The deadly cost of global growth in antibiotic resistance
‘One minute I was well and the next I was nearly dead’, says patient, hit by superbug in routine op
WHEN Kirsten Lavine went into hospital three years ago, it was for a routine procedure, a hysteroscopy, where doctors feed a thin telescope into the womb to check for abnormalities.
Thousands are performed across the country every year and Kirsten was home within hours. But that night she felt searing pain in her abdomen.
She took painkillers but after a sleepless night, she went back to hospital, where things went from bad to worse. Her skin became mottled and she was breathless. She was just 43.
Doctors realised she had an infection in her bloodstream, causing sepsis, and she was going into septic shock.
She was rushed to intensive care but her blood pressure dropped and her organs began to shut down. She was fed intravenous antibiotics and put into an induced coma, but the infection raged on. Her partner was told she might not live. She wasn’t responding to antibiotics, said the doctors, because the infection was from a strain of E.coli bacteria that was resistant.
She was lucky to survive.
After microbiology tests revealed her infection was resistant, doctors switched her to last line antibiotics and she slowly began to recover.
The infection left her with long-term damage to her small bowel, and it took her a year to fully recover.
She said: “One minute I was perfectly
A growing concern
well and the next minute I was nearly dead, after a routine procedure.”
This is no longer as rare as it was. The increasing use of antibiotics both in medicine and farming around the world is constantly causing bacteria to mutate and become resistant.
Although the latest data show the steepest rises in consumption are in developing countries, the problem is a global one as so-called superbugs, once created, are rapidly spread across the world through international travel, trade and tourism.
And it’s not only bacterial infections that are becoming resistant but viruses like HIV, fungal infections such as thrush and parasitic infections like malaria. All over the world, doctors are finding drugs used to treat these infections, called antimicrobials, are failing. Official figures say antimicrobial resistance (AMR) kills 5,000 people a year in the UK, though experts have argued the real figure is at least double that. Getting global figures on the problem is difficult but reliable estimates suggest 700,000 are already dying each year. If no action is taken, a government-commissioned report, chaired by Lord Jim O’neill, found the death toll will rise to 10 million by 2050.
Sir Bruce Keogh, a cardiac surgeon and ex-medical director of the NHS, said he, like many doctors and nurses, had seen patients die because of resistance, leaving him with a “deep sense of futility and hopelessness”.
In a typical scenario, a patient would be operated on and then develop an infection. Antibiotics would be given but the patient would not respond because the bug was resistant. By the time a more powerful antibiotic could be administered the patient – already weakened by surgery – would die.
“I’ve watched patients deteriorate in front of my eyes because the germs are resistant. It’s terrible. People think of it as a future problem but the reality is it is a problem now and it’s likely to get a lot worse in years to come.”
Resistance also causes repeat visits to GPS, longer stays in hospital and treatment with more expensive drugs. One superbug outbreak in Manchester has cost a single hospital trust £8.4 million and is still ongoing. The Global Bank has estimated it could cost the world economy $100trillion by 2050.
So how did we get to a place where a common graze or a urinary tract infection could prove fatal? Who and what is feeding it? And how can we fight back?
Life-saving drugs
Antibiotics are actually a relatively new medical phenomenon – not much older than the NHS itself. Right up until the Forties, when drugs such as penicillin and arsphenamine started being mass produced, hospital wards were full of people dying of common infections.
Antibiotics allowed for procedures like joint replacements, organ transplants, bowel surgery, caesarean sections and chemotherapy for cancer.
Without them, the threat of infection would be too high.
The only way to stop resistance developing is to expose microbes to crucial antimicrobials only when absolutely necessary.
In the UK, there has been a concerted effort to reduce unnecessary or inappropriate antibiotic use in the healthcare system, with incentivised targets introduced in GP practices and hospitals to halve inappropriate prescribing by 2020.
Across primary care prescriptions fell by 5.1 per cent between 2011 and 2016, though they rose within hospitals. However, there is still significant variation in antibiotic use across the country and a recent Public Health England report found a fifth of prescribing by GPS is still inappropriate.
While some progress has been made in the UK and across other Western European countries, the global picture is alarming, as the data released today attests. In many countries weak regulation means it is still possible to buy antibiotics and other antimicrobials over the counter with no diagnosis or prescription, leading to inappropriate consumption.
The position is made worse by pharmaceutical companies which typically abide only by local rules rather than the much tougher international recommendations and standards.
In India, The Daily Telegraph found that it was possible to purchase antibiotics of any sort, in a single packet or in bulk, without a prescription in any chemist. As a result the country has soaring resistance rates and the resistant bugs produced are being spread round the world. One recent study
found that in central Birmingham infection rates for a resistant bug called ESBL were as much as three times higher than other parts of the UK because of the city’s links to South Asia.
No new drugs
While resistance among many pathogens is soaring, the pipeline for new drugs is near-empty.
Of the 51 in clinical development, the
World Health Organisation says only eight will add value to the current arsenal of antibiotics. In the Fifties and Sixties, many new classes of antibiotics were discovered. However, since 1987 only one new class of antibiotic has been discovered, with scientists making tweaks to existing classes instead.
Developing new antibiotics is not profitable – it costs hundreds of millions to develop new drugs, and the opportunity for volume sales is limited by
the problems of resistance.
Ron Daniels, of the UK Sepsis Trust, said the thought of no new antibiotics in the pipeline was “terrifying”.
Hope for the future
The O’neill report, published in 2016, suggested a whole raft of measures to tackle the problem of AMR. This included creating new models of payment to incentivise pharmaceutical
companies to develop new drugs. Many companies are also coming up with promising alternatives to antibiotics, from probiotics, promoting the growth of ‘good bacteria’; phage therapy, using viruses to kill bacteria; and gene editing software which chops out resistance genes from bacteria’s DNA.