(Following on from the previous post on infection control in hospitals.)
The Centre for Research in Critical Infection held a meeting recently at the University of Sydney, where the threat of antibiotic resistance was a major topic of discussion.
In the article below, the Centre’s director, Dr Jon Iredell, suggests that the lack of policy action addressing antibiotic resistance may result in this becoming the “greatest failure of modern medicine”.
Why don’t people care about antibiotic resistance?
Jon Iredell writes:
Use of a powerful antibiotic is the single most important urgent intervention in modern medicine.
Unfortunately, the threat from antibiotic resistance in bacteria is quickly escalating – in population-dense countries like India, the majority of ordinary gut bacteria are resistant to the major antibiotics we use in modern hospitals.
The resistance genes that cause this are mobile and are moving quickly into regional bacterial gene pools at the same time as drug companies are turning away from the unprofitable business of making new antibiotics.
However, there seems to be little concern among policy makers. Despite worldwide publicity over issues like the new NDM-1 gene (a drug-resistant bacterial gene), transmissible resistance in bacteria is not even a notifiable disease and there is no systematic surveillance of this gene pool.
Much can be learnt from the approach to influenza. Influenza is lethal in less than 0.1% of its victims, but as a vaccine-preventable disease, it commands massive public funding allocations.
Influenza gene sequences are routinely generated and made available in a systematic fashion, so as to inform vaccine development and monitor viral epidemiology.
The ‘bird flu’ scare prompted our National Health and Medical Research Council to spend millions in urgent research, and the ‘swine flu’ pandemic in 2009 drove huge national stockpiling of drugs, and millions of dollars more were released for urgent research, but the mortality of influenza is trivial compared to bacterial sepsis.
Community-acquired severe infection (‘sepsis’ and ‘septic shock’) directly hospitalises more than 1500 Australians each year, and affects many more who are already in hospital.
Even with modern treatment including effective antibiotics, it kills about 30% of those who develop it – this is several hundred times more lethal than influenza, killing more people than breast and colon cancer and three times more than our roads.
Antibiotic resistance increases fatality rates dramatically – even with optimal resuscitation and modern intensive care, the chance of dying increases by about 7% every hour that passes without effective antibiotic treatment.
Untreated septic shock is almost invariably fatal, and we are now seeing untreatable lethal infections in previously well young people – something we have not seen in the 70-year antibiotic era. The spread of antibiotic resistance is silent, while new viruses rise in our imaginations like biblical plagues.
As with global warming, we are imperilled by our failure to act on intangible threats with distant consequences.
Unless we act now to better understand and manage the threat of mobile antibiotic resistance in bacteria we will look back soon at possibly the greatest failure of modern medicine.