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Posted on 8-4-11 Bacteria 2, Humanity 1
By Frank Swain, guardian.co.uk, 8 April 2011
In what has surely become the most ritualised medical practice since the
Hippocratic Oath, the World Health Organization took to the stage again
today to warn that the misuse of antibiotics was threatening to render one
of our most potent medicines useless. This comes a decade after an
identical appeal from the organisation warned of a global crisis in the
making.
Health experts have been ringing the alarm over antimicrobial resistance
for so long that it seems to have become part of our collective background
noise, like the endless rasp of waves on the shore. And like stupid
tourists, we sleep in the sun while the tide comes in.
It might surprise you to learn that resistance to antibiotics was
identified even before Fleming's wonder drug hit the shelves. The first
clinical application of penicillin came in the early 1940s, but the
discovery of beta-lactamase a bacterial enzyme capable of destroying
penicillin preceded that revolution by a few years. The microbes were
always one step ahead. As early as 1960, it was clear that overuse of
antibiotics was driving the emergence of resistant species.
We also knew how to combat the problem: restricting the use of
antimicrobials, ensuring patients completed their courses, containing
outbreaks of resistant species. But despite repeated appeals at every
level, we couldn't match the tenacity of microbes. Last year, resistant
bacterial infections killed around 25,000 people in Europe alone.
In 2008 the rising waters were finally lapping at our feet. An unusually
hardy strain of Klebsiella pneumoniae was isolated from a 59-year-old
Swedish patient who had been treated in a New Delhi hospital. The
bacterium was found to be indifferent to even our most powerful
antibiotics. To make matters worse, the genes that gave it this superpower
were found on a small ring of DNA that is easily traded between different
species of bacteria.
New Delhi metallo-beta-lactamase (NDM-1) has since turned up in more than
16 countries across the world, including Britain. A study published in
Lancet Infectious Diseases today shows the resistance factor has spread to
14 different species of bacteria, including pathogenic varieties
responsible for dysentery and cholera. Most bacteria holding the NDM-1
plasmid are resistant to all but a couple of our most clumsy, brutal
antibiotics. One strain is immune to all of them.
In a report published last year, the US Institute of Medicine described
antimicrobial resistance as "a global public health and environmental
catastrophe", while the WHO called the rise of NDM-1 a "doomsday scenario
of a world without antibiotics".
These are not hollow words. Beyond antibiotics, we have few options left
on the table. New antibiotics take around 10-20 years to develop, and
there are few in the pipeline. Vaccines are the most obvious alternative,
but vaccination programmes are challenging to run even in the most
industrialised societies.
Scientists have been training viruses to chase down bacterial cells like
packs of hunting dogs for the better part of a century, but Georgia is the
only country in the world where such phage therapy is licensed. More
exotically, an experimental procedure using a jet of ionised argon gas
shows promise, although it can only treat external infections.
After a torrent of dramatic headlines, interest in NDM-1 fell away. After
all, in a world well-stocked with superbugs MRSA, MDRTB, C diff what
was another acronym? The media tend to train their spotlight on highly
pathogenic diseases those that kill in no time flat at the expense of
untreatable diseases, which are far less dramatic. The trouble with
superbugs like NDM-1 is that once they gain a foothold in hospitals, even
minor surgerical procedures are burdened with a much higher risk of
serious postoperative complications.
Last year, the chairman of the Board for the Canadian Committee on
Antibiotic Resistance, Professor John Conly, spoke out on the issue. I
asked him why NDM-1 had elicited such little concern. "None of us have the
answers as to why the issue of antimicrobial resistance does not capture
more meaningful attention by governments and governmental agencies," he
wrote. "The problem is that it is somewhat akin to climate change and so
slow and insidious that people, and notably our politicians, are lulled
asleep."
Although previous campaigns in France and the USA have achieved
substantial reductions in the prescription of antibiotics, their
uncontrolled use in other countries has undermined those successes
microbes do not respect national borders. As such, the failure of
governments to control drug resistance has often been labelled a "tragedy
of the commons".
But there's a crucial difference. Left to their own devices, forests and
fisheries restock themselves. Medicine cabinets don't. Even if we rein in
our appetite for antibiotics, NDM-1 is here to stay. Perhaps that will be
enough to prompt the action called for by health practitioners 50 years
ago, but it's hard to shake the feeling that the microbes have us in
checkmate.
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