Antimicrobial resistance (AMR) describes the ability of bacteria to develop ways of evading antimicrobials. Antimicrobials kill bacteria and with this environmental pressure comes the selection for survivors, and those survivors propagate their survivor genes contributing to a population of superbugs–bacteria that can’t be killed with any known antimicrobial. This is challenging, because we rely on antimicrobials to help our bodies eliminate infection. What happens when we catch an infection that we don’t have treatment for? More often than not, these kinds of infections occur in individuals with suppressed immune systems, the very sick, the very young, and the very old.

Rodica Stamo, an immigrant from Romania, started her business in assisted living almost 16 years ago, and she’s grown intimately familiar with the threat of superbugs. “Maybe 30–40% of my residents will get infections that just don’t respond to antibiotics.” Centers for Disease Control and Prevention state that nearly four million individuals receive services at assisted living facilities across the U.S.. Antibiotics are commonly prescribed among residents, with 50-70% residents receiving at least one antibiotic course every year. As high as 75% of these are prescribed incorrectly and Rodica has observed this.

“I see doctors give them all sorts of medication, almost randomly.” A challenge in responsible use of antimicrobials is their application only when necessary. Doctors may prescribe broad-spectrum antimicrobials to treat an unidentified infection (and antibiotics don’t work for all infections) or use the wrong antibiotics, but this approach may hasten us toward a post-antibiotic era. Rodica takes these prescriptions with a grain of salt, questioning doctors and even giving residents remedies such as oregano oil, which she has seen be effective when nothing else helped.

Antibiotics are not selective. Everyone has a gut microbiome—an ecosystem of “good” bacteria necessary to help us digest food and protect against invasive “dangerous” bacteria. Antibiotics can kill off our good bacteria, and it can take up to 6 months to replenish this diversity of bacterial species.

It’s a common misconception that resistant bacteria are rare, exotic strains. MRSA—a bacteria responsible for over 10,000 infections annually—is staphylococcus aureus that has developed resistance. Staphylococcus aureus exists naturally on many healthy people’s skin and hair.  Antibiotics create an environment that selects for AMR genes amongst our native microbiota, cultivating dangerous strains of superbugs that are very close to home. Some antimicrobials are used as “maintenance drugs.” Infections can become long-term and antibiotics must be taken to keep the resident stable and prevent the bacteria from overwhelming the immune system.
Once the antibiotic treatment is taken away, the patient dies. But this long-term use of antibiotics continuously selects for AMR bacteria, curating strains of MRSA or C. difficile.

Rodica acknowledges that antibiotics should only be used when their benefits outweigh the risks. That’s why she prioritizes good hygiene, antibiotic-free food, and supplements to keep immune systems and bodies strong, preventing infections from starting in the first place. But despite her efforts, her residents will still catch bugs. After many years of experience across 4 separate locations, she’s noticed some patterns.

“They’ll stop moving, they become very static, so you treat them. The next year, they get another infection, so you treat them again. It keeps getting more and more frequent. By the time they have three infections within a year, the antibiotics stop working.”

The importance of sustainable use of antimicrobials goes beyond personal choice. By overusing antimicrobials, we accelerate the evolution of superbugs. For people with weaker immune systems—like Rodica’s residents—our antibiotics must remain effective to help these patients fight off infections. Otherwise, a simple urinary tract infection could mean death.

Rodica joined ARC Labs last month to support new research and new technology that can help her residents. In addition to encouraging responsible use of antimicrobials, she also works very closely with her residents’ doctors to ensure antibiotics are not being overprescribed. We’re so happy to have her on our team.