Frontline: Antibiotic Resistance "One of the Great Catastrophes of Our Age"
A recent PBS Frontline documentary, Hunting the Nightmare Bacteria, delved into the horrors of antibiotic resistance, examining the depth and breadth of the problem and the attempt to locate a solution.
The documentary highlighted the fundamental basis of the antibiotic resistance problem: it can happen to anyone at any time, and there are no conventional tools to stop it.
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In Tucson, Ariz., a case of community-associated methicillin-resistant Staphylococcus aureus became life-threatening for eleven-and-a-half-year-old Addie Rerechich after she developed complications from pneumonia. Put on a lung-bypass machine, she contracted Stenotrophomonas maltophila, another drug-resistant bacteria, from the incisions in her neck for the life support device.
After her medical team discovered the bacteria was a resistant to all available antibiotics, Addie's only hope was to have the infected tissue removed through a lung transplant. Though her physician initially believed she was too ill to survive the procedure, Addie's responsiveness and her mother's advocacy spurred her team to take a risk — one that has proved successful so far.
While on a mission trip in Calcutta, India, David Ricci was accidentally pulled under a moving train by his sweater. Mr. Ricci survived, though the train ran over his leg, which was subsequently amputated in an Indian hospital. After his condition stabilized, he was transferred to a Seattle hospital. There, physicians discovered Mr. Ricci had acquired a bacteria with MDM1, an antibiotic resistance gene little-known in the U.S. and capable of transfer between microorganisms, effectively causing the antibiotic-resistance of any infection-causing bacteria.
To save Mr. Ricci, physicians turned to Colistin, an antibiotic discontinued due to the damage it causes to the renal system. When that didn't work, surgeons removed Mr. Ricci's leg up to his pelvis. His condition finally stabilized, though physicians believe he may again deal with the infection in his lifetime.
Along with patients' individual encounters, some of the most prestigious healthcare institutions in the U.S. suffer from problems with antibiotic resistance, as well. In 2011, the Bethesda, Md.-based National Institutes of Health accepted a patient into its intensive care unit who was infected with carbapenem-resistant Klebsiella pneumoniae. The NIH implemented measures and tests to prevent the spread of the bacteria, and all seemed well, until 5 weeks after the initial patient, or "patient zero," was discharged.
KPC began appearing in cultures all over the hospital, killing 6 and leaving NIH staff baffled as to how the organism had spread. Discovering they had missed a transmission pathway — the bacteria could survive undetected in patients' stomachs — the institution has struggled to eradicate KPC ever since. The initial outbreak subsided, but another patient died recently from a KPC infection. No new KPC patients had been admitted to the NIH since patient zero in 2011.
The industry and data problems
These stories are just a fraction of the many cases of antibiotic resistance that occur worldwide. Paradoxically, the solution creates the problem. According to several experts interviewed in the documentary, antibiotics are a unique class of drugs — their use contributes to their future ineffectiveness as bacteria are exposed and develop resistance.
In addition to the problem of antibiotic mis- and over-use, experts in the documentary alleged the resistance problem is also part of the drug industry dynamic. As the low-hanging fruit of antibiotic discovery began to disappear in the 1980s, drug companies stopped investing in the process. Antibiotics, if used appropriately, are only short-term medications, a fact that disincentivizes companies from investing in antibiotic production in favor of producing more lucrative drugs like those for lifelong chronic conditions.
The documentary tells this story by highlighting drug-giant Pfizer. While the company initially committed itself to researching antibiotic solutions for resistant bacteria, it opted to close up shop in 2011. In the documentary, Pfizer commented on that decision, saying it was a "portfolio decision about serving medical need in the best way," and "investors require it of [them]". "I answer to the shareholders," said the vice president for clinical research at Pfizer.
The problem faces additional complications. Antimicrobial resistance is 70th in research priorities at the NIH, and the problem is complex enough that no one person or agency in government can take full responsibility for spearheading a solution. Antibiotic-acquired infections are not listed as a cause of death, so data is lacking for a comprehensive plan to deal with antibiotic resistance. The type of teamwork and prioritization required to gather the necessary data to take stock of the problem of antibiotic resistance is as-of-yet nonexistent.
As another expert noted on the lack of antibiotic use data for both physicians and patients: "Who is using antibiotics? How are they using antibiotics? We don't know."
Frontline will continue the series in the spring with an examination of antibiotics in the food supply.
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