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Are antibiotic-resistant bacteria more dangerous besides their resistance?

I am aware of the way things were before the first antibiotics: people died from infections often and diseases like syphilis were protracted death sentences.

My question is motivated by the following ideas:

  1. Is it possible that antibiotic resistance also means that some bacteria will be harder for the immune system (without effective antibiotics) to combat? That in a general sense, antibiotic-resistant bacteria are "stronger" or more aggressive?

  2. If there is a genetic component to fighting off bacterial infections, do the generations since antibiotics have a higher percentage of members who are not going to be as good as people were on average 90 or so years ago at dealing with infections?

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  • Here's one interpretation of that possible frightening near-future: surgeonx.co.uk
    – Chris
    May 3, 2019 at 8:34
  • That sounds like fiction. Also like the Japanese comic Blackjack. Is there any reason to believe this is fact-based?
    – releseabe
    May 3, 2019 at 10:34
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    This question is entirely hypothetical, so not answerable with a convincing evidence. You may want to search about what is already known about antibiotic resistant bacteria, such as MRSA.
    – Jan
    May 4, 2019 at 9:05
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    @LangLangC I hope so too.
    – Carey Gregory ♦
    May 5, 2019 at 4:04
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    I tried to pare this down to a more answerable question that can focus on what is known today rather than speculation about the future.
    – Bryan Krause ♦
    May 17, 2019 at 21:16

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Is it possible that antibiotic-resistant bacteria become stronger, that is harder for the immune system to combat?

Short answer: It depends on the species of bacteria, immune status of an individual, etc.

The authors of this article: The Complex Relationship between Virulence and Antibiotic Resistance (PubMed, 2017) make a vague conclusion that:

Increased virulence [the potential of certain bacteria to cause disease] may naturally evolve in response to or concurrently with increased antibiotic resistance...

In one study in mice, antibiotic-resistant bacteria were less virulent than the antibiotic-sensitive ones. Comparison of the virulence of methicillin-resistant [MRSA] and methicillin-sensitive Staphylococcus aureus [MSSA] (PubMed, 1994)

These results indicate that MRSA is less virulent than MSSA in normal hosts, but that they are equally virulent in immunocompromised hosts.

It's not possible to make a general conclusion from a single animal study, though.

Another aspect is that bacteria resistant to one antibiotic are prone to become resistant to other antibiotics. Staphylococcus aureus can become resistant to methicillin (methicillin-resistant S. aureus or MRSA), vancomycin (VRSA) and several other antibiotics (PubMed, 2009). Furthermore, plasmids (the DNA particles in the bacteria that induce antibiotic-resistance) can spread to other species of bacteria, for example, from staphylococci to enterococci.

If there is a genetic component to fighting off bacterial infections, do the generations since antibiotics have a higher percentage of members who are not going to be as good as people were on average 90 or so years ago at dealing with infections?

Antibiotics helped to survive many "bacteria-sensitive" people, and their offsprings may be more sensitive too, so it is possible that today there are more individuals sensitive to bacteria than 90 years ago. However, according to one 2015 study in twins, variation in the human immune system is largely driven by non-heritable influences (Cell.com).

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