Antibiotics: From Miracle to Mirage

Hook

When penicillin first hit hospital wards in the 1940s, it was nothing short of miraculous. Infections that once meant death were suddenly curable. It was the dawn of modern medicine.
But just as Alexander Fleming warned in 1945, misuse would breed resistance. Eighty years on, that warning rings louder than ever — and COVID showed just how fragile our “progress” really was.

Context

For nearly a decade, the U.S. had been slowly chipping away at drug-resistant infections. Hospital-onset MRSA was down, C. difficile was receding, carbapenem-resistant organisms were being held in check. It looked like stewardship, infection control, and investment were finally paying off.

Then 2020 hit. The pandemic tore through every safeguard.

• CRE (carbapenem-resistant Enterobacterales) up 35%. These are “nightmare bacteria” — E. coli, Klebsiella, and their cousins — now resistant even to carbapenems, our antibiotics of last resort.
• Carbapenem-resistant Acinetobacter up 78%. Another hospital pathogen, notorious for infecting ventilated patients and surviving on surfaces.
• ESBL (extended-spectrum beta-lactamase–producing Enterobacterales) up 32%. These enzymes make common gut bacteria resistant to penicillins and cephalosporins.
• MRSA (methicillin-resistant Staphylococcus aureus) bloodstream infections up 13% in hospitals.
• Candida auris cases surged ~60%, a fungal pathogen spreading quietly in COVID wards, often resistant to multiple antifungals.

One year of crisis erased a decade of hard-won gains.

Breakout Box: What We Mean by Resistance

• Antibiotic resistance happens when bacteria or fungi adapt so drugs no longer work against them.
• It threatens surgery, cancer care, neonatal medicine — any field that relies on infection control.
• COVID-19 disrupted prevention and stewardship, fueling spikes in resistant infections.

Common examples:

• CRE = carbapenem-resistant Enterobacterales (E. coli, Klebsiella and similar “nightmare bacteria”).
• MRSA = methicillin-resistant Staphylococcus aureus, a hospital and community superbug.
• ESBL-producers = gut bacteria resistant to many penicillins and cephalosporins.

🔎 See the full Antibiotic Resistance Guide for causes, risks, and prevention.

Your Take

We still act as if antibiotics are infinite — reflex prescribing, “just in case” coverage, entire ICUs flooded with broad-spectrum drugs during COVID despite low bacterial coinfection rates.

The truth is they’re not infinite. Antibiotics are a limited, fragile resource. Once lost, they don’t come back.
They’re more like clean water than like oil: everyone assumes there’s an endless supply, until the taps run dry. Misuse is pollution; every unnecessary course contaminates the pool for everyone else.

And just like with water, the crisis creeps in slowly — until one day, what was abundant becomes scarce, and lives hang on what we wasted.

Implications

• Antibiotics are infrastructure. Without them, modern surgery, neonatal care, and cancer treatment collapse.
• Prevention is preservation. Vaccines, hygiene, and infection control buy time for the drugs we have.
• Stewardship is survival. Every “just in case” script chips away at the future.
• Policy must harden. Funding for labs, infection prevention, and surveillance can’t be optional — or progress will unravel again at the next system shock.

Further Reading

• Guide: Antibiotic Resistance
• CDC: COVID-19 Impact on AMR (2022 Special Report)

Closing

Antibiotics turned the tide of medicine once. But unless we start treating them with the same respect we give to clean water — precious, finite, and worth protecting — we’ll watch that tide recede.
And when it does, we won’t get it back.