugs are a strand of bacteria that are resistant to several antibiotics. The most common of superbugs is the MRSA (methicillin-resistant Staphylococcus aureus). This particular superbug is resistant to almost all antibiotics and can only be treated through very powerful drugs. Bacteria are one of the oldest forms of life and they have adapted and survived for a long time and developed many different mechanisms. They have survived many different extreme environments and antibiotics are just another one of them. Infections from MRSA can turn deadly within a few days. As Antibiotics are used, they kill off the sub population that is not resistant to antibiotics and leave behind the stronger bacteria which live to pass on the gene that helped them survived in the antibiotics. These bacteria are able to reproduce in an antibiotic environment. Over time as people keep on taking antibiotics when not needed, bacteria can continue to adapt and thrive.

# data[].attributes.headline
Causes of The Evolution of Drug-Resistant Bacteria

# data[].attributes.subject
Causes of The Evolution of Drug-Resistant Bacteria

# data[].attributes.body
One of the biggest causes of the emergence of these "Superbugs" are the overuse of unnecessary antibiotics. Antibiotics is one of the most commonly prescribed drugs. Antibiotics are effective on only bacterial infections and are ineffective to viral infections yet they are still prescribed as a "go-to" drug to cure anything. When patients take antibiotics when not needed, they kill off the healthy bacteria that help the human develop and stay healthy. Another main cause of superbugs is through the meat industry. Meat companies want to keep their meat as cheap as possible to maximize profits so they have their animals in close quarters and in terrible living conditions. This set-up is the perfect breeding ground for antibiotics so they give their animals antibiotics keep the animals from getting sick. This also causes overuse and lead to easy adaptations by bacteria. Another ability that bacteria have is called gene transfer. This is where bacteria can pass on immunity genes on to other bacteria which cause a spread of superbugs as well.

# data[].attributes.headline
Effects of The Evolution of Drug-Resistant Bacteria

# data[].attributes.subject
Effects of The Evolution of Drug-Resistant Bacteria

# data[].attributes.body
According to U.S. Centers for Disease Control and Prevention (CDC) more than 2 million people are infection by superbugs and 23,000 are killed every year in the US. As a result of these antibiotics, bacteria have developed different phenotypic and genotypic mechanisms to resist different types of antibiotics.

Phenotypic Mechanisms of Resistance

The bacteria can change its cell wall to so that the antibiotics cannot penetrate it.

Bacteria can produce different enzymes to dispose of the antibiotics before they can function properly

Some bacteria are able to utilize a mechanism called efflux pumps. These "pumps" can eject the antibiotics from the cell before they are able to function properly.

Bacteria can alter its target site to make it impossible for the antibiotic to bind to the bacterial cell.

Genotypic Mechanisms of Resistance

Changes to the DNA can result in alterations in the final proteins or enzymes, which in turn can lead to antibiotic resistance

Bacteria can acquire small strands of DNA called plasmids of transposons which can code for a antibiotic-inactivating enzyme which can destroy an antibiotic before it has time to properly function.

# data[].attributes.headline
Possible Solutions and Future of Medical Research of Superbugs

# data[].attributes.subject
Possible Solutions and Future of Medical Research of Superbugs

# data[].attributes.body
Some possible solutions include the overall reduction of the use of unnecessary antibiotics. We can slow down the spread of drug-resistant bacteria if we only take antibiotics when needed and not as a "go-to" drug for everything including viral infections which they are ineffective on. Antibiotics are ineffective against viral infections but are still prescribed for viral conditions such as colds or the flu. Also the use of these antibiotics stretch to animals. They are using them with little cause making the adapting easier for these bacteria. Vancomycin used to be the last resort antibiotic but its use has been skyrocketing. As the frequency of the use of vancomycin rose and it became the first choice of antibiotic, bacteria have been able to learn how to defeat it. 2 cases of vancomycin-resistant strains of bacteria was documented which may cause a "major medical crisis if that strain were to spread" (Daum). The latest antibiotic that companies have been developing is Zyvox but even this has developed resistance within 4 years. The estimated additional medical costs $20 billion. But as companies continue to think outside the box on these medical issues, it could cost taxpayers additional money. The government may resort to paying these companies to develop new antibiotics. But "faster diagnostic testing offers one of the best hopes for treating infectious diseases. Technology is catching up and new research in this area looks promising." (Fowler) He believes that the development of new antibiotics will outweigh the continuous adapting of these bacteria. Another solution they have come up with are bacteriophages. These are bacteria-killing viruses that help get rid of harmful bacteria. In the future this may be the only way to kill the sugerbugs as the superbugs gets more powerful.