The alarm­ing rise of an­tibi­otic re­sis­tance

Sci­en­tists warn cur­rent prac­tices must be halted if the world is to avoid a ma­jor medic­i­nal cri­sis

The Guardian Weekly - - Front page - Robin McKie

Sci­en­tists at­tend­ing a re­cent meet­ing of the Amer­i­can So­ci­ety for Mi­cro­bi­ol­ogy re­ported they had un­cov­ered a highly dis­turb­ing trend. They re­vealed that bac­te­ria con­tain­ing a gene known as mcr-1 – which con­fers re­sis­tance to the an­tibi­otic col­istin – had spread round the world at an alarm­ing rate since its orig­i­nal dis­cov­ery 18 months ear­lier. In one area of China it was found that 25% of hospi­tal pa­tients now car­ried the gene.

Col­istin is known as the “an­tibi­otic of last re­sort”. In many parts of the world doc­tors have turned to its use be­cause pa­tients were no longer re­spond­ing to any other an­timi­cro­bial agent. Now re­sis­tance to its use is spread­ing across the globe.

In the words of Eng­land’s chief med­i­cal of­fi­cer, Sally Davies: “The world is fac­ing an an­tibi­otic apoc­a­lypse.” Un­less ac­tion is taken to halt the prac­tices that have al­lowed an­timi­cro­bial re­sis­tance to spread and ways are found to de­velop new types of an­tibi­otics, we could re­turn to the days when rou­tine op­er­a­tions, sim­ple wounds or straight­for­ward in­fec­tions could pose real threats to life, she warns.

That ter­ri­fy­ing prospect was the fo­cus of a ma­jor in­ter­na­tional con­fer­ence due to be held in Berlin this week. Or­gan­ised by the Well­come Trust, the UN and sev­eral na­tional gov­ern­ments, the meet­ing was at­tended by sci­en­tists, health of­fi­cers, phar­ma­ceu­ti­cal chiefs and politi­cians. Its task is to try to ac­cel­er­ate mea­sures to halt the spread of drug re­sis­tance, which now threat­ens to re­move many of the ma­jor weapons cur­rently de­ployed by doc­tors in their war against dis­ease. At present about 700,000 peo­ple a year die from drug-re­sis­tant in­fec­tions. How­ever, this global fig­ure is grow­ing re­lent­lessly and could reach 10 mil­lion a year by 2050. The dan­ger, say sci­en­tists, is one of the great­est hu­man­ity has faced in re­cent times. In a drug-re­sis­tant world, many as­pects of mod­ern medicine would sim­ply be­come im­pos­si­ble. An ex­am­ple is pro­vided by trans­plant surgery. Dur­ing op­er­a­tions, pa­tients’ im­mune sys­tems have to be sup­pressed to stop them re­ject­ing a new or­gan, leav­ing them prey to in­fec­tions. So doc­tors use im­muno­sup­pres­sant cancer drugs. In fu­ture, th­ese may no longer be ef­fec­tive.

Or take the ex­am­ple of more stan­dard op­er­a­tions, such as ab­dom­i­nal surgery or the re­moval of a pa­tient’s ap­pendix. With­out an­tibi­otics to pro­tect them dur­ing th­ese pro­ce­dures, peo­ple will die of peri­toni­tis or other in­fec­tions. The world will face the same risks as it did be­fore Alexan­der Fleming dis­cov­ered peni­cillin in 1928.

“Rou­tine surgery, joint re­place­ments, cae­sarean sec­tions and chemo­ther­apy also de­pend on an­tibi­otics, and will also be at risk,” says Jonathan Pearce, head of in­fec­tions

and im­mu­nity at the UK Med­i­cal Re­search Coun­cil. “Com­mon in­fec­tions could kill again.”

As to the causes of this grow­ing threat, sci­en­tists point to the wide­spread mis­use and overuse of an­tibi­otics and other drugs and to the fail­ure of phar­ma­ceu­ti­cal com­pa­nies to in­ves­ti­gate and de­velop new sources of gen­eral medicines for the fu­ture. West­ern doc­tors are over­pre­scrib­ing an­tibi­otics to pa­tients. In many coun­tries, both land and fish farm­ers use an­tibi­otics as growth pro­mot­ers and in­dis­crim­i­nately pour them on to their live­stock. In the lat­ter case, the end re­sult is an­tibi­otics leach­ing into streams and rivers with alarm­ing re­sults, par­tic­u­larly in Asia.

“In the Ganges dur­ing pil­grim­age sea­son, there are lev­els of an­tibi­otics in the river that we try to achieve

in the blood­stream of pa­tients,” says Davies. “That is very, very dis­turb­ing.”

The cre­ation of th­ese anti-bi­otic-laden wa­ters and banks of drug-soaked soils is ideal for the de­vel­op­ment of “su­per­bugs”. Rare strains that are re­sis­tant to an­tibi­otics start to thrive in farm an­i­mals and emerge as highly po­tent in­fec­tious agents that then spread across the planet with star­tling speed. Ex­am­ples of th­ese in­clude tu­ber­cu­lo­sis, which was once eas­ily treated but which, in its mod­ern multi-drug-re­sis­tant form, claims the

lives of 190,000 peo­ple a year.

An­other even more re­veal­ing ex­am­ple is pro­vided by col­istin. “Col­istin was de­vel­oped in the 50s,” says Matthew Avi­son, reader in molec­u­lar bi­ol­ogy at Bristol Uni­ver­sity. “How­ever, its toxic side-ef­fects made it un­pop­u­lar with doc­tors. So it was taken up by vets and used in an­i­mals. But as re­sis­tance – in hu­mans – to other an­tibi­otics has spread, doc­tors have re­turned to col­istin on the grounds that it was bet­ter than noth­ing.”

But the an­tibi­otic’s wide­spread use as a growth pro­moter for poul­try and pigs in Asia had – by this time – en­cour­aged the evo­lu­tion of re­sis­tant strains and th­ese have now spread to hu­mans.

Bans on the agri­cul­tural use of an­tibi­otics are be­ing im­posed in Asia but have come far too late to be ef­fec­tive, a prob­lem ac­knowl­edged by Lord Jim O’Neill, whose re­port to the UK gov­ern­ment on an­timi­cro­bial re­sis­tance was pub­lished last year. “When we were putting our re­port to­gether, col­istin re­sis­tance was con­sid­ered to be a prob­lem that would not af­fect

us for some time. Now we find it has al­ready spread all over the place.”

The re­port put for­ward pro­pos­als to stop an­tibi­otic re­sis­tance from over­whelm­ing health ser­vices. In par­tic­u­lar, it ar­gued that drug com­pa­nies should foot the bill for the de­vel­op­ment of new an­tibi­otics and that pa­tients should not be al­lowed to get them with­out a test to en­sure they are needed.

The pro­posal is pop­u­lar, although Pro­fes­sor Alastair Hay of Bristol Uni­ver­sity coun­sels cau­tion. “It is a very good idea, but … a new type of di­ag­nos­tic test like this will also add time and work for our al­ready over­bur­dened health ser­vice,” he points out.

Then there is the is­sue of travel, one of the big­gest prob­lems we face over the spread of an­timi­cro­bial re­sis­tance, ac­cord­ing to Davies.

Tourism, per­sonal hy­giene, farm­ing, med­i­cal prac­tice – all are af­fected by the is­sue of an­tibi­otic re­sis­tance, and it will be the task of the con­fer­ence to high­light the most ef­fec­tive and speedy so­lu­tions to tackle the cri­sis.

In the Ganges dur­ing pil­grim­age sea­son, there are an­tibi­otics lev­els in the river that we aim for in pa­tients

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