Infections caused by bacteria that don't respond to treatment are rare, but they pose a growing threat to public health.


Hugh Hefner’s cause of death has been listed as cardiac arrest (which also killed Tom Petty just days later) and respiratory failure. But the week before he died on Sept. 27 at age 91, Hefner had an E. coli infection as well as septicemia, or bacteria in the blood, according to his death certificate, PEOPLE reported.

E. coli, or Escherichia coli, bacteria live in our intestines normally, but certain strains can make us sick. Some cause diarrhea, urinary tract infections, pneumonia, and other illnesses, according to the Centers for Disease Control and Prevention. What makes Hefner's E. coli alarming, however, is that his death certificate listed it as resistant to antibiotics. Drug-resistant E. coli is particularly troubling because public health officials are running out of ways to treat such infections. “There are some infections that we see that are so resistant to antibiotics, we wouldn’t predict that any antibiotic would be able to work,” says Pritish K. Tosh, MD, a Mayo Clinic infectious disease physician and researcher.

Most people with an E. coli infection in the gut, which would cause diarrhea, get better after a few days of rest and extra fluids to prevent dehydration. But more serious E. coli infections may require antibiotics and could be life-threatening, says Dr. Tosh, especially if first-line antibiotics are not effective. (Dr. Tosh did not treat Hefner.) When E. Coli doesn’t respond to treatment, doctors might use older antibiotics, but those can be less effective and more toxic, he says.

Think of antibiotic resistance as a survival mechanism for bacteria, Dr. Tosh explains. Bacteria developed resistance over time to drugs designed to kill them off so they could keep multiplying. But humans may be making it easier for these so-called superbugs to thrive—in part by taking more antibiotics than we need and not using them as recommended by doctors. “The more antibiotics we use, the more pressure there is on bacteria to survive,” he says. “If we aren’t taking conscious steps, we will find ourselves back in the pre-antibiotic era."

Thankfully, cases of antibiotic-resistant E. coli infections are rare, says Dr. Tosh. The bacteria, which are usually spread through contaminated food, water, or from person to person, first set up shop in the gut. In most healthy people, good gut bacteria keep the bad ones in check. But if you’re already sick or your immune system is compromised, taking antibiotics will reduce your levels of healthy gut bacteria and give drug-resistant bacteria a greater chance of surviving, thriving, and triggering serious illness, he explains.

The cause of Hefner’s E. coli infection was listed on his death certificate as unknown, according to PEOPLE. He also had septicemia, or bacteria in his blood. “Sepsis is the body’s overwhelming response to an infection that leads to organ shut-down,” Dr. Tosh explains. It’s a sign that bacteria infecting another part of the body have infiltrated the bloodstream and provoked a serious, life-threatening reaction.

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While antibiotic-resistant infections of any kind pose a looming public health threat, there are two simple things you can do to help on an individual level: Get your vaccines (so you don't become sick in the first place and badger your doctor to give you antibiotics you don't need) and wash your hands on the regular, according to the CDC, which significantly reduces the spread of bacteria and other bugs.