In 1928, Alexander Fleming discovered Penicillin, saving countless lives. But he already foresaw that bacteria will evolve to become resistant to antibiotics in the future. Fleming was correct because currently, about 700,000 lives die each year from antibiotic resistance, causing it to be a global crisis (TED). Antibiotic resistance is when bacteria can resist the effects of an antibiotic, making it harder to get treatment for bacterial infections. For example, Gonorrhea infects 820,000 American every year and ? is resistant to drugs. In the 1900s, one out of seven died of Tuberculosis in the United States and Europe, but the antibiotic created in 1943 caused Tuberculosis to vanish. But now it has come back infecting 10,500 cases each year, who are not responding to antibiotics. (Millman 2016) These are a few of many infections that bacteria have developed resistance from and it will not go away. Antibiotic resistance is approaching us more rapidly every day until one day in the future everyone will have full resistance to antibiotics. Over time, bacteria evolve resistance to antibiotics from the antibiotic overuse and spread throughout the environment from livestock. Currently, antibiotic resistance is impacting people’s health harmfully and lethally at an alarming rate. But there is still hope to solve this global crisis by knowing how to prevent antibiotic resistance and continuing to learn more about the genetic and molecular mechanisms in order to come up with more possible solutions. How has antibiotic resistance impacted the people’s bodies and livesIn Maryland, the summer of 2011, a hospital at the National Institute of Health experienced its first KPC outbreak. KPC, or Klebsiella pneumoniae carbapenemase is a deadly superbug that lives in the digestive system and can spread resistance to other bacteria. Patients carrying it are put into isolation because of the danger and harm this superbug can bring to other patients. It started with a patient transferred to NIH with a rare lung disease and carrying KPC. The patient was in the intensive care unit and then five weeks later, KPC appeared in a 34-year-old man who wasn’t even in the same ICU as the first patient. The male patient was resistant to five antibiotics and six antibiotic combinations. DNA tests were then taken to show that KPC was shown to spread from the ICU into the general hospital area. The hospital’s outbreak infected many patients throughout the hospital, causing there to be many isolation areas. This went on for six months, ending with 18 infected and six dead. When the hospital finally thought this outbreak was done, 19-year-old Troy Stulen, a patient recovering from a bone marrow transplant, came back to the hospital for a check-up. Troy started to resist drugs because he obtained the KPC superbug, even though he was on an entirely different floor during the KPC outbreak. He died on September 7, 2012 (Young 2014). Antibiotic resistance can do its toll in entire hospitals, but it also impacts the patient’s lives and health significantly. Thirteen year-old, Tony Love scraped his elbow during gym class in 2007. His elbow healed quickly, but in a couple days, he got a high fever and his left knee, left foot, hands, hip joints were swollen and in pain. Since he didn’t want to eat or even walk to go to the bathroom, he was admitted to Comer Children’s hospital in Chicago, Illinois. In the ICU, his blood cells were clumping in his arteries, his organs were failing and he went into septic shock. What started as a scrape on his elbow turned into Tony dying in front of his mother’s eyes. In the operating room, surgeons cut him open to drain pus from his fingers, feet, hips, shoulders, knees, and hands. In the middle of his left hand, there was pus with the size of a golf ball and the pus in his left knee could fill a baseball. Tests from the lab showed that he had MRSA, methicillin-resistant Staphylococcus aureus. Staphylococcus, or a Staph infection has symptoms like boils, rashes, muscle or bone abscesses, pneumonia, toxic shock and infestations in heart valves. With half a million serious cases, the antibiotic called methicillin was created in 1960 to save these lives. But by 1996, there was already widespread resistance in every large US hospital with at least one patient with the MRSA infection. Tony Love was not only methicillin-resistant. but a new drug called Vancomycin was also not working. Tony had VISA, or Vancomycin intermediate Staphylococcus aureus. The drug killed only the susceptible bacteria, but not the more resistant ones, which can lead to more-resistant staph bacteria to multiply. Tony Love continued to have more than twenty surgeries to clean out infections and repair the damage the staph toxins made. After seventy days, he got transferred out of ICU, got eight weeks of rehab, many weeks of antibiotics and months of therapy. In March 2008, for the first time in seven months, Tony Love was able to put full weight on his leg. With his antibiotic-resistant infections, Methionine and Vancomycin could no longer help his grave condition. In result, an energetic and athletic thirteen-year-old boy will no longer be able to use his leg normally or play any type of sports (McKenna 2011). The mechanisms of antibiotic resistanceAntibiotic resistance has both genetic and molecular mechanisms that play their role and how they work. One mechanism is the genetic natural selection of antibiotic resistance. When exposed to antibiotics, the susceptible bacteria die, but few of the most resistant ones survive and multiply. These resistant bacteria have antibiotic resistant DNA, which can be passed onto their offsprings, creating fully-resistant future generations of bacteria. This process is also called vertical transfer. But there is new research that claims another process called horizontal transfer. The research shows that resistant genes can find their way onto pieces of DNA called plasmids, which can be easily spread from bacteria to another bacteria. This means that bacteria can give their drug-resistance to other bacterias, causing more problems. New research also shows that when antibiotics are repeatedly being exposed to bacteria, the resistance multiplies at a faster rate and it stays, even when there are no more antibiotics (Wenner 2016). Through natural selection, the resistant-bacteria use their molecular mechanisms to make drugs less effective, in order for them to survive. For example, structural changes to the bacteria can prevent the binding of antibiotics to the bacterial proteins, which they need in order to destroy the bacteria. They can alter the cell walls to prevent antibiotics from entering so that the drug cannot affect them (Sivalanka 2016). What factors can cause antibiotic resistance?There are significant factors contributed by humans that increase the rate of antibiotic resistance vastly. One factor is through the overuse and misuse of antibiotics in prescriptions and hospitals. There is a fifty percent usage of unnecessary antibiotics in hospitals and forty-five percent of prescriptions don’t work because they are inaccurate. In hospitals, drugs are used to kill off susceptible bacteria yet the resistant bugs survive and thrive, which makes it easier for them to contaminate medical equipment, staff and other patients (McKenna 2015). Livestock is another important factor to spreading resistance to humans through consumption and the environment. Annually, 80 percent of all antibiotics go to farm animals for their growth and to prevent their infections. In 2014, this meant farm animals received 21 million pounds of antibiotics, which is three times more than people. The antibiotics of animals will travel into their guts and when the livestock is disassembled, the guts contaminate the meat that we eat in the supermarkets. So as we consume meat products from the store, it’s antibiotic-resistant bacteria spreads to us also. Resistant bacteria can also spread through the environment from the fields of animal manure on farms. Every year farms have 600,000 gallons of pig manure spread on crop fields, having a gold mine of undigested antibiotics with antibiotic-resistant bacteria and genes. Animal manure is used to fertilize crops, which mean it’s bacteria spreads onto the crops we eat also. The manure will spread throughout the environment; it can be washed away in to our water system by the rain, it can be blown away in the wind or it can be left on the feets on insects and rodents. All these little things further the spread and impact of resistant bacteria (Gross 2017). Although some farmers and rich livestock company owners deny everything, there are many cases and studies that prove livestock spreads antibiotic resistance. In a 2012 study, FDA scientists tested raw meat products sold in supermarkets around the country and found that “84 percent of chicken breasts, 82 percent of ground turkey, 69 percent of ground beef and 44 percent of pork chops were contaminated with intestinal E. coli. More than half of the bacteria in the ground turkey were resistant to at least three classes of antibiotics” (Wenner 2016). Another specific case is in Arizona’s Flagstaff hospital, where there was a trend that showed completely healthy people getting antibiotic resistance to a Urinary-tract infection. This was serious because antibiotics are the common treatment for UTIs, and no treatment could lead to kidney infections that can infect the bloodstream, which will lead to death. Scientists took lab tests that showed more than a 100 UTI resistant cases link back to meat at the Flagstaff grocery store (Young 2014). When we consume meat products raised with antibiotics, it’s resistant bacteria can spread to our bacteria that live in our gut. That resistant bacteria is capable of traveling a short distance into a woman’s urinary system and cause a UTI. Doctors often fail to recognize that women have a foodborne UTI, not a sexually transmitted one. In result, women are given antibiotics that don’t work, but instead, they just think to consume more drugs for the effects to be able to work (Gross 2017). Another case is in Geisinger, Pennsylvania’s largest medical provider. They had a 30 percent increase of MRSA cases that were are all nearby animals farms. This shows those who live nearby a farm are 38 percent more likely to have MRSA (Young 2014). How we can prevent antibiotic resistanceAs antibiotic resistance is exponentially becoming a harmful effect on everyone, we need to prevent further antibiotic resistance and slow down this rate that’s infecting many. Reducing the antibiotic use agriculturally through crops and livestock will play a significant preventive factor. In 2013, the Food and Drug Administration took action to reduce antibiotic use in agriculture. They initiated rules to stop using antibiotics on farm animals for growth, but allowed farms to voluntarily choose to follow these rules (Young 2014). In 2014, Jim Perdue chose to follow these rules, as owner of the fourth largest chicken company in the United States. By 2017, he met his goal; his company raised 100% antibiotic-free chickens. Rather than using antibiotics, he prevents diseases in chickens by making them happy and healthy. In farms, these chickens exercise more, have more sunlight in barns, a pure diet with herbs, yogurt and no other slaughtered animals. Not many CEOs of livestock companies, like Perdue, choose to follow these rules, therefore most meat products in the supermarkets have been raised with antibiotics.In supermarkets, meats with labels like hormone-free, raised-cage free and organic can be indicators of antibiotic use in the product. Chickens can receive antibiotics when they are an egg or during the first day of their life. So, meat labeled “organic” can apply to these chickens who have still received antibiotics before the second day of their life (Gross 2017). It’s very important for consumers to choose to buy antibiotic-free meat because it will help reduce the spread and evolution of antibiotic-resistant bacteria immensely. Perdue’s company will have increased profits, which can provide incentives for other companies to find new methods to raise livestock without antibiotics. Another preventive factor is to ensure political commitment to the threat of antibiotic resistance. In the 1990s, there were failed attempts to control antibiotic use in farm animals by Former U.S. Food and Drug Administration Commissioner, Donald Kennedy. He wanted to withdraw licenses for antibiotic growth in poultry that was granted by the FDA in the 1950s. But powerful congressmen and Secretary of Agriculture, Jamie Whittmen completely opposed Kennedy’s idea and with his complete control of the FDA budget, he threatened to cut the budget, if this man continued his actions (Young 2014). Because of this, no further actions were taken politically to deal with antibiotic resistance until President Barack Obama came into office. In September 2014, President Obama set a five-year plan to further prevent antibiotic resistance. His plan consists of increasing surveillance, faster development of new antibiotics and having more careful prescriptions and usage of drugs. He also offered a $20 million dollar prize for an invention of a diagnostic test for highly resistant infections (Alic 2017). But with President Obama out of the office and President Donald Trump in replacement, the degree of attention and commitment to the global crisis of antibiotic resistance within politics is unsure. Other preventive methods include having a better control and knowledge in antibiotic usage. Tracking is a preventive method that is implemented with CDC’s National Healthcare Safety Network (NHSN). NHSN is used by these healthcare facilities to electronically report infections, antibiotic use, and resistance. With this information, facilities can focus on areas that need their attention, in order to make improvements there. Facilities also follow through and track the success there, after their efforts. Constant knowledge obtained through tracking, will be valuable to scientists and doctors who are looking for solutions to antibiotic resistance. Another method is preventing infections in the first place. Not having any infection to treat with antibiotics will prevent antibiotic resistance because there will be no need to use it. The more antibiotics you use, the more resistant future generations of bacteria will be. So, preventing infections can be done by getting vaccine shots, having safe food preparation, handwashing and much more. Using antibiotics only when necessary is also very important with preventing resistance. Another way to prevent antibiotic resistance is to make sure antibiotics are not misused or overused. Unfortunately, many people often receive inaccurate prescriptions for antibiotics when they are not warranted, causing them to use more antibiotics than necessary. Sometimes doctors don’t test their patient’s bacteria that’s causing the infection, which can result in useless antibiotics being prescribed. Other times, patients demand antibiotics for simple illnesses like a cold, but drugs are not necessarily needed. Yet, doctors and hospitals still give patients the satisfaction of having antibiotics, even though it can be a misuse or overuse (CDC 2017).What are the possible solutions that scientists are working on? One solution that’s being worked on is phage therapy. Scientists have known about phages since the early 1900s, but its existence has been largely dismissed when antibiotics were fully useful. But now as antibiotic resistance is occurring, phages could become the treatment of choice for infections. Patients can take phages in a pill, powder or ointment form. In phage therapy, a combination of viruses are selected to treat an infection by hijacking the cellular machinery of bacteria and killing them. Phages attach to bacteria’s outer surfaces and inject their own DNA, which codes for the cell to make phage proteins. The new production of phages burst out of the bacterium and destroys it in the process. In addition, phage therapy can selectively kill the bad bacteria causing the infection without harming the “good” bacteria. Phages are also specific to individual bacterias because their enzymes, called adhesins will only interact with particular molecules on the surface of bacteria. This causes phages to do little harm to other cells, whereas antibiotics often kill both good and bad bacteria. But the important characteristic of phage therapy is its ability to mutate and fight against bacterial resistance. Although phage therapy is a workable solution, there are some drawbacks. One drawback is that gravely ill patients may have to wait 48 hours for their infection to be identified and to have the correct phage to use. Another problem is that Russia, Georgia and Poland are the only ones primarily practicing phage therapy. The U.S. FDA prohibits most phage therapies because they haven’t got approval for clinical trials and there aren’t many clinical trials because they depend on investments of organizations. However in 2014, things are beginning to change as National Institute of Allergy and Infectious Diseases supported MIT researchers working on a phage that will deliver killer DNA to antibiotic-resistant bacteria. Other biotech firms are also developing their own innovations for phage therapy. Intralytix, a biotech company in Baltimore, developed skin-like patches that have phages that will fight three different bacterial wound infections. Exponential Biotherapies in Port Washington, New York State, is focusing on developing phages that will last longer in the body. The firm is also planning to start trials in patients with blood and skin infections caused by E.faecium, which is resistant to the antibiotic, vancomycin (Wilson 2003). Another possible solution is quorum-sensing inhibition. Bacteria communicate with each other by emitting a constant stream of signal molecules. By signaling each other, bacteria can recognize when they have a quorum– enough bacteria around them to do any task they need to. Quorum-sensing inhibitors will disrupt this signaling between bacteria, which will cause them to be unaware if they have a quorum to cause antibiotic-resistant infections or infections as a whole. The bacteria will instead just float around aimlessly until the host gets rid of them. Although there is nearly more than 15 years of research on this solution, there are no reliable and consistent anti-quorum-sensing compounds that have been found yet. This solution still is years away from having workable therapies (Millman 2016). A future without effectful antibiotics will cause chaos with untreated illnesses and injuries that will lead to death. One out of six people would die because common infections, like strep throat, rashes, pneumonia and many more will become fatal again with no effectful treatment. Cancer patients, surgeries, transplant patients, and moms in labor will not longer have the antibiotics to support their health (McKenna 2015). This global crisis is impacting us harmfully and approaching more of us at an alarming rate. For this rate to slow down, everyone needs to take part by educating themselves on this topic, reducing antibiotic overuse in agriculture, correcting the antibiotic misuse in prescriptions and coming up or helping with more sustainable solutions.