Tag: antibiotic resistance

Are you listening yet?

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It was about a year ago that I wrote the We’re All Buggered post, referring to antibiotic resistance and the potential threat of living in a post-antibiotic era. At that point, it wasn’t really news to anyone in the microbiological community: indeed, in that post I mentioned a seminar I attended ten years ago in Oxford, and even then it wasn’t really news to us.

But slowly, surely, these stories are beginning to infiltrate the media more and more often. And the reasons for this are fairly clear – scientists are becoming ever more concerned about the impending problems we are facing and moreover, a great number of the public are being affected by the issue, thus it’s becoming more relevant and therefore, more newsworthy.

Of course, if this problem wasn’t so insidious, we’d all be panicking about it already. If there were a 9/11 or a Hurricane Sandy – a single event – there would be far more awareness. (Not that awareness would really help anyway.)
But that’s not the case with the antibiotic resistance problem. It’s sneaking up on us and, for those of us in the know, it’s rather worrying*.

The latest “big name” to have come out with a stark warning is an associate director for the CDC, Dr. Arjun Srinivasan:

For a long time, there have been newspaper stories and covers of magazines that talked about “The end of antibiotics, question mark?” Well, now I would say you can change the title to “The end of antibiotics, period.”

We’re here. We’re in the post-antibiotic era. There are patients for whom we have no therapy, and we are literally in a position of having a patient in a bed who has an infection, something that five years ago even we could have treated, but now we can’t.

Quote via kottke.org (take tinfoil hat along for some of the comments). Here’s the full programme on PBS.org, with the suitably dramatic title: Hunting The Nightmare Bacteria. (Hint: it’s not difficult – just go to any major hospital and they’ll come find you.)

Jason Kottke suggests that drug-resistant infectious diseases should be added to the list of “disasters with no clear low point”, and he’s probably correct. Remember that Dame Sally Davies (the Chief Medical Officer in the UK) thought that:

“…the threat from infections that are resistant to frontline antibiotics was so serious that the issue should be added to the government’s national risk register of civil emergencies.”

and that puts it alongside threats like “explosive volcanic eruptions” and “catastrophic terrorist acts”.

As previously, I don’t expect this post to do anything to make a difference to the situation. There’s actually nothing we can do to prevent this now. I just thought that you ought to know.

Have a great weekend.

* The latter part of this sentence contains a fair amount of understatement.

Two more ways microbiology is going to kill you

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Well, I say two “more”, but in fact we’ve covered one of these on more than one occasion previously. That’s the issue of antibiotic resistance and the fact that we’re all – at some point or other – going to die a horrible infected death.

But we won’t be the first. Not by a long shot. Because The Centers for Disease Control and Prevention (CDC) in the US revealed (just before the Federal Shutdown) that of the 2 million plus Americans affected by antibiotic resistant bugs each year, around 23,000 will die. This is news because it’s the first time they’ve put a hard number on the number of deaths. And they’ve done it as objectively as possible:

The number of deaths is substantially lower than previous estimates, in part because researchers from the Centers for Disease Control and Prevention stripped out cases in which a drug-resistant infection was present but not necessarily the cause of death.

Which isn’t great, but does at least set down the ground rules – and therefore a baseline – for future calculations. Those future calculations are unlikely to be pretty:

“We are getting closer and closer to the cliff,” said Dr. Michael Bell, a CDC official who presented the data.

Yes, we know. Sally already told you that.

However, should you currently be in Madagascar (and especially in its prisons), antibiotic resistance is probably not going to worry you.
BUT THE BUBONIC PLAGUE MIGHT.

Yes, really.

Also known as The Black Death, this is exactly the same disease the swept through Europe in the 17th Century, killing about half the population of the continent. I remember a scare back in the lab in Oxford in the late 90s when one of our ID tests gave a result that could have indicated Y.pestis (the bug that cause bubonic plague) and everyone crapped themselves.
Fortunately, it turned out not to be the case and anyway, crapping oneself is not a symptom.

But now experts have warned that Madagascar is on the point of a major epidemic unless it slows the spread of the disease:

The Red Cross and Pasteur Institute say inmates in the island’s dirty, crowded jails are particularly at risk. The number of cases rises each October as hot humid weather attracts fleas, which transmit the disease from rats and other animals to humans. Madagascar had 256 plague cases and 60 deaths last year, the world’s highest recorded number.

Because this is a bacterial disease, it can easily be treated with antibiotics – and fortunately there are very few resistance problems in this case. For the moment at least.

The major issues with getting people treated are socioeconomic ones:

a lack of facilities and traditional shame over the disease made this tricky in outlying parts of Madagascar

Look, I’m not saying “don’t go to Madagascar”. It’s got a lot to offer: lemurs… and… stuff. But if you do go to Madagacar, it’s probably best to not end up in one of their prisons.

I’m sure you knew this already. I’m just saying that right now, it could be even worse than you expected.

Sally Speaks

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Professor Dame Sally Davies – Britain’s Chief Medical Officer – was a busy lady yesterday, speaking to the Commons Science and Technology Committee on a range of health related issues, two of which will come as no surprise to readers of this blog.

First off, as I reminded you guys late last year, we’re all going to die horribly because pretty soon we’re not going to have any useful antibiotics available to us. By “useful”, I mean ones that work.

Prof Davies even went as far as to suggest that:

“…the threat from infections that are resistant to frontline antibiotics was so serious that the issue should be added to the government’s national risk register of civil emergencies.”

She described what she called an “apocalyptic scenario” where people going for simple operations in 20 years’ time die of routine infections “because we have run out of antibiotics”.

I would (and do) agree, but I take exception with her use of the term “apocalyptic”. Recent failed apocalypses (Harold Camping, The Mayans) have meant that the word lacks any sort of gravitas amongst the general public any more. They simply don’t take it seriously. And this is serious, although there’s actually very little that the general public can do about it. Except die. Horribly.

On a lighter, far more comedic note, the meeting of the Science and Technology Committee also included a brief discussion on Homeopathy. This is about as appropriate a conversation about tree-felling methods at a meeting of the Monetary Policy Committee or a chat about the fungal diseases of goldfish at a meeting of the Institute of Motor Mechanics Committee, but fortuitously, Dame Sally dealt with the subject with the ridicule it so richly deserves.

Professor Dame Sally Davies said she was “perpetually surprised” homeopathy was provided on the NHS, and branded homeopaths “peddlers””

She also expressed fears about the prescription of homeopathic remedies to treat malaria and other illnesses:
“I’m very concerned when homeopathic practitioners try to peddle this way of life to prevent malaria or other infectious disease,” she said. “I am perpetually surprised that homeopathy is available on the NHS.”

Dame Sally, who is England’s most senior doctor, concluded by remarking that homeopathy “is rubbish”.

Now all that we need is a Secretary of State for Health that chooses to listen to scientific and er… medical advice. Not like the incumbent Jeremy Hunt, who is an idiot.

We’re all buggered – when news is not news

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According to Sky News today yesterday (note subtle hint that this might be a post-dated blogpost):

The Chief Medical Officer has raised the prospect of a future without cures for common infections – unless antibiotics are used more responsibly.

You don’t say, Professor Dame Sally Davies?

This isn’t news.

Over ten years ago, while in Oxford, I attended a seminar by Dr David Livermore, then Director of HPA’s Antibiotic Resistance Monitoring and Reference Laboratory in the UK. He basically told the gathered microbiologists (I have no idea what the correct collective noun is here – “a culture”?) that we were all buggered, because we were heading back to a pre-antibiotic era due to the prevalence of antibiotic resistance.

The effect of his stark warning on an educated, usually sceptical audience was interesting. Every single person agreed. Because we were already seeing more and more resistant bacteria in our laboratories every single day and we were having to resort to more and more outlandish, expensive and (in some cases) relatively untested antibiotic treatment regimens to cure patients of their infections.

But the time will come (soon), when we run out of antibiotics and we’ll be at the mercy of what are – at the moment at least – minor infections. Advanced surgery like transplantation, will become impossible – immunosuppressed patients will simply not survive the inevitable infections without prophylactic (preventative) antibiotic treatment. Even “basic” surgery will be impossible for the same reasons. Anything around the abdomen – appendicitis, for example – will effectively mean game over.
But it’s not just this “running out of options” that is the issue:

When somebody has a severe infection – say blood poisoning – causing a high fever, a hospital clinician will dispatch blood samples to the lab to find out exactly what he is dealing with. But that takes time. “He will start you on antibiotics because that will kill infection within 48 hours,” says Livermore. “So during 48 hours, you are being treated blind. The more resistant your bacteria are, the less likely the antibiotic is going to work.”

It’s an unpleasant thought, so why aren’t we more concerned?

Well, because this is an insidious problem. There’s hasn’t been and there’s not going to be one specific, defining moment in this horror story. No 9/11, no Marikana, no December 21, 2012. It’s just slowly happening and sadly, we’re pretty powerless to stop it. Here in South Africa, we have already had problems with first MDR, then XDR tuberculosis. If you think that it’s all ok, because things are going to end there, then maybe you shouldn’t google “TDR-TB”.

Professor Dame Sally Davies blames over-prescription of antibiotics for the rise is resistance, but the evidence for this is far from conclusive.
Livermore again:

Governments worldwide are pressing for reduced antibiotic use, hoping thereby to reverse resistance trends. Is success likely? The evidence is mixed, and expectations should be tempered by the growing realization that many resistant bacteria are biologically fit, making them difficult to displace.

Yes, he’s basically suggesting that the bacteria are actually too strong for us to defeat. We are being outwitted – out evolved – by microbes. It’s kind of difficult to stomach, but:

“The emergence of antibiotic resistance is the most eloquent example of Darwin’s principle of evolution that there ever was,” says Livermore. “It is a war of attrition. It is naive to think we can win.”

So there you have it. Happy thoughts for the weekend. I just thought that I really should tell you today, because with the country and the world so very full of good news right now, you probably needed a reality check.

None of it matters. We’re all buggered.