It’s easy to take the miracles of modern medicine for granted, including the discovery of antibiotics. Roughly since WWII, grave infections that had once killed or maimed with frequency, no longer did. Penicillin and then other antibiotics were the difference, typically allowing a patient to go home just a few days after commencing treatment.
A woman’s recent death in Nevada reminds us that we face a future that will look far different. After decades of widespread use, often inappropriately, in both human medicine and livestock production, our doctors are simply running out of antibiotics that work for the sickest patients.
In the Nevada example, the 70 year old patient had contracted a hip infection and ultimately died from it after 26 different antibiotics had failed to stop the infection. The source of the hip infection was pan-resistant Klebsiella pneumoniae, a bacterium that had the New Delhi metallo-beta-lactamse, making it resistant to the last resort drug, carbapenem. The authors that studied her case, state that it is likely she was exposed to the resistant bacterium. The latter had likely originated in India, where the woman had been hospitalized for reoccurring infections over the past two years.
However, this case highlights a stark reality about the threat to us from antibiotic resistance: bacteria, including resistant ones, don’t recognize our borders. In this age of multicultural families and a booming tourist industry, people travel all over and often have family members abroad and resistant bacteria find plenty of opportunities to hitch a ride. My own toddler, for example, spent New Year’s in a Bavarian children’s hospital after he was diagnosed with a lung infection and was prescribed antibiotics. These things happen, even when on vacation, opening up the borders that bacteria, including the resistant ones, can travel across. However, an outbreak of a highly resistant infections at the National Institutes of Health in Maryland also reminds us that you don’t have to go abroad to pick up such infections.
But that’s not all—recent cases on the farm also show how resistant bacteria are traveling from farms to communities or vice versa. For example, resistance to the same critical antibiotic carbapenem, which isn’t approved for veterinary use in the US, found its way onto a farm and in pigs anyway. While we don’t know how it got there, the major finding is that carbapenem resistance, which until now was limited primarily to hospitals where the antibiotic actually is in use as in the above case, was found on a farm. Also, since resistant bacteria can collect resistance traits, other approved uses of antibiotics on the farm can drive resistance to carbapenem or any other antibiotic, when multidrug resistant bacteria evolve and carry a sharable “utility belt” of resistance traits. In other words, the use of one antibiotic can spread resistance to another antibiotic, which is why all antibiotics, even on the farm, should be used sparingly.
As a parent and a patient, I want to be able to trust in the miracle of antibiotics and I am sure that others want the same. This is why it is critical that antibiotics be used prudently in any setting—in a hospital wing or on a farm when animals are sick. It is also why it is important that we collect antibiotic use information quickly to determine what uses can be limited or phased out and why incremental progress via policy at state level is an important step to push forward and drive momentum to safeguard antibiotics. Because the sad story in Nevada shows that while we drag our feet in tackling the problem of antibiotic overuse waiting for the other agency, state, or industry to do something, bacteria are making their way through the world and beginning to outsmart all of the antibiotics we have in the medicine cabinet.