Superbugs Are Not Science Fiction Anymore

Authored by: Rma Polce

Art by: Sophia Li

Did you know that even if you're not taking antibiotics, you still consume them? They’re in household items like disinfecting wipes and personal care items like toothpaste [1]. Antibiotics also appear in wastewater, rivers, and streams [2]. Alarmingly, bodies of water are some of the largest reservoirs of antibiotic-resistant bacteria (ARB). Escherichia coli (E. coli), a type of bacteria commonly found in the intestines of humans and animals, can cause serious infections when present in contaminated water [2]. A recent study by Watershed Investigations, York University, and Surfers Against Sewage found that over half of UK water bodies tested had levels of E. coli far above the safe limit, with some having up to 20 times more than the U.S. limit for safety [2].

Why does this matter? 

ARB present significant clinical challenges, with methicillin-resistant Staphylococcus aureus (MRSA) being a prime example. Each year in the U.S., MRSA infects more than 80,000 people, resulting in approximately 11,000 deaths [3]. Treating and ultimately curing MRSA is exceptionally difficult due to its resistance to many frontline antibiotics, including beta-lactams [4] – a widely prescribed class that includes penicillin and ampicillin [5]. The impact of MRSA is even more severe in developing countries, where beta-lactams like penicillin are among the few readily available and affordable antibiotics [6]. 

Beyond their clinical relevance, ARB also have a significant financial burden. Since many cost-effective, first-line antibiotics are ineffective against ARB, doctors often resort to expensive alternatives such as carbapenems. For uninsured patients, a single treatment course of carbapenems like ertapenem can exceed $1,000 [7]. Additionally, severe infections often require hospitalization and surgical intervention. MRSA patients with deep abscesses often need surgical drainage to remove infected tissue [8], increasing healthcare costs. According to The World Bank, treating ARB could cost $1 trillion in additional healthcare costs by 2050 [9], underscoring the gravity of the situation. 

Unfortunately, surviving ARB infections, colloquially called “superbug infections,” does not fully guarantee a high-quality life without side effects. Exposure to antibiotics and ARB is correlated with an increased likelihood of developing lifelong complications. For example, just taking an antibiotic is associated with up to a 60% increase in the likelihood of developing rheumatoid arthritis [10]. Also, the use of antibiotics is correlated with gut dysbiosis, which decreases the diversity and efficacy of gut microbiota [11]. This hinders health as gut microbes provide the enzymes necessary for various vitamin synthesis and other bodily functions like bile acid reabsorption and recycling [12]. Moreover, antibiotics increase the chances of resistance in your microbiota and the proliferation of opportunistic pathogens, predisposing individuals to more superbug infections in the future [13]. 

Superbug infections have a devastating global impact, claiming over a million lives each year, including approximately 60,000 infants [14]. The crisis is only expected to worsen, with projections estimating nearly 39 million deaths between 2025 and 2050 – equivalent to three lives lost every minute during that period [15].

So what can we do?

Be sparing, smart, and strategic in our approaches to antibiotics and development. 

Frontline antibiotics are often prescribed at the first signs of sickness “just in case.” But “just in case” medicine is not helping. In 2015, over 30% of U.S. ambulatory visits led to antibiotic prescriptions, which had no documented need, contributing to the over 24 million unnecessary antibiotic prescriptions written in the U.S. alone [16]. According to the World Health Organization, the overuse of antimicrobials in humans and animals is the primary driver of ARB [9]. Implementing better prescription strategies can help curb the development of superbugs. For example, providers should wait and test patients for infection before prescribing to ensure the proper class, dosage, and duration are being used and to confirm if antibiotics are even necessary. 

Patient compliance also needs to increase. A study by the Kaiser Family Foundation found that many people take antibiotics incorrectly, with 16% stating they took them without consulting a medical professional [17]. In addition, they found that 39% of patients reported not completing their prescribed course of antibiotics [17]. These improper uses diminish treatment efficacy. For example, Klebsiella pneumoniae – a common cause of sepsis – is becoming more resistant to antibiotics used as first-line treatments (from 13.5% resistance in 2018 to 17.4% in 2022) [18]. 

It is crucial to continue development. Recent advances in reverse vaccinology (RV) present significant potential for ARB treatment development. RV involves sequencing the genomes of microbes to identify novel targets that can provide broad protection against pathogens [19]. This method has been utilized to create vaccines, such as the meningococcus B vaccine, which exhibited an effectiveness of 82.9% against all MenB strains [19], highlighting the potential of RV. Additionally, antibiotic-bacteriophage combinational therapies have had promising results. This approach includes phage cocktails paired with antibiotics to enhance bacterial clearance [20]. Several in vitro studies have demonstrated the effectiveness of such combination therapies. In one of those studies, a sample population of mice infected with E. coli received a combined treatment immediately after infection and all survived [21]. There have also been many clinically successful regimens; for example, a patient with recurrent urinary tract infections caused by K. pneumoniae was successfully treated with a combination therapy and had no recurrence within six months [20]. 

Our habits, environment, and prescribing practices have all fueled this resistance crisis, so now more than ever, fighting superbugs is no longer a choice – it’s a necessity. 

References:

1. The University of Queensland, “Toothpaste and Hand Wash May Contribute to Antibiotic Resistance.” UQ News, https://www.uq.edu.au/news/article/2018/06/toothpaste-and-hand-wash-may-contribute-antibiotic-resistance. Accessed 5 Feb. 2025.

2. Hosea, Rachel Salvidge |. Leana. UK Bathing Sites Polluted by ‘Genes That Could Create Superbugs.’ 14 Dec. 2024, https://www.thetimes.com/uk/environment/article/uk-bathing-sites-polluted-by-genes-that-could-create-superbugs-clean-it-up-fl3j68jkl.

3. MRSA blood infections are less fatal in kids, vs. Adults, but cause significant complications. (2017, May 5). Children’s National Hospital. https://www.childrensnational.org/about-us/newsroom/2017/mrsa-blood-infections-are-less-fatal-in-kids-vs-adults-but-cause-significant-complications

4. Baylor College of Medicine Associates. (2023, December). Methicillin-resistant staphylococcus aureus (Mrsa) | bcm. https://www.bcm.edu/departments/molecular-virology-and-microbiology/emerging-infections-and-biodefense/specific-agents/mrsa

5. Varghese, J. M., Roberts, J. A., & Lipman, J. (2011). Antimicrobial pharmacokinetic and pharmacodynamic issues in the critically ill with severe sepsis and septic shock. Critical Care Clinics, 27(1), 19–34. https://doi.org/10.1016/j.ccc.2010.09.006

6. Hart, C. A., & Kariuki, S. (1998). Antimicrobial resistance in developing countries. BMJ : British Medical Journal, 317(7159), 647–650. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113834/

7. nvanz Prices, Coupons, Copay Cards & Patient Assistance. (2025, February 23). Drugs.Com. https://www.drugs.com/price-guide/invanz#:~:text=The%20cost%20for%20Invanz%201,not%20valid%20with%20insurance%20plans 

8. MRSA infection-MRSA infection—Diagnosis & treatment. (2025, February). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/mrsa/diagnosis-treatment/drc-20375340

9. World Health Organization Associates. (2023, November 21). Antimicrobial resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

10. Sultan, A. A., Mallen, C., Muller, S., Hider, S., Scott, I., Helliwell, T., & Hall, L. J. (2019). Antibiotic use and the risk of rheumatoid arthritis: a population-based case-control study. BMC medicine, 17(1), 154. doi:10.1186/s12916-019-1394-6

11. Kesavelu, D., & Jog, P. (2023). Current understanding of antibiotic-associated dysbiosis and approaches for its management. Therapeutic advances in infectious disease, 10, 20499361231154443. https://doi.org/10.1177/20499361231154443

12. What is your gut microbiome? (2025, February). Cleveland Clinic. https://my.clevelandclinic.org/health/body/25201-gut-microbiome

13. Mancuso, G., Midiri, A., Gerace, E., & Biondo, C. (2021). Bacterial antibiotic resistance: The most critical pathogens. Pathogens, 10(10), 1310. https://doi.org/10.3390/pathogens10101310

14. India’s “blockbuster” drugs to combat antibiotic-resistant superbugs. (2024, December 5). https://www.bbc.com/news/articles/c80vrjkkrero

15. Antibiotic resistance has claimed at least one million lives each year since 1990 | University of Oxford. (2024, September 17). https://www.ox.ac.uk/news/2024-09-17-antibiotic-resistance-has-claimed-least-one-million-lives-each-year-1990

16. Ray, M. J., Tallman, G. B., Bearden, D. T., Elman, M. R., & McGregor, J. C. (2019). Antibiotic prescribing without documented indication in ambulatory care clinics: National cross sectional study. BMJ, l6461. https://doi.org/10.1136/bmj.l6461

17. Poll: Most americans see antibiotic resistance as a public health problem, but nearly half have not taken antibiotics as prescribed. (2019, June 21). KFF. https://www.kff.org/other/press-release/poll-most-americans-see-antibiotic-resistance-as-public-health-problem-nearly-half-have-not-taken-antibiotics-as-prescribed/

18. Antibiotic resistant infections and associated deaths increase. (2023, November 15). GOV.UK. https://www.gov.uk/government/news/antibiotic-resistant-infections-and-associated-deaths-increase

19. Masignani, V., Pizza, M., & Moxon, E. R. (2019). The Development of a Vaccine Against Meningococcus B Using Reverse Vaccinology. Frontiers in immunology, 10, 751. https://doi.org/10.3389/fimmu.2019.00751

20. Li, X., He, Y., Wang, Z., Wei, J., Hu, T., Si, J., Tao, G., Zhang, L., Xie, L., Abdalla, A. E., Wang, G., Li, Y., & Teng, T. (2021). A combination therapy of Phages and Antibiotics: Two is better than one. International journal of biological sciences, 17(13), 3573–3582. https://doi.org/10.7150/ijbs.60551

21. Kortright, K. E., Chan, B. K., Koff, J. L., & Turner, P. E. (2019). Phage Therapy: A Renewed Approach to Combat Antibiotic-Resistant Bacteria. Cell host & microbe, 25(2), 219–232. https://doi.org/10.1016/j.chom.2019.01.014