A superbug discovered last November originating in Southern China threatens to overwhelm modern medicine within a few decades causing bacterial infection to become – once again, the leading cause of death in the world, has quickly spread internationally. Unless immediate and effective steps to combat it, and the overuse of antibiotics, are taken it can cause 10 million deaths a year by 2050 and cost trillions of dollars, warn scientists.
This is not some movie killer-bug that may emerge from the depths of the Congo jungle. This is an every-day bug that already exists and is evolving in our midst, they say.
For the first time, researchers have found a person in the US carrying bacteria resistant to antibiotic of last resort, an alarming development that top US public health officials say 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. Researchers determined that she carried a strain of E. coli resistant to the antibiotic colistin, according to the American Society for Microbiology. The researchers warned the discovery “heralds the emergence of a truly pan-drug resistant bacteria.”
Colistin is the antibiotic of last resort for particularly dangerous types of superbug, including a family of bacteria known as carbapenem-resistant Enterobacteriaceae (CRE), which health officials have dubbed the “nightmare bacteria.” In some instances these superbugs kill up to 50 percent of patients who become infected. The Centers for Disease Control & Prevention (CDC) has called CRE one of the country’s most urgent public health threats.
Health officials say the case by itself is not cause for panic. The strain found in the woman is treatable with other antibiotics. But – researchers worry the antibiotic-resistant gene found in the bacteria, known as mcr-1, will spread to other types of bacteria that already evade other antibiotics.
It’s the first time this colistin-resistant strain has been found in a person in the US. Last November, public health officials worldwide reacted with alarm when Chinese and British researchers found the colistin-resistant strain in pigs, raw pork meat and in a number of people in China. The deadly strain was later discovered to have spread to Europe, Africa, South America and Canada.
“What this tells us is 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 told newspapermen.
US Department of Agriculture researchers reported that testing of hundreds of livestock and retail meats had turned up the same colistin-resistant bacteria in a sample from a pig intestine and is working to determine the pig’s farm of origin. CDC officials are working with Pennsylvania health authorities to establish how the woman, who had not traveled overseas in six months or been hospitalised, might have become infected with the bacteria.
Colistin is widely used in Chinese livestock, and probably led bacteria to evolve and gain a resistance to the drug. The gene must have leaped from livestock to human microbes through food, according to doctors at the Department of Infectious Diseases, University of Pittsburgh.
Food handlers are at high risk in places like China, where live animal markets are often in close proximity to food stalls, and it is easily possible for the bacteria to spread from animals to humans. In the US, and elsewhere, where food is sealed in packages and containers, the situation is different and there is no immediate cause for panic as yet.
That said, infectious disease experts worldwide are calling for speedier action to curb the overuse of antibiotics in livestock, which is now very serious, if not critical.
Scientists rang the alarm bells about the gene in November, but not enough attention was paid. “Now the gene has made its way into pigs and people in the US. I hope this opens the eyes of government to the abyss that lies before us”, said Dr. Price.
Public health officials have long warned that if drug resistant bacteria continue to spread, treatment options could be seriously limited, routine operations become deadly and minor infections become life threatening. Pneumonia in particular will be very difficult to treat.
Already, doctors had been forced to rely on colistin as a last-line defense against antibiotic-resistant bacteria. The drug is hardly ideal. It is more than half a century old and can seriously damage a patient’s kidneys. And yet, because doctors have run out of weapons to fight a growing number of infections that evade more modern antibiotics, it has become a critical tool in fighting off some of the most tenacious infections.
Bacteria develop antibiotic resistance in two ways. Many acquire mutations in their own genomes that allow them to withstand antibiotics, although that ability can’t be shared with pathogens outside their own family. Other bacteria rely on a shortcut: they make copies of themselves and transfer their genes to other bugs within the same family or jump to other bacteria, which then become resistant without having to develop via evolution. The colistin-resistant E. coli found in the Pennsylvania woman was this type of resistance gene.
Despite the fact that public health officials have known about the overall problem for over a decade and been expecting this resistance gene to turn up in the US, steps to combat it have been limited and slow to kick in.
The cost of failure to tackle drug-resistant infections will be dire, leading to at least 10 million extra deaths a year and cost the global economy up to $100 trillion by 2050, a UK government report published last year warned.
These stark figures, the first to quantify the potential impact of antimicrobial resistance (AMR) – drug-resistant infections or superbugs – makes a compelling case for global action. To put the figures in context there are currently 8.2 million deaths a year from cancer and annual global GDP stands at $70 to $75trillion.
Former Goldman Sachs chief economist Jim O’Neill, who chaired the report, said AMR represents a more certain threat than climate change in the short term. “We cannot allow these projections to materialise for any of us, especially our fellow citizens in the Bric (Brazil, Russia, India, China) and Mint (Mexico, Indonesia, Nigeria, Turkey) worlds. We must search for bold, clear and practical long term solutions,” he said.
The review, looked at three bacteria – K pneumoniae, E coli and Staphylococcus aureus – out of a group of seven bugs highlighted by the WHO as already showing concerning resistance levels. It also examined HIV, tuberculosis and malaria as broader public health issues for which resistance is a concern.
No country is considered immune from the threat but for some regions and nations the outlook is particularly bleak. The world’s most populous countries, India and China, face 2 million and 1 million deaths a year respectively by 2050 and one in every four deaths in Nigeria by then is forecast to be attributable to AMR.
Despite the grim prognosis, O’Neill said there is hope if international consensus is reached and through advances in diagnostics, stimulating the development of new AMR drugs and alternative therapies such as vaccines. Clearly they need to get a move on.
If you can dismiss this as scaremongering by Big Pharma, who do indeed have a lot to answer for, so as to sell us more vaccines – I hope you’re right. But I fear not. Too many people going into hospitals for routine procedures are succumbing to opportunistic infections already for that to wash.
Modern surgery relies on the risk of infection remaining low. That could be about to change and that’s a game changer. Within a few decades, death from infection may once again become the leading cause of death.
We have been warned.