A soldier is wounded by a roadside bomb. His serious injuries are survivable, but the wound is infected with antibiotic-resistant bacteria and the soldier dies from the infection. A severely premature infant is growing and gaining strength, but she gets a drug-resistant lung infection that spreads to her blood and she dies. A fit teenager gets a cut on a hike. The cut becomes infected and this otherwise healthy adolescent succumbs to what should be a treatable infection.
Antibiotic resistance may be the greatest medical challenge of our time. It threatens major advances of modern medicine including organ transplants, cancer chemotherapy, and routine surgical procedures that would not be possible without these life-saving drugs. We are all at risk.
{mosads}The Centers for Disease Control and Prevention (CDC) estimates that at least 2 million illnesses per year in the United States are caused by antibiotic-resistant bacteria.
That means eight million extra days of hospitalization, 23,000 deaths and over $20 billion in additional healthcare costs. Worldwide, an estimated 700,000 deaths per year are caused by antibiotic-resistant organisms, and if current trends continue, annual deaths are predicted to reach a shocking 10 million by the year 2050, adding $100 trillion to healthcare costs.
This crisis has been looming for decades but we continue to fall behind in this fight. Recent research shows that the situation is worsening. Take, for instance, an antibiotic called colistin. It is a “last resort” drug used to treat infections caused by a group of highly antibiotic-resistant bacteria named carbapenem-resistant enterobacteriaceae (CRE).
CRE, including the bacterium Klebsiella, cause infections with an alarmingly high mortality rate of 40 percent. Researchers have discovered a new bacterial gene that causes resistance to colistin. The gene is in a mobile form that can be shared between different strains, allowing resistance to spread rapidly.
Then we and other researchers at the Emory Antibiotic Resistance Center found a form of resistance to colistin that is “disguised” by the bacteria and thus goes undetected. The lack of detection could lead to a worrisome scenario in which clinicians unwittingly prescribe colistin for infections it cannot treat, increasing patient morbidity and mortality.
We are also now living with a long feared “nightmare” scenario in which bacteria gain both increased virulence and resistance to antibiotics.
Researchers recently discovered that some highly antibiotic-resistant Klebsiella acquired genes that make them at least 10,000 times more virulent than previous strains. These genes too are in a mobile form that can be shared easily between bacteria and thus spread rapidly. Such strains led to a recent outbreak in a Chinese hospital that killed all five of the infected patients.
The bacteria are not slowing down, and they are certainly not waiting for us to catch up to them. We must act now if we are to keep pace with this threat to the nation’s public health, economy, and national security.
With the largest economy in the world, we can clearly afford to do more. Just as the United States has invested heavily and led technological advances for decades, so should we lead the fight against antibiotic-resistant bacteria. How do we do this?
Scientists have warned us for years that we must develop new antibiotics. But we can’t fight an always-evolving enemy without fully understanding where it is and what makes it tick. We must invest heavily in research just to catch up — to discover the new and ever-changing ways in which bacteria resist antibiotics and become more virulent.
We must be able to respond in real-time to current and newly emerging threats by more widely and carefully tracking the spread of antibiotic-resistant bacteria in humans as well as in animals. And we must develop more sensitive diagnostics that rapidly detect all forms of antibiotic resistance and more effectively guide patient treatment.
These steps require an interdisciplinary approach in which clinicians, clinical microbiologists, basic scientists, epidemiologists, and other experts work together, removing barriers that have traditionally divided their fields.
This is the way we identified the “disguised” antibiotic resistance to colistin. The same approach can give us the knowledge required to invent novel antibiotics as well as to effectively conserve the power of those that remain.
Imagine a world in which a simple cut could be deadly, where people die of diseases that were once treatable, and many advanced medical procedures are impossible due to the risk of infection. We must act quickly to ensure that such a world never becomes a reality.
David Weiss is the director of the Emory Antibiotic Resistance Center. James Hughes and William Shafer are co-directors. Weiss and Shafer are members of the Medical Research Service of the Atlanta VA Medical Center.