In 1945, Alexander Fleming, the discoverer of penicillin, already noticed bacteria’s ominous ability to acquire resistance to the antibiotic that saved so many lives. At the time, he even warned that overuse of penicillin would lead to more people dying from infections that are impervious to the revolutionary treatment.
Since Fleming’s medical breakthrough, his sobering forecast is evidently coming to fruition in astounding ways as described in a recent PBS Frontline report by David Hoffman. The piece delves into why the Center for Disease Control and Prevention (CDC) finds that drug resistant bacteria is infecting 2 million people in the United States every year with 23,000 resulting in death.
While antibiotic-resistant infections can happen anywhere, a majority crop up in healthcare settings like hospitals and nursing homes. For example, the CDC classifies the threat level of Clostrifium Difficile, which causes severe life-threatening diarrhea, as urgent since it is naturally resistant to many drugs that are used to treat other infections. This bacteria alone infects 250,000 people and creates over $1 billion in medical costs per year.
“Bacterial resistance is largely inevitable,” explained Dr. Arjun Srinivisan, Associate Director of the CDC, in the PBS program. “But it is also something we have helped along the way; we fueled this fire of bacterial resistance.”
Brad Spellberg, an infectious disease specialist and Associate Professor of Medicine at Harbor-UCLA Medical Center, described to Hoffman how antibiotic drugs — in comparison to cholesterol and cancer drugs, for example — are the only class of drugs that become less effective with more use. This is especially alarming when the CDC finds that half of all antibiotic use in the nation is unnecessary or inappropriate. For decades, misguided overuse of antibiotics has fueled the need for more effective antibiotic drugs. Yet the private sector has backed away from spending research and development dollars in developing a class of drug that would have to be used as sparingly as possible to minimize the build up of resistance. Ultimately, the pharmaceutical industry has come to view investing in such a drug as unsustainable, especially when the price tag of bringing drugs to market typically entails a $1 billion price tag.
Apparently, the government has also been hesitant to act. According to Hoffman’s investigation, research into antimicrobial resistance ranks 70th in terms of National Institute of Health (NIH) research dedication. Srinivisan attributed part of this lack of resource prioritization to complacency that stems from the expectation that newer drugs will emerge to solve the problem.
A proper surveillance system is another federal issue that Spellberg sees needing drastic improvement. “We… have not had a comprehensive plan for how to deal with antibiotic resistance,” he explained in the program. “Reporting mechanisms aren’t in place like they are in Europe that identify where resistance is being observed…and to what extent antibiotics are being used.”
In 2011, one form of dangerously resilient bacteria, known as KPC, managed to spread uncontrollably among patients at the NIH Clinical Center and ended in six deaths. To the facility’s Deputy Director, David Henderson, the pivotal incident means that a new reality is setting in. “This organism and organisms like this are going to be with us ‘til the cows come home” he commented in the Frontline episode. “We have to learn how to deal with them [and] change our culture in the hospital.”