It happens now with surprising regularity.
Your television flashes images of Petrie dishes packed with squirming microbes. Your newspaper runs bold, front-page headlines. Yet another strain of antibiotic-resistant bacteria is announced to the world.
Just this past May the Washington Post and New York Times, along with a swarm of broadcast and cable TV networks, feverishly reported on what they called a “first-ever” case of a bacteria that is resistant to Colistin, one of the so-called “antibiotics of last resort.”
On May 27, Reuters reported that Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, went so far as to say, “We [now] risk being in a post-antibiotic world.”
What Frieden didn’t mention is that the likely trigger for that apocalyptic vision may well be hiding in plain sight along the aisles of your local supermarket.
Speaking with Dayla Boldt, an infectious diseases clinical pharmacist at the Indian River Medical Center, and Matt Lambie, the hospital’s pharmacy clinical manager, illuminates the problem.
According to Lambie, “Something like 70 percent of all antibiotics are used in agriculture,” and – according to the Alliance for the Prudent Use of Antibiotics at the Tufts University School of Medicine – in both human and veterinary medicine, “the risk of developing resistance rises each time bacteria are exposed to antibiotics.”
That resistance “opens the door to treatment failure for even the most common pathogens and leads to an increasing number of infections.”
The Union of Concerned Scientists, a non-profit science advocacy organization or “think-tank” founded at the Massachusetts Institute of Technology in 1969, says all those antibiotics are used in agriculture primarily “not to cure sick animals but to promote feed efficiency. That is, to increase the animal’s weight gain per unit of feed.”
In simpler terms UCS says “relatively cheap meat prices at the grocery store” is the main goal of antibiotic use in agriculture.
For that reason, the vast majority of beef, pork and chicken products in supermarkets come from animals raised on a steady diet of antibiotics. The same is true of most farm-raised fish found in stores.
The problem is – small as they may be – bacteria are living organisms. They adapt.
These bacterial micro-organisms eventually learn to produce an enzyme within their cell walls which, Boldt explains, “chews up the antibiotics we give which means the antibiotic is no longer effective.”
Dr. Aisha Thomas-St. Cyr, an infectious disease expert at the Sebastian River Medical Center, cautions that while the May media “uproar” was brought on by the discovery of a Colistin-resistant Multi-Drug Resistant or MDR-1 superbug in Pennsylvania, drug resistant strains are already common.
Methicillin-Resistant Staphylococcus Aureus or MRSA bacteria and Carbapenem-Resistant Enterobacteriaceae or CRE are two of the most troubling.
And Thomas-St. Cyr says it’s likely “only a matter of time” before more such superbugs evolve or are discovered.
The current list of “antibiotics of last resort” includes Colistin, Tigecycline, Avycaz and Zerbaxa, but bacteria are being exposed to those drugs on a regular basis.
While Boldt, Lambie and Thomas-St. Cyr have no control over decisions made by meat producers and sellers to keep the price of boneless chicken breasts and New York strip steaks low, possibly at the cost of human lives, all three do point to “antibiotic stewardship” programs within the healthcare arena as now-essential measures to slow the evolution of killer bacteria.
In a hospital setting, according to the Centers for Disease Control, “prevention of antimicrobial resistance depends on appropriate clinical practices that should be incorporated into all routine patient care. These include optimal management of vascular and urinary catheters, prevention of lower respiratory tract infection in intubated patients, accurate diagnosis of infectious etiologies, and judicious [antibiotic] selection and utilization.“
To that end, Boldt says, “I basically look, every single day, at every single patient in the hospital that’s on antibiotics and evaluate that for appropriateness. I work with Dr. Callahan from our infectious disease department really closely.”
“We work with providers,” she continues, “to try to either get antibiotics de-escalated to something more narrow so we’re not using these big gun antibiotics unnecessarily, or in some cases we’re even stopping antibiotics earlier to help decrease exposure. Then, sometimes it’s the flip side. We might have a patient with a drug-resistant bug that we actually need to escalate therapy on and maybe have multiple antibiotics onboard to try to combat it.”
Boldt and Lambie aren’t doing this all alone. The hospital is a member of DASON – the Duke Antimicrobial Stewardship Outreach Network – and as such it has access to the network’s “regional pharmacy liaison” who travels between member hospitals sharing the most recent information on what other facilities are doing in infection control.
“Stewardship is so extremely important,” says Lambie. “It’s refreshing to see that the federal government is now getting involved and mandating stewardship practices and stewardship activities, because five years ago we were on the route to having no antibiotics that are effective.”
The U.S. National Library of Medicine at the National Institutes of Health sums up the situation this way: “Antibiotics are arguably the single most important and widely used medical intervention of our era. Almost every medical specialty uses antibiotic therapy at some point.”
It goes on to say, “Since bacterial adaptation and resistance were reported soon after antibiotics were first used,” there’s no reason to believe that’s going to stop anytime soon.
