Episode 222: Antibiotic Resistance Mehr Boparai and Jeremy Pan, medical students, mention five common antibiotic-resistant bacteria and what the current treatments are. Dr. Arreaza asks questions to guide the presentation and adds an example of antibiotic resistance in a patient. Written by Mehr Boparai, OMS-III, and Jeremy Pan, OMS-III, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Edits and comments by Hector Arreaza, MD.
Arreaza: Welcome back tothe Rio Bravo qWeek Podcast! My name is Dr. Hector Arreaza, I am a family physician and faculty member in the Rio Bravo Family Medicine Residency Program. Today I am joined by two excellent medical students who will introduce themselves now, welcome, guys!
Mehr: Thank you for the introduction! My name is Mehr Boparai, third year medical student at WesternU COMP-NW.
Jeremy: And my name is Jeremy Pan, also a third-year medical student at WesternU COMP Pomona and we will be discussing a very prevalent topic today in the clinical world that is arguably becoming one of the biggest threats to modern medicine: antibiotic resistance.
Mehr: That’s right! Imagine this scenario: a routine infection, something we’ve treated easily for decades, suddenly becomes life-threatening because the drugs we always thought we could rely on just don’t work anymore. You likely ran into this problem just last week with one of your patients! That’s not science fiction. That’s happening every day in hospitals across the world.
Dr. Arreaza: I agree, antibiotic resistance must be taken seriously. I increased my awareness in 2023, when I attended a medical research conference in Carmel(which is a popular conference that takes place in that beautiful town). I heard Dr. David Gilbert, a famous and accomplished ID doctor who helped develop the Sanford Guide to Antimicrobial Therapy, he warned everyone about antibiotic resistance as one of the biggest threats for humanity, the other two were a nuclear bomb and an epidemic.
Jeremy: Woah, comparing antibiotic resistance to a nuclear bomb is absolutely crazy, but likely very real!! Well today, we’re going to be focusing on five of the most common infections or “bugs” you’ll see in a hospital setting. We’ll talk about what typically causes them, what antibiotics we used to rely on, and what happens when resistance decides to enter the picture.
Mehr: If you are a medical student (or resident), you understand that dreaded feeling when an attending asks “what antibiotics should we start?” But don’t worry, in this episode, we hope to address the decision-making process in a simple framework.
What is Antibiotic Resistance?
Dr. Arreaza:
Before we jump into specific common infections and pathogens, let’s cover our basics. Antibiotic resistance occurs when bacteria evolve to survive drugs designed to kill them. This can happen through genetic mutations or by getting resistance genes from other bacteria. Why does this matter?
Jeremy: It matters because antibiotics play a huge role in modern medicine. Without them, surgeries, chemotherapy, organ transplants—even childbirth—become significantly more dangerous.
Mehr: According to the CDC, in the U.S. alone, antibiotic-resistant infections affect over 2.8 million people each year and cause more than 35,000 deaths! So, when we talk about resistance, we’re not just talking about inconvenience for treatments. We’re talking about a fundamental threat to healthcare.
Staph aureus
Dr. Arreaza: So, if you have a patient who comes in with a skin infection or is maybe showing signs of pneumonia or bacteremia, what is one of the most common bugs that you should think about?
Jeremy: Staph aureus! Typically to treat methicillin-sensitive strains (MSSA), we would utilize antibiotics like nafcillin, oxacillin, or cefazolin. But there is one strain in particular that is worrisome, Mehr?
Mehr: yeap, that would have to be MRSA, one of the most well-known resistant organisms. MRSA is resistant to all beta-lactam antibiotics, which means we can say goodbye to all penicillin and most cephalosporins.
Dr. Arreaza: And what is the first antibiotic that comes to mind if we see MRSA on a culture in the hospital?
Mehr: Vancomycin! Alternative treatments include linezolid and daptomycin depending on the type of infection. But what is the problem that we are starting to see?
Jeremy: You guessed it, cases of resistance to vancomycin are starting to appear—VRSA. These cases are still uncommon today, but these findings show a worrying trend, that we will eventually start running out of reliable options.
Dr. Arreaza: Fortunately, VRSA infections are extremely rare, with only 14-16 documented cases in the United States. As of 2019, 52 VRSA strains have been identified in the United States, India, Iran, Pakistan, Brazil, and Portugal. Let’s keep an eye on VRSA in the future.
E. coli
Dr. Arreaza: Alright, so let’s say you have a patient with dysuria, urinary frequency, maybe even a catheter in place. What’s the most common bug you’re thinking of?
Mehr: That one’s a classic, we are thinking E. coli.
Jeremy: Exactly. E. coli is the leading cause of urinary tract infections, especially in both community and hospital settings.
Dr. Arreaza: So Jeremy, what are we using for uncomplicated UTIs?
Jeremy: We usually think of trimethoprim-sulfamethoxazole, nitrofurantoin, or sometimes fosfomycin. And in more complicated cases, we might consider fluoroquinolones like ciprofloxacin.
Mehr: But here’s where things get tricky. Resistance to TMP-SMX and fluoroquinolones has been increasing significantly. In some areas, resistance rates are over 20–30%, which really changes your empiric choices.
Conclusion:
Dr. Arreaza: So we’ve talked about five major organisms today: Staph aureus, E. coli, Klebsiella, Pseudomonas, and C. diff. What’s the overarching takeaway of the discussion?
Jeremy: The main takeway is that antibiotic resistance is already here, and it’s affecting some of the most common infections we see in clinical practice on a day-to-day basis.
Mehr: And as students and future physicians, it’s important to not just memorize antibiotics, but understand why we’re choosing them.
Dr. Arreaza: Exactly. Always think: What organism am I targeting? What are the local resistance patterns? And can I narrow therapy once I have cultures?
Jeremy: And maybe most importantly—don’t overuse antibiotics, especially in cases when they’re not needed.
Mehr: Because the more we use them, the faster we lose them.
Dr. Arreaza: I’d like to share the story I listed to in a RadioLab episode about Dr Steffanie A. Strathdee, one of the most influential ID doctors in the world and Co-Director at the Center for Innovative Phage Applications and Therapeutics (IPATH). She shared that her husband got infected by Acinetobacter baumannii, an opportunistic infection that can cause severe infection. After trying many antibiotics, he was treated with “phages”, “bacteriophages”. So, that’s part of “thinking out of the box”.
Jeremy: Thank you all for tuning in to the Rio Bravo qWeek podcast series and thank you Dr. Arreaza for having Mehr and me on the podcast today!
Stay informed, stay curious—and we’ll see you next time
Mehr: Guys! I had so much fun! We hope this episode helped simplify antibiotic selection for the most common infections and bugs seen in a hospital setting and gave you a framework you can for initial treatments and cases of antibiotic resistance. Thanks for hanging out with us!
Dr. Arreaza: And remember, antibiotics are one of the most powerful tools we have in medicine. Let’s use them wisely. This is Dr. Arreaza, signing off.
_____________________
References: