A recent study suggests that superbugs could kill up to 40 million people by 2050.1 The World Health Organization has identified antimicrobial resistance (AMR) as one of the most serious global public health issues.
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But what exactly are superbugs, and how did they come to be?
What are superbugs?
What are microbes?
Microbes are tiny biological organisms that exist all around us. They can be found in the air, on surfaces, in food, and even within our bodies. They are present in enormous numbers throughout the human body. The human body contains an estimated 30 trillion human cells and 38 trillion bacterial cells.2
The beneficial microbes in your body work together to support functions such as digestion, immunity, and reproduction. In contrast, harmful microbes (pathogens) can cause disease and illness in humans, animals, and plants. They reproduce quickly and spread easily, posing a serious threat to health.
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What are antimicrobials?
Antimicrobial medications can treat a wide range of diseases. There are several types of antimicrobials: antibiotics are used to treat bacteria, antifungals to treat fungi, antivirals to treat viruses, and antiparasitics to treat parasites.
The battle against infections (mostly bacterial infections) was believed to have been won in the late 1920s when Alexander Fleming discovered penicillin (a commonly used antibiotic). This was followed by the discovery of many additional broad-spectrum and specialized antibiotics.
However, with the widespread overuse of antibiotics in both humans and animals, microorganisms have grown stronger than previously imagined. Superbugs are microorganisms that were once sensitive to specific antibiotics but have become resistant to them.
What are some common superbugs?
One in every five instances of urinary tract infection (UTI) caused by E. coli is resistant to commonly used medications such as ampicillin and fluoroquinolones. Klebsiella pneumoniae is a common intestinal bacterium that resists beta-lactam antibiotics, which are widely used.
Methicillin-resistant Staphylococcus aureus (MRSA) is a major concern due to its high mortality rate and resistance to several medications used to treat common staph infections.3 Between 2017 and 2021, approximately 20 % of MRSA bloodstream infections in Canada resulted in death within 30 days of diagnosis.4
Other prevalent antibiotic-resistant bacteria include vancomycin-resistant Enterococcus (VRE), multi-drug-resistant Mycobacterium tuberculosis (MDR-TB), and carbapenemase-producing Enterobacterales (CPE).5
AMR is a dangerous and rapidly growing global health crisis. Understanding how it develops can provide researchers and medical staff with the tools needed to address this urgent threat.
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What causes antimicrobial resistance?
Several factors contribute to the emergence and spread of AMR, the most significant of which is the misuse and overuse of antibiotics in clinical settings. Antibiotics work by killing bacteria and/or disrupting their reproductive cycles.
Incorrect use of antibiotics occurs when a patient misses one or more doses of their prescribed medication or discontinues therapy earlier than recommended. This allows the bacteria to begin reproducing, with the potential to develop resistance to the remaining antibiotic in the system.
Overprescribing antibiotics for mild infections, as well as misdiagnosing viral infections, is accelerating AMR.
AMR is especially concerning in low-income communities and developing countries, where inadequate sanitation, lack of access to clean water, and limited immunization programs are often the primary causes of infection.
Antibiotics are often used inappropriately for these infections, even when they are unnecessary, worsening the problem. In some areas, antibiotics are widely available without a prescription, further contributing to their overuse.6
In addition, farming practices, such as the use of unnecessary antibiotics for growth promotion in livestock, contribute significantly to the spread of drug-resistant bacteria in both animals and humans. A 2015 study projected that total antibiotic use in livestock in 2010 was 63,151 tons.
It is estimated that antibiotic use in livestock will rise by 67 % by 2030.7 Antibiotic use in agriculture promotes the development of antibiotic-resistant bacteria and genes in the soil, which eventually enter the water system as pollutants.8 A 2009 study found antibiotic-resistant genes and bacteria in the tap water supply.9
While antibiotics have an important role in agricultural production and growth, their long-term, low-dose use may contribute to the development of AMR, potentially costing the healthcare system millions of dollars in treatment.
How does antimicrobial resistance occur?
The mechanism of antimicrobial resistance is well studied and is generally divided into two categories.
Intrinsic resistance
The first way AMR originates is through intrinsic resistance, which is a microorganism’s innate ability to withstand antibiotics. "For example, an antibiotic that affects the wall-building mechanism of the bacteria, such as penicillin, cannot affect bacteria that do not have a cell wall."10
Acquired resistance
Acquired resistance occurs when antibiotic-susceptible bacteria gain the ability to withstand the effects of an antibiotic, allowing them to reproduce and spread under selective pressure.
This type of resistance is achieved either by modifying existing genetic material (gene mutation) or by acquiring new genetic material from another source (horizontal gene transfer).
Acquired resistance genes may allow bacteria to degrade or chemically modify antibiotics, rendering them ineffective. They may also produce or upregulate efflux pumps, which actively transport antibiotics out of the cell, preventing the drug from reaching its intracellular target.
Additionally, bacteria may alter the drug’s target site or develop an alternative metabolic pathway that bypasses the drug’s effects.11
How to prevent antibiotic resistance
The first step in preventing AMR is to stop the spread of infections entirely.
This includes staying home when sick, practicing proper hygiene, and keeping up to date with vaccinations, among other precautions. The Canadian government emphasizes that the appropriate use of antimicrobials (primarily antibiotics) is critical to preventing the emergence of superbugs.
Overuse and misuse of antibiotics are among the primary drivers of AMR development.12 According to a 2017 study, "up to 40 % of antibiotic prescriptions for these conditions are unnecessary." 13 This not only leads to more mutant bacteria but also harms the gut microbiome since antibiotics kill both beneficial and harmful bacteria.
Doctors must accurately diagnose bacterial infections and prescribe antibiotics only when truly necessary. Patients must also take responsibility for using antibiotics properly.
Sharing medication, flushing it down the drain, failing to complete the full course of therapy, or not taking the prescription as directed can all contribute to the rapid spread of AMR.
We must each do our part to help prevent the rise of superbugs.
Things you may wonder
Does hand sanitizer cause superbugs?
No, using hand sanitizer does not lead to the emergence of superbugs. Hand sanitizers contain ethanol, which kills bacteria immediately by breaking down their cell walls, whereas antibiotics inhibit bacterial growth. Hand sanitizers also evaporate quickly, preventing bacteria from developing resistance.
Does bleach create superbugs?
No, bleach does not promote the emergence of superbugs. Bleach destroys microorganisms by breaking down their cell structure. It is a fast-acting disinfectant that gives microbes no time to develop resistance.
References and further reading
- Naghavi, M., et al. (2024). Global Burden of Bacterial Antimicrobial Resistance 1990–2021: a Systematic Analysis with Forecasts to 2050. The Lancet, (online) 404(10459), pp.1199–1226. https://doi.org/10.1016/s0140-6736(24)01867-1.
- Sender, R., Fuchs, S. and Milo, R. (2016). Revised Estimates for the Number of Human and Bacteria Cells in the Body. PLOS Biology, 14(8), p.e1002533. https://doi.org/10.1371/journal.pbio.1002533.
- World Health Organization (2023). Antimicrobial Resistance. (online) World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.
- Public Health Agency of Canada (2024b) Antimicrobial resistance: Seasonal update — Canada.ca. Available at: https://health-infobase.canada.ca/carss/amr/results.html?ind=14.
- Better Health Channel (2023). Antibiotic resistant bacteria. (online) Better Health Channel. Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/antibiotic-resistant-bacteria.
- Chouhan, A.S. (2024). Overuse of Antibiotics Causes Serious Adverse Effects in the Body: A Literature Review. Journal of Clinical Medicine & Health Care, (online) pp.1–4. https://doi.org/10.61440/jcmhc.2024.v1.09.
- Van Boeckel, T.P., et al. (2015). Global trends in antimicrobial use in food animals. Proceedings of the National Academy of Sciences, (online) 112(18), pp.5649–5654. https://doi.org/10.1073/pnas.1503141112.
- Manyi-Loh, C., et al. (2018). Antibiotic Use in Agriculture and Its Consequential Resistance in Environmental Sources: Potential Public Health Implications. Molecules, [online] 23(4), p.795. https://doi.org/10.3390/molecules23040795.
- Xi, C., et al. (2009). Prevalence of Antibiotic Resistance in Drinking Water Treatment and Distribution Systems. Applied and Environmental Microbiology, 75(17), pp.5714–5718. https://doi.org/10.1128/aem.00382-09.
- Habboush, Y. and Guzman, N. (2023). Antibiotic resistance. (online) National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/books/NBK513277/.
- Tenover, F.C. (2006). Mechanisms of Antimicrobial Resistance in Bacteria. The American Journal of Medicine, 119(6), pp.S3–S10. https://doi.org/10.1016/j.amjmed.2006.03.011.
- Public (2024). Antimicrobial resistance: Prevention and risks - Canada.ca. (online) Canada. Available at: https://www.canada.ca/en/public-health/services/antimicrobial-resistance/prevention-risks.html.
- Fiore, D., et al. (2017). Antibiotic overprescribing: Still a major concern. (online) Available at: https://www.frontlinemedcom.com/wp-content/uploads/AntibioticOverprescribing_JFP_Dec2017.pdf.
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