Antibiotic resistance: When UTIs turn lethal

Imagine, for a moment, that you have a urinary tract infection (UTI).

At first it's just uncomfortable, but pretty quickly it gets really painful. Lying down with a heating pad and drinking lots of cranberry juice isn't cutting it with this one.

Not to worry, there's an easy way out: You go to your doctor and get a prescription for an antibiotic.

Your symptoms are likely to be gone in three to five days after you started taking the little pills. Pain-free in less than a week! Hooray for the wonders of modern medicine.

Now imagine there are no antibiotics. The infection could spread to your kidneys or make its way into your bloodstream. Your life would be at risk.

Many bacteria are already resistant to antibiotics

A world without antibiotics isn't some alternative universe or horror movie scenario. It is a reality, now.

More and more bacteria are becoming resistant to the drugs we've developed to treat the infections these bacteria cause.

The basic idea is to kill bacteria with antibiotics. But there is always a chance that the bacteria will survive, and adapt. They can multiply unchecked and pass on "survivor" genes that have grown resilient.

That doesn't mean that every antibiotic will suddenly disappear, but having access to an antibiotic that doesn't work anymore is the same as not having an antibiotic at all.

Antibiotics 'will stop working'

In 2019, around 1,27 million people across the world died as a result of antibiotic-resistant bacterial infections, according to a study published in the medical journal The Lancet.

The European Centre for Disease Prevention and Control estimates that Europe sees more than 670,000 infections with antibiotic-resistant bacteria every year, and that roughly 33,000 people on the continent die every year as a result.

Medical experts are increasingly concerned about the declining effectiveness of many of our trusted antibiotics.

"They will stop working, so we have to find an alternative," says Chris Dowson, who has researched antibiotic resistance for decades and is the head of the Infectious Disease Research Group at the University of Warwick in the UK. "We do not have a choice."

More on the search for alternatives and new antibiotics in a little bit. But first ― how did we get here?

Why are there more and more bacteria ― from E. coli (in that undercooked hamburger that gave you diarrhea) to staphylococcus (which can trigger an infection after surgery) ― that aren't killed by treatment with our wonder drugs anymore?

How antibiotic resistances develop

Resistance has grown steadily over the past years because of over-exposure to antibiotics.

Doctors prescribe the drugs more readily than before, including in cases where they might not be necessary.

Sometimes patients stop taking their antibiotic medication when they feel better ― even though doctors say patients should always take the full course of antibiotics.

The reason is simple: you might feel better, but the infection may still be there, and because you haven't taken the full dose, it may not have been enough to kill all the bacteria. The bacteria then have a fighting chance of overcoming the "low level" of antibiotics and adapt.    

And in some countries, you can get antibiotics without a prescription, which increases the likelihood of misuse.

All these factors contribute to bacteria becoming resistant to drugs that used to kill them in the past.

Antibiotics in the human food chain

In agriculture, antibiotics are sprayed on fruit in orchards to keep away pests, or fed to animals in mass meat production. This way, antibiotics make it into our water and our food.

The trace amounts of antibiotics that bacteria are exposed to aren't enough to kill them, and instead work as training materials: Bacteria learn from them and adapt to become resistant.  

Antibiotic-resistant infections: from salmonella to tuberculosis

According to the World Health Organization (WHO), the number of infections caused by antibiotic-resistant E. coli bacteria and certain types of salmonella (hello, food poisoning) has increased by 15% from 2017 to 2021.

Bacteria causing that UTI you imagined at the beginning of this article are becoming more and more resistant, too.

"Many antibiotics used to treat the typical urinary tract infection pathogen are ineffective today," Edwin Heucke, a senior physician in charge of optimizing antibiotic treatment in the German Helios network of hospitals, said in an interview with Helios Magazin. 

Tuberculosis is also fast becoming harder to treat because of antibiotic resistance. Researchers from Germany and Mozambique found that there are tuberculosis strains spreading in Mozambique that are resistant to one or multiple of the antibiotics that the WHO recommends for treatment.

Their study, published in The Lancet, states that in 2021, roughly 4,800 people in Mozambique developed a type of tuberculosis resistant to rifampicin, an antibiotic used to treat the disease in combination with other drugs.  

What will medicine look like in the future?

Now back to the crucial effort of discovering alternative medications to take on bacteria that have grown resistant to exist antibiotics.

Funding in this area is dwindling, which means many scientists have given up their research.

"We are losing not only antibiotics but the teams to discover them," Dowson wrote in an email to DW.

The microbiologist shared a paper he compiled, which emphasizes "the current cliff edge in the field of global antibiotic discovery."

Dowson refers to the global dashboard on antimicrobial resistance research and development, which shows that worldwide funding for this field has been in sharp decline.

In 2020, global funding stood at $2.03 billion (€1.84 billion), in 2022 it was only $1.2 billion. For 2023, the number is estimated to drop to $663 million (€611 million).

That decrease in funding is the opposite of what should be happening, Dowson states in the paper ― antibiotic resistance should be a "global strategic priority."

It "requires innovative global solutions both [for] the discovery of new therapies and to train the next generation of leaders."

Edited by: Zulfikar Abbany