Common infections such as pneumonia, gonorrhea, and post-operative infections, as well as HIV, tuberculosis and malaria, are becoming increasingly hard to treat because of antimicrobial resistance. And there is now conclusive evidence that the antibiotic colistin–the last-line defense against bacterial infections–has been officially penetrated. As reported by The New York Times, last week 193 nations at the United Nations General Assembly signed a declaration summoning each of them to a war against a the superbugs that have learned to evade science’s last remaining defenses.The antibiotic colistin--the last-line defense against bacterial infections--has been penetrated Click To Tweet
UN secretary general, Ban Ki-moon, said antimicrobial resistance is a “fundamental threat” to global health and safety at the first general assembly meeting on drug-resistant bacteria. It is only the fourth time the general assembly has held a high-level meeting for a health issue.
“If we fail to address this problem quickly and comprehensively, antimicrobial resistance will make providing high-quality universal healthcare coverage more difficult if not impossible,” said Ban. “It will undermine sustainable food production. And it will put the sustainable development goals in jeopardy.”
These bacteria, viruses and other microbes are responsible for 700,000 deaths a year, according to a 2014 British study. In the United States alone, says the Centers for Disease Control and Prevention, at least 23,000 people die annually from drug-resistant infections that could once be easily cured. Given current trends, these numbers are likely to rise.
Two forces are at work, according to The Times. Excessive and improper use of existing drugs by doctors, patients and farmers has hastened the natural process through which microbes develop immunity. And scientists and pharmaceutical companies are not developing new medicines fast enough to replace futile treatments.
A successful counteroffensive will involve multiple strategies. Through regulation and educational campaigns, doctors need to be instructed in the dangers of prescribing antibiotics for viral flus and other common infections for which they are largely useless. The CDC estimates that at least 30% of antibiotic prescriptions in the United States are unnecessary.
In addition, doctors and nurses need to take routine customs like hand washing and equipment sterilization much more seriously to reduce pervasive drug-resistant infections in hospitals. Consumers must ensure they and their children are vaccinated, which helps prevent infections in the first place.
More than 70% of the antibiotics used in the United States are given to livestock. Because the indiscriminate use of drugs in animals can destroy the drugs’ effectiveness for humans, the Food and Drug Administration has issued regulations that it says will reduce antibiotic use in livestock. The agency will need to monitor farms closely to make sure the rules are being upheld and adhered to.
Increasing the supply of new drugs and vaccines is another challenge. Many companies find it more profitable to produce drugs for cancer and other chronic diseases that patients fight for months or years at a time. Just two new classes of antibiotics have been brought to market in the last 50 years, Dr. Margaret Chan, the director-general of the World Health Organization, told the UN.
The private sector’s disinclination toward developing new, effective antibiotics places a burden on governments to invest more in research and development. Governments could also offer incentives– -rewards have been suggested, for instance–to companies that develop new vaccines and antibiotics, and they could agree contractually to buy medicines to assure companies that they will have a profitable market for their products.
In a joint statement, all 193 UN member states pledged to develop national action plans on antimicrobial resistance based on a WHO global action plan developed in 2015, according to Reuters. They called for stronger systems to monitor drug-resistant infections and the volume of antimicrobials used in humans, animals and crops, as well as increased international cooperation and funding.
The countries also pledged to tighten the regulation of antimicrobial medicines, increase communication on how best to use them and find new alternatives to such medicines, including the use of better diagnostics to match the right treatment with the right infection, and the use of vaccines to prevent infections.
“The commitments made today must now be translated into swift, effective, lifesaving actions across the human, animal and environmental health sectors. We are running out of time,” Chan said.
Dr. Martin Blaser, who chairs U.S. President Barack Obama’s Advisory Council for Combating Antibiotic Resistant Bacteria, said the scale of antibiotic use in the world is “enormous,” exceeding 300,000 tons a year. Given that antibiotics are dispensed in milligrams, he said that amounts to 73 billion doses of antibiotics given in the world, or about 10 doses for every man, woman and child on the planet.
Steves Take: Most of us weren’t around back in the day when antibiotics simply didn’t exist, hard as that is to imagine now. Penicillin wasn’t discovered until 1928 when bacterial infections were among the leading causes of premature death. Nowadays, physicians and dentists routinely prescribe them for a wide variety of infections. And, less widely known, but importantly, farmers place large amounts of antibiotics in animal feed.
In a thought-provoking piece in Forbes, I learned it was almost immediately after antibiotics arrived on the scene that antibiotic-resistant bacteria showed up. Soon penicillin became ineffective against many bacteria, requiring new antibiotics to be developed. But once a new antibiotic reached the market, bacteria soon found ways to adjust and adapt.
“Bacteria are like email spam,” says Forbes contributor Bruce Y. Lee. “Once you find a way to defend against them, they soon evolve to get around your defenses. So, you have to save your ammunition and keep developing new weapons.”
Today, the antibiotic colistin is our antibiotic of last resort. But in late 2015 in China, microbiologists found bacteria with a gene called the “mcr-1 gene” that gave the bacteria resistance to colistin and could be transferred from one bacterium to another via plasmids (i.e., fragments of double-stranded DNA that can replicate independently of chromosomal DNA, and usually carry genes.)
Although they can be found in bacteria, archaea and eukaryotes, they play the most significant biological role in bacteria where they can be passed from one bacterium to another by horizontal gene transfer, usually providing a selective advantage, such as antibiotic resistance. Since then, bacteria with this gene have appeared in Europe, Canada and most recently, the United States.
According to a recently published article in the journal Antimicrobial Agents and Chemotherapy, this past April the urine of a 49-year old woman in Pennsylvania contained Escherichia coli bacteria with the mcr-1 gene. Needless to say, this finding was a stunner to scientists.
Colistin is one of the last antibiotics effective against carbapenem-resistant enterobacteriaceae (CRE), a superbacterium that is steadily spreading throughout healthcare facilities around the country and can kill up to half of the people it infects. People have dubbed CRE the “phantom menace” because of the substantial but largely unnoticed threat that CRE poses.
One computational modeling study published in the American Journal of Epidemiology shows how quickly CRE can spread throughout healthcare facilities in a region, unless more hard-hitting measures are taken. For example, in Orange County, CA, within a decade, CRE could go from being relatively uncommon to very common in all healthcare facilities. And remember, it has up to a 50% kill rate.
It’s all well and good that the UN member states all signed several pledges. But afterwards, their representatives returned home and by this week are back to their customary posts. What “action” will they each take to uphold and carry out the pledges made?Steve's Take: The superbug menace makes the #ZikaVirus look like a butterfly by comparison Click To Tweet
Forbes’ Lee quips: “This is scary stuff, like finding a vampire who is no longer affected by sunlight.” I’ll readily agree with Lee’s “scary” assessment about the superbug menace. I just hope as a nation we will lead by example to actually do something about this burgeoning menace, which makes the Zika virus look like a butterfly by comparison.