You can panic now
It’s over. We’re about to lose antibiotics.
For the first time, researchers have found a person in the United States carrying bacteria resistant to antibiotics of last resort, an alarming development that the top U.S. public health official says could signal “the end of the road” for antibiotics.
The antibiotic-resistant strain was found last month in the urine of a 49-year-old Pennsylvania woman. Defense Department researchers determined that she carried a strain of E. coli resistant to the antibiotic colistin, according to a study published Thursday in Antimicrobial Agents and Chemotherapy, a publication of the American Society for Microbiology. The authors wrote that the discovery “heralds the emergence of a truly pan-drug resistant bacteria.”
Colistin is the antibiotic of last resort for a horrific strain of supberbugs, some of which kill half the infected people.
Health officials said the case in Pennsylvania, by itself, is not cause for panic. The strain found in the woman is treatable with some other antibiotics. But researchers worry that the antibiotic-resistant gene found in the bacteria, known as mcr-1, could spread to other types of bacteria that can already evade other types of antibiotics.
It’s the first time this colistin-resistant strain has been found in a person in the United States. In November, public health officials worldwide reacted with alarm when Chinese and British researchers reported finding the colistin-resistant strain in pigs, raw pork meat and in a small number of people in China. The deadly strain was later discovered in Europe, Africa, South America and Canada.
“It basically shows us that the end of the road isn’t very far away for antibiotics — that we may be in a situation where we have patients in our intensive-care units, or patients getting urinary tract infections for which we do not have antibiotics,” CDC Director Tom Frieden said in an interview Thursday.
It’s like the opening scene of a horror movie, except that it’s not a movie. You know the Black Death? It took out a third of the population in much of Europe; in some places it took half. Think about it.
Scientists and public health officials have long warned that if the resistant bacteria continue to spread, treatment options could be seriously limited. Routine operations could become deadly. Minor infections could become life-threatening crises. Pneumonia could be more and more difficult to treat.
That secure feeling we’ve all grown up with, that most diseases and infection are treatable? That’s over.
I’ve been warning my students about this for some time now. When I was down in Texas, a lot of people would drive into Mexico to get antibiotics over the counter. That way they could save money, and not go to the doctor. So they took antibiotics for everything.
Plus the antibacterial soap. Which isn’t necessary outside of hospitals. A few years ago, fear of Ebola led our school to put antibacterial soap in all bathrooms. All of us biologists tried to talk them out of it, but they plunged ahead with the stupid move, even after we pointed out that antibacterials aren’t going to do any good against Ebola, anyway, since it’s a virus.
I’ve been talking about it and fearing it for a long time, and trying to argue people out of taking antibiotics for a cold. Sigh.
Yup, yup, yup, yup….
All of which makes me even more furious at fucking anti-vaxers eroding our other line of defence.
The Federal facility that found this? It had only been funded about three weeks previous.
The fact that they found it as soon as they started looking either means it was a huge coincidence, or that the resistance gene is already quite widespread in the US.
In the “West,” it was first found in the UK in 2008. So it’s been around a while, but, yes, if we — meaning especially agriculture — don’t stop scattering antibiotics like bird seed, we’re really in trouble.
Couple of biological caveats before panicking though: The genes for antibiotic resistance are “expensive” metabolically for bacteria. That means that in the *absence* of antibiotics, resistant bacteria are outcompeted by ordinary ones by a wide margin. So, in the absence of antibiotics, resistance is lost fairly quickly, in a matter of years. Any plagues that want to take out large numbers of people will have to be fairly quick about it.
Two is that phage treatment exists. It uses viruses that are the natural enemies of given bacteria to destroy them. It works very well, but it’s definitely personalized medicine, has to be done on an almost one-off basis at this point, is very expensive, medicine is not set up to apply it, it’s more of a research lab thing, etc., etc. So it’s not that we’re actually helpless at this point. It’s that we don’t have anything as cheap, easy, and generally applicable as antibiotics.
I’ve seen some studies where the resistance disappeared in less than ten years. That’s good news, if we can manage to wean them one at a time; if we can always have some antibiotics that are “fallow”, we might be able to keep them useful.
The problem is, getting people to stop using antibiotics improperly. And as long as there are huge feedlots where livestock are crammed in close together, the farmers are going to want antibiotics as a routine part of the feed, because a single diseased cow can destroy the entire herd. But that’s no way to raise animals, anyway. We need to seriously revisit our food production if we want to maintain our system indefinitely.
^ so glad it’s not just me does that….
iknklast: “if we can manage to wean them one at a time; if we can always have some antibiotics that are “fallow”, we might be able to keep them useful.”
Yes, indeed. It’s one of those things where you have to preface with “Now, if everyone would cooperate” which always sounds a lot like “Good luck with that.”
Still, people do make amazing efforts sometimes when faced with a type of death they can imagine. (Unlike, say, climate change.)
There are going to be so many changes in the near future.
The answer to “Now, if everyone would cooperate” is that Hobbes was absolutely right. There’s no cooperation without coercion (environmental or direct).
Minor quibbles:
It’s an antibiotic of last resort, one of multiple. There is no formal definition for this term, but the things dubbed ‘last resort’ are often ‘last resort’ because they have undesirable side effects that make them unsuited to ‘first resort, please use this stuff whenever you want.’
According to wiki, this particular one is highly effective, but is inconvenient because it can only be administered by injection, and can mess with kidneys temporarily. Otherwise, it would probably be used more often… though as iknklast notes, artificially keeping some antibiotics underused, or entirely unused, is a very good idea.
No, most diseases and infections are still treatable. In the rare event that you have this particular strain, then yes panic stations.
I’m optimistic about technology winning out here… in the long run. I fully expect AI to soon surpass our human capacity in exactly these contexts. We will eventually build computers that can attain a sufficiently deep understanding of the workings of these pathogens in order to design 100% effective countermeasures (e.g. nanobots that can pluck bacteria from the bloodstream as reliably as gardeners pull weeds from a garden).
The key phrase is “in the long run”. Though we’re on an ever-accelerating trajectory toward attaining such technological feats, we’ve still got a long stretch of years before we get there. I do hope, in the interim, that we can devise and implement cooperative strategies and eek out another decade or two of utility from our antibiotic arsenal. It’s probably too optimistic to think we’ll keep these diseases’ resurgence wholly in check, but I am optimistic that we’re capable of avoiding a nightmarish 21st century super-bug pandemic.
So my “optimism” here isn’t a rosy/happy/pie-in-the-sky vision. It’s similar to the way I’m “optimistic” that replacing human drivers with autonomous vehicles will bring an end to our current plague of 40,000 annual vehicular fatalities (in the US alone). Yes, once that transition occurs, that 40,000 deaths/year will plummet into the hundreds – perhaps only dozens. But depending on which expert is asked, we’ve got anywhere from 5-20 years before we’ll have enough autonomous vehicles on the road to make a dent in that 40,000. Which means half a million more people (again, just in the US), maybe more, will die of this “plague” before we finally roll out a “cure”. That “optimism” rings pretty hollow when the daily news is speckled with headlines like “7-year-old hit and killed last Friday.”
I made a reply to that effect on the earlier post, OB. It disappeared into the ether, and then prevented me from reposting it, saying that it was a repost… so maybe it is still in your moderation queue or something…?
Oops, I thought I was replying to the follow-up post you made on this topic.
Sorry Holms – yup it did go into the spam file, for no apparent reason – spam files just do that sometimes. Out now!