The Atlanta Journal-Constitution
Antibiotic resistance spreads fast
CDC says 9,000 affected annually, with 600 deaths.
How quickly can antibiotic resistance spread? Consider the case of a Swedish man who traveled to India in 2009.
While in New Delhi, the man became infected by a strain of Klebsiella bacteria bearing a gene that made it impervious to the antibiotic carbapenem. Microbiologists quickly found the gene in bacterial samples from Mumbai as well.
In the span of just two years, it also turned up in Croatia, Pakistan, the United Kingdom, Canada, Japan and China.
“They found it everywhere,” Hanage said. “The cat was not just out of the bag. It had gotten out of the bag, made its way into the hamster cage, and was eating the hamsters.”
Today, the Centers for Disease Control and Prevention estimates that 9,000 U.S. patients per year are infected with carbapenem-resistant bacteria, causing 600 deaths annually.
“We’re always trying to keep one step ahead,” said Harvard infectious disease epidemiologist William P. Hanage, who warned that bacteria have been at this competition far longer than humans. “There are lots of bugs, lots of drugs, and lots of ways that resistance can happen, and they can start overlapping with each other. It’s damnably complicated.” agents and turning them into medicines, there might be less cause for worry.
Researchers haven’t identified a new class of antibiotic medication since 1987. As a result, though bacteria have continuously evolved new ways to thwart antibiotics, the medicines have not gained new mechanisms to fight back.
The economics of drug development are partly to blame.
To offset the millions of dollars they pour into research, clinical trials and the Food and Drug Administration approval process, pharmaceutical companies aim to develop blockbuster drugs, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. An ideal candidate would be used by millions of people every day for the rest of their lives, like pills to keep cholesterol or blood pressure in check.
Antibiotics won’t pay the freight. They should be prescribed sparingly and used only for about a week. They could be rendered obsolete at any time by resistance genes. Worst of all, they compete in a field of inexpensive generics.
Without government policies that encourage investment in the antibiotics, “there’s very little incentive” for companies to do it themselves, Fauci said.
Other approaches can help. Under Fauci, his institute is funding the development of tests that would speed the diagnosis of infections and prompt more careful use of antibiotics by physicians and hospitals.
New vaccines to prevent bacterial infections are under study, and existing vaccines could be more widely used. The use of bacteria-killing viruses — an approach called phage therapy that revives an idea largely abandoned in the 1930s — is getting a second look.
A matter of time
The Pennsylvania patient whose infection was impervious to colistin was able to beat back the bacteria in her urinary tract with the help of other antibiotics. She survived.
Others have not been so lucky. Hospital patients infected by antibiotic-resistant bacteria are twice as likely to die as those infected by the nonresistant strains of the same bacteria, studies show.
Experts say it’s just a matter of time before other disease-causing bacteria pick up the fateful mcr-1 gene. Since its discovery was reported in China in November 2015, it has spread to human, animal, food and environmental bacteria on every continent.
“It’s not apocalyptic until it is,” said Peter Pitts, president of the Center for Medicine in the Public Interest and former associate commissioner of the FDA. “Shame on us if we wait till bodies are in the street.”