Superbug

What is a superbug?

A superbug (or multidrug-resistant microbe) is any kind of infection that’s hard to get rid of because it’s resistant to (unable to be destroyed with) available treatment. Most superbugs are bacteria that’ve developed antibiotic resistance, especially to multiple antibiotics. There are also fungal superbugs that are resistant to antifungal medications.

Ever wonder why there seem to be so many rules around taking antibiotics as directed? And not taking them when you don’t need to? You can thank superbugs. Antibiotics are really useful for fighting bacterial infections. But when germs (pathogens) see them a lot, they know what to expect and can develop ways to avoid them. This can be very dangerous if you get a superbug that knows how to survive many types of medications. It can lead to life-threatening, potentially untreatable diseases.

Examples of superbugs

Any bacteria can become resistant to antibiotics, but there are some that become superbugs more often. Examples of bacteria with superbug strains include:*

• Staphylococcus aureus (like MRSA).
• Carbapenem-Resistant Enterobacterales (CREs) and other drug-resistant Enterobacterales. This includes Klebsiella pneumoniae, E. coli, Salmonella and Shigella.
• Neisseria gonorrhoeae (gonorrhea).
• Pseudomonas aeruginosa.
• Acinetobacter baumannii.
• Mycobacterium tuberculosis (TB).
• Streptococcus pneumoniae (pneumococcal disease).
• Campylobacter.
  • Mycoplasma genitalium.
  • Bordetella pertussis (whooping cough).

Candida auris and Aspergillus fumigatus are examples of fungal infections that can be superbugs.

It’s important to remember that there are versions of these germs that are resistant to medications and ones that aren’t. If you get an infection with something on this list, it doesn’t necessarily mean you have a superbug.

*The Centers for Disease Control and Prevention (CDC) also includes Clostridium difficile (C. diff) on its list of antibiotic resistance threats. While C. diff doesn’t usually become a superbug, it’s often caused by antibiotic use.

What are the symptoms of a superbug?

Symptoms of a superbug infection can vary depending on where in your body you’re infected. Some symptoms could include:

• Fever.
• Chills.
• A rash or area of skin that’s red, discolored, painful, swollen, or filled with pus or fluid.
• Cough.
• Shortness of breath.
• Chest or abdominal (belly) pain.
• Fatigue or lethargy (extreme tiredness).
• Muscle or joint pain.
• Low blood pressure.
• High heart rate (tachycardia).
• Low body temperature (hypothermia).

These can be symptoms of many types of infections, not just superbugs.

What causes superbugs?

Superbugs develop drug resistance for many reasons. Sometimes, it happens naturally to co-exist with other organisms. Other times, it happens when the bacteria or fungi develop defense mechanisms to block or destroy antibiotic or antifungal medications.

In hospitals and other healthcare settings, bacteria can become resistant to antibiotics that providers use frequently. This is where superbugs often develop, and it can be hard to avoid, even when antibiotics are used properly.

Bacteria can pass their resistant genes to other, existing bacteria (horizontal gene transfer). They can also survive the antibiotics by other means and go on to reproduce, passing on their genes (including resistance) to more copies of the bacteria.

How do you get a superbug?

You can get superbugs through:

• Direct contact with someone who’s infected or colonized. Some people naturally carry bacterial or fungal superbugs on or in their bodies and never get sick from them (colonization). If you’re colonized with a pathogen, you can spread it to others, who might get sick from it.
• Touching contaminated objects or surfaces.
• Sharing contaminated items, such as bedsheets, clothes, medical or sports equipment, towels, shaving razors or utensils.
• Contaminated medical equipment and medical devices in your body (like a central venous line or breathing tube).
• Contaminated food or water and unpasteurized dairy products.

Who’s at higher risk for a superbug infection?

You might be at a higher risk for a superbug infection if you:

• Have a central venous line, breathing tube, feeding tube, or other tube or device that goes into your body. These can allow superbugs to get into your body from the outside.
• Have been on antibiotics for a long time or use them frequently. Longer exposure to antibiotics can give bacteria more opportunities to develop resistance. It also can kill off “good” (non-harmful) bacteria in your body that prevent other bacteria from growing out of control and causing an infection.
• Have a weakened immune system from an underlying health condition. This includes having HIV, blood cancers or diabetes, or receiving an organ or stem cell transplant. These conditions make it harder for your body to fight off infections.
• Are hospitalized for a long time or in a long-term care facility. Many superbugs develop in healthcare settings.

What are the complications of superbugs?

If providers can’t treat an infection quickly enough, it can cause serious complications, including:

• Sepsis and septic shock (extreme reactions to an infection that lead to low blood pressure, tissue damage and organ failure).
• Respiratory failure.
• Loss of infected limbs (amputation).

How are superbugs diagnosed?

Your provider may think you have a superbug if you have symptoms of an infection that don’t get better with treatment. They may look for bacteria and fungi or try to grow (culture) them from samples of body fluid or tissue, including:

• Blood.
• Pee (urine).
• Poop (stool).
• Fluid or tissue from a wound.
• Sputum (mucus coughed up from your lungs).

Tell your provider about any implanted medical devices you have or if you’ve stayed in a hospital recently.

Is there a cure for superbugs?

No one medication cures superbugs, which is why they’re so dangerous. Providers treat superbugs by finding medications that are effective against the specific germ causing the infection. You may need a combination of medications, like different types of antibiotics, taken together to fight the infection.

Additionally, providers treat skin infections by caring for open wounds, which could include draining fluid and surgically removing infected tissue. They might also remove infected medical devices, including prosthetics.

Antifungals called echinocandins can treat some resistant fungal infections, like Candida auris.

Can superbugs be prevented?

The best way to prevent superbugs from developing is to use antibiotics only when necessary. Healthcare providers have guidelines to follow to prevent unnecessary antibiotic use. But there are ways that you can do your part, including:

• Taking all medications as prescribed.
• If a healthcare provider prescribes antibiotics, taking the entire course, even if you feel better.
• Not taking antibiotics if you don’t need them. Colds and other respiratory infections are most often caused by viruses. Antibiotics won’t help them go away.

How can we reduce the spread of superbugs?

Healthcare providers follow safety and sterilization rules to reduce the risk of healthcare-acquired infections (including potential superbugs). These include:

• Washing their hands.
• Disinfecting surfaces.
• Ensuring that people only take antibiotics when they have bacterial infections.
• Sterilizing medical devices.
• Quarantining (isolating) people with superbug infections so they don’t spread to other people.

While more common in healthcare settings, superbugs can spread in many ways. You can reduce your risk of superbugs with the same habits that reduce your risk of infectious diseases, in general:

• Keep wounds clean and covered.
• Don’t reuse needles used for injecting nonmedical drugs or medications (even your own).
• Regularly wash sheets, towels and clothes in the recommended water temperature.
• Use disinfectants that kill germs to wipe down high-touch areas like light switches, remote controls and athletic equipment.
• Get vaccinated. There are vaccines against many types of bacteria that have superbug strains, including Bordetella pertussis and Streptococcus pneumoniae (pneumococcal vaccines).
• Practice good hygiene. This includes maintaining good hand-washing habits, wearing clean, dry clothes and not sharing personal items with other people.
• Practice safe food habits. This includes storing food properly, heating meat and poultry to a temperature that kills bacteria, and washing or peeling fruits and vegetables before eating.
• Use a condom or dental dam during any kind of sex.
• Ask your provider how long you need to use invasive medical devices (like catheters) and how to prevent infection while you need the device.

What happens if you get a superbug?

If you get a superbug, you may need to be treated longer than expected or with multiple medications. Some people develop life-threatening infections. If you have a severe or invasive (widespread in your body) infection, you’ll be treated in a hospital where healthcare providers can monitor you closely.

If you have a skin infection, your provider will surgically treat and drain your wounds. They might give you topical or oral antibiotics.

Can you survive a superbug infection?

Yes, people survive superbug infections. But the mortality (death) rate is high — in some cases, up to 50% — for severe infections or ones that spread to your blood.

When should I see my healthcare provider?

If you have an implanted medical device or a weakened immune system, ask your healthcare provider what signs of infection you should look out for. Follow up with your provider if you have any concerning symptoms.

Even when you’re in the hospital, communication with your healthcare team is important. Let them know if you’re experiencing symptoms of an infection, like pain, rapid heart rate, weakness or fever.

When should I go to the ER?

Go to the emergency room if you have any signs of severe illness, including:

• Fever over 103 degrees Fahrenheit or 40 degrees Celsius.
• Severe pain.
• Seizures.
• Confusion or disorientation.
• Sudden drop in blood pressure (symptoms include weakness, dizziness and fainting).

What questions should I ask my doctor?

It might be helpful to ask your healthcare provider:

• What are my treatment options?
• How do I take my medications?
• When can I expect to feel better?
• How did I get this infection?
• What can I do to prevent an infection like this in the future?

How common are superbugs?

Nearly 3 million people in the U.S. get sick with antibiotic-resistant bacterial infections every year. Over 35,000 people die from them.

What is the hardest infection to get rid of?

Strains of pathogens that’ve developed resistance to multiple drugs are the hardest to get rid of. Infections like MRSA and CREs are often resistant to more than one type of antibiotic, so finding one that’s effective (or a combination of medications that work together) can be challenging and take a long time.

A note from Cleveland Clinic

Superbugs would exist in the environment even if humans weren’t around to create germ-destroying medications — it’s how they survive in nature. But our use of antibiotics, especially when they’re taken unnecessarily, is speeding up their development.

Superbugs can cause life-threatening infections that are hard to treat. If you have symptoms of a bacterial or fungal infection, especially if you’ve recently stayed in a hospital or healthcare facility, see a provider right away. Quick treatment can reduce your risk of getting seriously ill.