Just how fast can bad bugs become resistant to the antibiotics we use to treat them? The answer is in weeks, if not sooner; and, importantly, in the very patient who wasn’t resistant to the antibiotic when he began taking it. In other words, that’s how fast we can go from Step 1 to Step 3 in this diagram:
This is a recent phenomenon. Until about 10 years ago resistance was seen as a problem for populations of people but not for individual patients – either you were resistant or you weren’t, but you didn’t develop resistance during the course of antibiotic treatment.
But in the early 2000s clinicians saw a change. For example, in Antibiotic Resistance by Karl Drlica, PhD, and David Perlin, PhD, they tell us about a patient, JH, suffering from bacterial pneumonia caused by a Staphylococcus aureus infection. Initially, JH was resistant to 4 antibiotics including erythromycin, so they put him on oxacillin and vancomycin (the antibiotic usually given to treat MRSA). However, his illness continued; 2 months later they discovered he had developed resistance to oxacillin and so they discontinued it. Three weeks later JH also developed resistance to the vancomycin. One week later, he died.
Rule 1 in the use of antibiotics is that the more we use them, in people and in food animals, the more we encourage the emergence of antibiotic resistance. That means more and more people will be resistant to an antibiotic before they ever take it; and, like JH, more people will acquire their resistance after starting a course of antibiotics – and because of it.
So where does that leave us? In a word – Prevention.
Last month, the United States government rolled out its National Strategy to fight the growing crisis of antibiotic resistant bacteria. When the president’s science advisors tabled their report that became the basis of the National Strategy, Christine Cassel, MD, made these poignant remarks:
Dr. Christine Cassel. Member, President's Council of Advisors on Science and Technology.
“I just wanted to – and this is not really I think in the report yet … – add to the definition of stewardship [restricting antibiotic prescriptions and use] in two ways. One is we think of stewardship as not prescribing antibiotics unnecessarily. But there’s another kind of stewardship which is reducing the risk of infection so the person doesn’t need the antibiotic … if you think about American hospitals … Medicare & Medicaid, and in particular the innovation center programs have incentives in place … to reduce HAIs, which is where some of the more dangerous ones are.
And we learned just in the last year that’s down 10%. You may say 10% is not a lot, 10% is half a million adverse events and 15,000 lives. Not to mention lots of dollars, but also lots of avoided need for antibiotics in the first place, and for exposing those bacteria to more antibiotics. So I think there’s a way in which looking at prevention is an important thing.” (My emphasis.) (Webcast, Antibiotic Resistance Report Discussion, 39 minute mark.)
Here’s what’s at stake. Each and every year at least 2 million Americans are severely hurt and at least 23,000 die (almost half due to MRSA alone), because of infections that antibiotics can no longer cure. And as antibiotics continue to lose their usefulness, these numbers will grow.
However, people tend not to be persuaded by numbers. So here’s the thing: Imagine, for example, that the Ebola virus hadn’t just caused the hospitalization of one person in Dallas, but was knocking us off at the rate of 23,000 a year. Just imagine our response to it then.
So how is it that we pay so little attention to the deaths and infections caused by all these other untreatable bugs – and that we know will cause it all over again next year – yet pay so much attention to the one bug that really hasn’t caused any local harm yet?