Seventy-five years after the discovery of penicillin, experts fear we have reached the end of the antibiotic age.
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In a small, dimly lit hospital chapel, behind the first of four bare wooden pews, a man in his early 30s kneels in front of a cross at the front of the room, head bowed.
After a long moment of silence, he thinks, How did we get here? It was supposed to be a routine procedure.
For the first time since he was a child, he prays. Why her? he pleads.
His wife had come in for minor knee surgery. After the seemingly successful procedure, the area around her knee turned black and swollen.
Minutes pass and the man gets up to return to his wife’s side.
Days later, he wheels his wife to the car. There is a bandage wrapped around the stub of a now amputated leg.
His prayer went unanswered.
The culprit? Methicillin-resistant Staphylococcus aureus, or MRSA (pronounced “mersa”) for short. This hard-to-cure superbug is an extreme form of staph infection. MRSA infections—which are contracted through open wounds and during surgical procedures—are common in healthcare facilities. Once in the bloodstream or lungs, it can lead to serious illness or death.
As with most bacteria, treating MRSA at the outset was simply a matter of administering antibiotics. But over the nearly 55 years since the organism’s discovery, something changed. MRSA “learned” to resist ever-increasing and more powerful antidotes. The microbe mutated, hindering the usual cure.
It gets worse. MRSA is dropping in rank on the United States Centers for Disease Control and Prevention’s Biggest Threats list. Why is this bad? It means other even deadlier antibiotic-resistant threats have emerged.
Topping the list is Clostridium difficile (C. difficile). Listed as an urgent threat, it typically affects patients in hospitals or long-term care facilities. The bacteria attacks the human digestive system, causing nearly half a million infections annually just in the U.S.
Battling C. difficile has become a national priority as its financial impact has ballooned to a devastating $4.8 billion annually.
CRE, which is short for carbapenem-resistant Enterobacteriaceae, is another emerging threat. A relatively new family of bacteria, its rapid spread is even more alarming due to its resistance to the most powerful antibiotics available. Unlike other antibiotic-resistant bacteria that took time to mutate, it has already managed to stymie even the most potent treatments. The deadly infection kills up to half its victims. Like MRSA and C. difficile, CRE is inextricably linked to treatment in healthcare facilities.
Hospital superbugs have become rampant, with the death toll quietly rising in the very place people go to regain their health. More and more, the path to wellness is becoming a path to the grave.
As these bacteria become stronger, doctors use the strongest antibiotics to combat them. But the bacteria continue to adapt and will soon overtake even the most powerful drugs. What happens when all antibiotic options run out?
According to the CDC: “MRSA occurs most frequently among patients who undergo invasive medical procedures or who have weakened immune systems and are being treated in hospitals and healthcare facilities such as nursing homes and dialysis centers. MRSA in healthcare settings commonly causes serious and potentially life threatening infections, such as bloodstream infections, surgical site infections, or pneumonia.”
As resistance to antibiotics has increased, hospitals have had to turn to vancomycin—“the drug of last resort”—to combat MRSA.
Regarding C. difficile, the CDC describes it as “a bacterium that causes diarrhea and more serious intestinal conditions such as colitis.” Symptoms include at least three bowel movements per day for two or more days, fever, loss of appetite, nausea and abdominal pain or tenderness.
An estimated 35,000 C. difficile infections occur per year in American hospitals, and tens of thousands more in nursing homes—with 15,000 to 20,000 killed annually.
The CRE family of bacteria is actually common in human intestines. It becomes dangerous once it travels outside of this environment and into other parts of the body. Healthcare facilities can be breeding grounds for CRE infections since their staff routinely work with biohazardous waste and materials, increasing the likelihood of exposure. Also, the microbes affect those with compromised immune systems and those who routinely have tubes or other devices penetrating their bodies—both commonplace in the healthcare environment. Even the use of certain antibiotics can make it more likely that patients contract CRE.
These deadly superbugs are showing no sign of decrease. According to the CDC, between 1999 and 2005, MRSA hospitalizations more than doubled from 127,026 to 278,203. The year 2011 saw 11,285 deaths due to complications from the bacteria. That same year, 29,000 deaths were attributed to C. difficile. All of those deaths occurred within one month of diagnosis.
CRE deaths are significantly lower at about 600 per year. Yet the extraordinary level of resistance coupled with its rate of increase is what is troubling.
More worrisome is that even if you have a healthy immune system, you can carry these virulent superbugs into the hospital environment without realizing it. Doctors can take them into exam rooms, family members can infect a patient they are visiting, and even surgeons can carry them into the operating room.
These bacteria can infect a person through a wound the size of a mosquito bite.
How did these near-unstoppable bacteria grow to such formidable proportions?
For each decade following the 1928 discovery of penicillin, physicians prescribed antibiotics as “cure-alls” for just about everything. Have an earache? Take some Amoxicillin. Have bronchitis? Try Zithromax. Sinusitis? Trimethoprim-sulfamethoxazole. Still won’t go away? Take moxifloxacin; it’s stronger.
Entire generations have been born and bred on this thinking. Nearly every trip to the doctor ends with a stop at the local drugstore—antibiotic prescription in hand.
Now the healthcare industry is reaping the effects of antibiotic overuse. What was once a giant safety net against disease has created monstrous bacteria: Clostridium difficile, methicillin-resistant Staphylococcus aureus, and carbapenem-resistant Enterobacteriaceae, among others.
Why are antibiotics no longer working? Adaptation. After an unwanted bacterium is introduced, the body’s immune system fights back. To aid this, physicians typically prescribe antibiotics (any drug that either kills bacteria or hampers their growth).
With each use, however, bacteria can begin to “resist” the drug using a number of tricks. Some make themselves less permeable so that the antibiotic cannot be absorbed. Other bacteria change their structure so that antibiotics no longer recognize and destroy them.
In the worst case, bacteria can produce an enzyme to dissolve the antibiotic—rendering it useless. In effect, the hunter antibiotic becomes the hunted!
Another danger associated with the misuse of antibiotics is that they destroy bacteria indiscriminately. The body also has healthy bacteria that aid in digestion and help protect the body.
In the case of C. difficile, a bacterium can often survive the initial course of antibiotics. This means that, once all other bacterial competition is killed, it can grow and flourish. Often a person will be put on another round of stronger antibiotics—meaning that C. difficile can become stronger and more resistant as it spreads to new hosts. Antibiotics influence CRE similarly.
Scientists are finding that, after long courses of antibiotics, C. difficile patients can pass the bacterium’s spores into the environment around them—even after treatment has ended and the patient appears symptom-free.
Researchers at the Wellcome Trust Sanger Institute created a “mouse hospital” to simulate the spread of C. difficile in a healthcare environment.
“We treated mice with short and longer courses of antibiotics,” said Professor Gordon Dougan, Head of Pathogen Genetics at the Sanger Institute and senior author of the study. “After a short course most mice had dropped back to normal spore shedding levels around two weeks after cessation of the treatment. But after long term exposure to antibiotics some of the mice remained in their ‘supershedder’ state for weeks or even longer after treatment was stopped. We should consider that patients still pose a considerable transmission threat some weeks after treatment is terminated even if they have not exhibited signs of C. difficile disease.”
The towering threat of drug-resistant superbugs has hospital, government and local officials scrambling for answers. Because these dangerous microbes can transfer from devices such as breathing machines and urinary and vein catheters, or contact from healthcare workers, there are no easy answers.
One solution is for medical facilities to test everyone for the bugs upon admission and quarantine those infected. Yet many hospitals fear potential lawsuits from patients who tested negative when they were admitted but became infected during their stay.
While implementing more tests and isolating infected patients have shown promising results, the main problem in the superbug fight is the over-prescription of antibiotics. Although researchers have noted a decline in antibiotic prescriptions for ear infections, stronger antibiotic types are still regularly overused.
“There is good news about declining antibiotic use, since inappropriate use of antibiotics can result in bacteria that are resistant to these antibiotics,” Dr. Marie R. Griffin, a professor of preventive medicine at Vanderbilt University Medical Center and co-author of a study published in the Journal of the American Medical Association, said. “However, overuse of powerful antibiotics remains a problem.”
But is it too little too late? Even as healthcare facilities work to quell outbreaks of superbugs within their walls—the virulent bacteria are increasingly turning up in the community outside their walls. Although researchers have yet to put an accurate number on superbug infections, newspapers regularly report outbreaks in gyms, public pools, and high school locker rooms.
Professor Richard James, an infections expert at the University of Nottingham, told The Telegraph: “The threat from [community-acquired] MRSA in the US is a very serious concern, especially if there is an epidemic. It could trigger a large number of cases of necrotizing pneumonia, which has a mortality rate of 50 per cent in 72 hours.”
Antibiotics have been a pillar of medicine for nearly a century. In a sad twist of irony, the very drugs created to defeat diseases have helped form bacteria poised to run rampant. Yet mankind thinks it will dig itself out of this trouble once again. Through our savvy and ingenuity, we can always remain one step ahead of disease, man reasons.
But what happens when man’s solutions no longer work? Clearly the explosion of antibiotic-resistant bacteria in the midst of tremendous advancements in medicine is a sign that overconfidence in humanly devised solutions is misguided.
As progressive as mankind is, there is a great unseen law that he has failed to grasp. Not following it has led to countless failures.
The law? Cause and effect.
From the beginning, God gave mankind a choice—compliance or non-compliance. Each alternative either led to abundance and prosperity or suffering and despair.
Often relegated to a bedtime story, the instructions given to the first human beings, Adam and Eve in the Garden of Eden, established the pattern by which God would deal with all their offspring.
Note God’s plain guidelines: “And the Lord God commanded the man, saying, Of every tree of the garden you may freely eat: But of the tree of the knowledge of good and evil, you shall not eat of it: for in the day that you eat thereof you shall surely die” (Gen. 2:16-17). If you do this, good things will happen. If you do that, bad things will happen. Simple.
Regrettably, Adam and Eve made the wrong choice and not only did they suffer for it, their offspring did as well. Yet this should have come as no surprise. God’s instructions were plain.
This same principle applies today. God gives us a clear choice to either obey Him, which includes living His way of life, or follow our own way. Both decisions have consequences.
For nearly 6,000 years, man has decided to do things his way. Like our parents in the garden, we feel as though we know what is best for us, despite warning to the contrary. While many admirably dedicate their lives to administering medical care, the industry itself is fundamentally broken. Everything from the reason people get sick to how illness is treated is a sad mix of misery, ignorance, greed and self-reliance.
Few understand that God did not intend for mankind to exist this way. In fact, very few understand the God of the Bible at all. He is a Father that, like His earthly counterparts, wants His children to prosper.
Consider Jesus Christ’s words, “I am come that they might have life, and that they might have it more abundantly” (John 10:10). God the Father is so committed to mankind prospering that He was willing to sacrifice His own Son.
Yet God will not force benefits upon us. They must come as a result of a conscious decision—a choice. Chapter 30 of Deuteronomy says, “…I have set before you life and death, blessing and cursing: therefore choose life, that both you and your seed may live” (vs. 19).
God is a God of consequences. He is not a monster waiting to punish the world undeservedly, nor is He a weak, inept Being who simply accepts indiscriminate conduct. He is a loving Creator who wants what is best for His children. He rewards obedience and punishes disobedience as any good parent would.
Understand, this is not a God preached from the pulpits on Sunday. This is not a God who makes empty promises. Rather, He is the God who will hear heartfelt, contrite prayers of repentance—and heals those who “seek…first the kingdom of God, and His righteousness” (Matt. 6:33).
In the Old Testament book of Exodus, God declares He is “the Lord that heals you” (15:26). Healing is tied to obedience—doing what is right in God’s sight by keeping His Commandments. This blessing points to a Being who is far from “fiery” and vengeful. Instead, He is a God who wants to see people prosper and succeed.