By Jared Shelly
Scenario: Doctors and nurses at the St. Regis Medical Center in Downtown Atlanta can't seem to figure out why people keep getting sick. In just the past week, they've been forced to quarantine an entire wing of the hospital, allowing only
medical staff dressed in gowns, gloves and masks to enter. The symptoms have the characteristics of staph infections like MRSA and blood infections like sepsis. The result is patients with non-healing wounds, fatigue and shortness of breath.
It's a nasty little combination.
Doctors have been administering antibiotics to their patients but the infections are still spreading. The bacteria even seem to be gaining strength. A local reporter wonders on the nightly news if this is the start of a "new plague."
Meanwhile, the wait to get into St. Regis lengthens and lengthens. There are simply no beds to spare.
The rush of patients from the previous month's tuberculosis outbreak was just starting to wane when the cold winter brought with it a slew of pneumonia patients. For some reason, antibiotic treatments just aren't doing anything to help either class of patient.
People are also having a tough time recovering from relatively minor ailments like urinary tract infections and are occupying beds that normally would be reserved for patients with graver diseases.
In fact, patients with abdominal infections like appendicitis as well as those with blood-stream infections, meningitis and certain types of cancers are finding that their hospital stays are increasing substantially because there just doesn't seem to be a sound way to treat them.
The medical professionals at St. Regis and countless other hospitals around the country are coming to a realization: The antibiotics that people have relied on for 80 years are just not working anymore. Since antibiotics and other antimicrobials became so prevalent as treatments -- whether they actually successfully treated the disease or not -- the environment became contaminated, which caused bacteria to mutate and become much more resistant. In classic Darwinian style, the strongest, most resistant types have survived. Now, they're spreading infection and making a wide variety of ailments tougher to treat.
For years, doctors, medical researchers and the American public saw antibiotics as wonder drugs and doctors prescribed them for everything from the common cold to serious ailments. But plenty of those diseases were viral infections, which antibiotics have no ability to cure.
Around 2016, doctors realized that antibiotics were losing their effectiveness, but many just increased the dosage. That only exacerbated the problem. Now, there are strict fines for prescribing antibiotics for anything that's not on the U.S. government's Antibiotic Treatment list. The situation is making it hard for people with legitimate needs for antibiotics to get them. But in developing countries, there is a serious lack of knowledge and antibiotics are still prescribed for all kinds of ailments.
The World Antibiotic Summit brings leaders from 20 countries to Rome in an attempt to solve the "antibiotic void," as the media has been calling it. They recommend stricter enforcement of penalties against antibiotic misuse as well as ramped up vaccinations for newborn babies. The leaders also issue new treatment guidelines for ailments like abscesses (drain and provide bed rest to let the body's natural healing take effect) and started a worldwide campaign to increase hygiene.
Meanwhile, in the United States, where the federal budget has been stretched to the brink,
the government has been forced to offer significant grants to ramp up antibiotic research.
Perhaps saddest of all, organ transplants have largely become a thing of the past. Without working antibiotics to help people's bodies accept the new organs and ward off infections, mortality rates skyrocket. Organ transplants were once the darling of the health care system because of the dramatic and uplifting shift in patients after transplants. Now, the driver's license centers don't even bother to ask if you'd like the words "organ donor" printed on your license.
Analysis: A world without effective antibiotics is a very real possibility, and one that is not too far off. Antibiotics have been saving lives and curing sicknesses for 80 years, but a new class of antibiotics hasn't been discovered since 1987. Meanwhile, bacteria have been mutating, gaining strength and becoming more resistant.
"People still don't understand how scary this is," said Otto Cars, professor of infectious diseases at Uppsala University in Sweden. "We were trapped into this deception that there will always be new antibiotics around the corner."
Evidence of the ineffectiveness of antibiotics is starting to show at hospitals. In March, the Centers for Disease Control and Prevention cited "nightmare bacteria" that is resistant to even the strongest antibiotics. Even scarier is that we only have a "limited window of opportunity" to halt the spread of powerful bacteria before they can pass their drug resistant traits on to other bacteria, said Dr. Thomas R. Frieden, director of the CDC, in a New York Times article.
The massive misuse of antibiotics has certainly played a key role in this ineffectiveness. They are often prescribed for viruses like the flu or the common cold -- which they have no effect on. More antibiotics entering people's bodies means there's more of a chance that bacteria will mutate into resistant forms. As a result, bacteria that may have been killed by an antibiotic 20 years ago may shrug it off today.
"It used to be second nature to walk into a doctor's office and walk out with a Z-pack [a common antibiotic containing Azithromycin]," said Jim Walters, managing director of Aon Risk Solutions Life Sciences and Chemical Group. "Now, doctors are reluctant to do that -- and that's encouraging from a public health standpoint."
While Cars said he could not predict when the United States and other developed nations would run out of working antibiotics, he did say that plenty of countries are already having problems.
"We know we are losing patients today because we know we can't give them antibiotics," said Cars. "It's true in the U.S. and it's true in Europe," he said. In fact, 25,000 patients in the European Union die yearly because antibiotics given to patients are not working, according to a 2009 study by the European Centre for Disease Prevention and Control and the international network ReAct - Action on Antibiotic Resistance.
Developing nations are even harder hit because the burden of infectious diseases is higher and poor hygiene, unclean water supplies and increasing numbers of people with immune system infections facilitates the evolution of resistant pathogens, according to a 2012 report by the Health Protection Agency.
The biggest problem is gram-negative enteric bacteria, which causes diseases like tuberculosis and gonorrhea, said Dr. Johan Struwe, member of the antimicrobial drug resistance team at the World Health Organization. Other diseases becoming tougher to treat are pneumonia, abdominal infections like appendicitis and peritonitis, bloodstream infections, meningitis, certain types of cancers, urinary tract infections and blood infections in newborn babies, said experts. It's even becoming tougher to perform organ transplants.
"People have died in major modern surgery care hospital units ... because of infections in blood," said Cars.
With a greater incidence of lengthy hospitalizations and sicknesses, the health care sector will be strained going forward. Businesses could be impacted by sick workforces or worker absences to care for sick children.
There's also been a shortage of resources for antibiotic research, said Walters. Also, there is no clear "disease face" for the lack of antibiotics. While HIV had its famous sufferers like Magic Johnson, the same is not true for the antibiotic shortage. "There needs to be much more political understanding or action and a new sustainable plan for the future," said Cars.
We also need to "massively reduce the amount of antibiotics we prescribe," said Cars, noting that incentives for doctors and pharmacists in the Third World to prescribe antibiotics need to be curtailed.
Worldwide government regulation, public-private partnerships and a general ban of antibiotics as growth promoters in animal husbandry and aquaculture could also help.
The scientific community needs to renew its interest in researching and developing antibiotics. There was a feeling in the 1960s, '70s and '80s that antibiotics had won the fight against bacteria, and funding waned.
We should also be strengthening the basic research in microbiology around infections and find ways to treat them with other kinds of medicines.
"Killing bacteria is not a good thing," Cars said.
On the treatment side, doctors will certainly try to combine existing antibiotics as they look for combinations that work, while increasing supportive therapies, increasing hygiene education and emphasizing vaccinations.
"We need to look for other ways to fight serious infections," said Dr. Struwe, "such as interaction with immune response and [reduction of] inflammation."
JARED SHELLY is senior editor/web editor of Risk & Insurance®. He can be reached at firstname.lastname@example.org.
April 12, 2013
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