Rise of the Superbugs
The human race has always been at war with bacteria, but the development of antibiotics in the 1930s and '40s gave us the upper hand over the bugs that were killing us. Suddenly we were superhuman. Prior to that, bacterial meningitis had 100% mortality, pneumonia 30% mortality and appendicitis 100% mortality, unless you had surgery.
Antibiotics allowed us to do things that no one could've dreamed of doing historically. They've allowed us to transplant organs, to undergo chemotherapy, to receive therapy in intensive K-units when we are critically ill. Without antibiotics none of those advances in human medicine would be possible.
We've still got the upper edge, clearly antibiotics still work, but it's the speed of change that concerns scientists. 20 years ago this wasn't an issue, but today it is. Infectious diseases kill more people than cancer. TB kills 5000 people a day, so if we don't start to act soon, within another 20 years we could be in serious trouble.
We've deployed our antibiotic defenses far and wide while the bacteria have kept up their counter attack. They've adapted and evolved. Now even our last and precious antibiotics are surrendering to the rise of the superbugs.
Now we know that people who return from overseas, after routine surgical procedures are getting superbugs in their bloodstream. With one billion people now travelling the world each year, bacteria are more mobile than ever before and so are superbugs. They're born when we abuse antibiotics and we're doing that across the globe. Every time we take an antibiotic we're giving the bug a chance to become a superbug. If more of us take antibiotics inappropriately the chances are greater that the superbug will come.
Australia is 7th in the world for overuse of antibiotics per capita. Australia is like many of other developed countries. They saw development and wealth equaling ability to use antibiotics, and they lost the plot in terms of realizing that many bacteria will not respond to antibiotics.
It's the Indian subcontinent which is proving to be a superbug's perfect petri dish. Antibiotic abuse is rampant there and there's no antibiotic policy. India mass produces antibiotics, sells them cheaply and the drugs are available over the counter without prescription. Waterways and even the soil are contaminated by waste from antibiotic manufacture. On top of poor sanitation and chronic overcrowding, it's fertile ground for antibiotic resistance.
There is a general principle in treatment of infections. The more we use any antibiotic the quicker the bacteria are going to become resistant to it. So if we have a situation where antibiotics are used in agriculture, where they're available over the counter, where in hospitals there is very little control over their use, clearly in that environment there's going to be a more rapid spread of resistance.
The documentary reveals unsettling information about the ongoing and ever-increasing prevalence of antibiotic-resistant bacteria, also known as superbugs, in our bodies and in our environment. Although this was an Australian broadcast, this issue is a global one, and it relates directly to a public health crisis that is currently affecting our nation and will likely worsen in the coming years.
The documentary begins by discussing the benefits that antibiotic drugs have afforded modern medicine. Antibiotics were first developed in the 1930’s and 1940’s to treat bacterial infections in the human body. Bacterial infections that caused meningitis and appendicitis used to be fatal for the afflicted patient, but, with the advent of antibiotics, became treatable. The need to amputate limbs because of infection greatly decreased. Antibiotics also enabled the advancement of new medical procedures, such as organ transplantation, chemotherapy, and other intensive care procedures.
However, today, the documentary has stated, infectious diseases kill more people than cancers do. The reason for this is that the bacteria are adapting, becoming more resilient to drug therapies. It is evolution on a fast-paced microscopic scale. The more hearty bacteria, that are able to withstand the drugs, survive and proliferate, passing on their advantageous genetic traits to future bacterial generations. Moreover, small segments of antibiotic-resistance genes can be shared among all bacteria, turning one’s harmless normal flora into superbugs. The documentary does not go into detail about this process of gene sharing, but the Schneider text does. Schneider has stated that the antibiotic-resistance bestowing genes are contained in plasmids which are readily taken up by all bacteria and incorporated into their bacterial genomes (p. 161). Therefore, subsequent fissions will have the superbug gene in place.
Turning the symbiotic bacteria living in our digestive tracts into superbugs can create problems, as is does with Joel Beclu, the first victim who is focused on in the documentary. After a routine visit to his doctor, Joel had discovered he needed to have some prostate needle-core biopsies taken to see if he has prostate cancer. In the procedure, a thin needle pierces through the wall of the rectum to retrieve core samples from the prostate. A prophylactic antibiotic is given to prevent the possibility of infection. In Joel’s case, the prophylactic has no effect because the E. coli in his bowel have adapted to become an antibiotic resistant strain. The infection is unaffected by almost every drug regimen thrown at it and subsequently runs rampant throughout his body, nearly killing him.
Before his nearly fatal infection, Joel had been traveling for a year in South Indonesia. The documentary reveals that there are hot spots overseas that serve as the breeding grounds for the burgeoning superbugs. When people travel overseas to these areas, they can be exposed to antibiotic-resistant strains of bacteria and not even realize it. One of the worst breeding grounds, the documentary acknowledges, is India. Poor sanitation practices is compounded with the misuse of antibiotics to create an enormous and formidable reservoir of superbugs. India has no policies established to regulate the production and use of antibiotics. These drugs are mass-produced and can be obtained easily and inexpensively over the counter by people throughout the country. Furthermore, they are used inappropriately for viral infections. It is evident, therefore, that public health professionals need to address the superbug crisis by first intervening in such hot-spot areas, eradicating what the documentary refers to as the world’s “petri dishes” of antibiotic-resistant bacteria. Billions of people travel to these places every year, unknowingly acquiring superbugs and then disseminating them globally.
David Ricci, an American traveler to India—and the next victim that the documentary describes—had become infected with one of the Indian superbugs after a tragic mishap. One of his legs had been accidentally run over by a passing train. The unsanitary conditions that he had been exposed to moments after the accident were likely the source of the invading pathogens. He had been placed in a cesspool of garbage after the accident happened where luckily a passer-by miraculously stopped his arterial bleeding. He then had been taken to a sordid clinic where they amputated his leg with unsterilized equipment. Back in the United States, it had become clear that his infection was not responding to a myriad of various antibiotics. Surgeons had to continuously cut away more and more of his leg in attempts to save him from fatal septicemia. It had been discovered through microbiological laboratory tests that the pathogen that was doing its best to kill him was a superbug called NDM-1. The only drug that was finally able to halt the sepsis was Colistin, a highly toxic drug that has deleterious side-effects. A professor from the University of Queensland, Dr. Matt Cooper, states in the documentary that the NDM-1 gene is highly proficient in jumping around from one bacterium to another, and, in the near future, even the drug, Colistin, will prove to be useless against NDM-1.
The next victim in the documentary, Nick Komilionis, also encountered the jumping superbug gene phenomenon, yet experienced it an even more alarming level after he had ruptured his bowel. In his case, the antibiotic-resistant-conferring plasmid had jumped from one genus, Klebsiella, to an entirely different one, Escherichia coli, inside his body. His body had become riddled with abscesses. There were no drugs that could kill this new strain. The only alternative available to him was radical surgery—cleaving away pieces of his body where abscesses spawned from his collar bone to his abdomen, including a large portion of his bowel. The awful scenario that happened to Nick, the documentary had warned, could be indicative of the direction that modern medicine is headed. Hospitals may find that, in the near future, they may need to treat patients with this sort of draconian approach, just as they had been treated in the pre-antibiotics era.
The final person highlighted in the documentary who has fallen prey to a superbug onslaught, is a young woman from Papua New Guinea named Cathrina. She has a superbug strain of tuberculosis known as XDRTB or extensively drug resistant TB. She is imprisoned in isolation in a hospital in Cairns, Australia, and has a forty percent chance of dying. The quarantined room has negative air pressure to prevent the highly virulent germ from escaping, and she and others—e.g. hospital staff and other TB patients—must wear masks at all times. A decade ago this superbug TB had not existed, but now it is spreading fast in poorer regions such as Papua New Guinea. Public health efforts to eradicate XDRTB in poor regions such as this that have a high endemic level of TB are vital to halt the transformation of the bacteria to the more virulent form. If this superbug TB gets into the population, it could cause a devastating epidemic because XDRTB is airborne and can spread quickly from person to person.
One of the reasons that poorer regions are at a high risk for the proliferation of XDRTB is because treating patients with TB is exorbitant. The documentary states that it costs an estimated one million dollars to treat just one patient with TB and that patient is yet still likely to die. A big reason for the high failure rate is that, due to the high cost of curative drugs, there are lapses in patients’ treatment. A patient may start an antibiotic regimen, and, weeks later, be unable to continue with it. Months can go by before another cost-constrained antibiotic regimen is resumed. During the lapse, more strains of superbug TB develop. The documentary estimates that, in ten years (by 2022), all of the tuberculosis strains will be totally resistant to all available antibiotics. And that disconcerting fact will be the most costly to us, in terms of money as well as people’s lives.
And what is even more disconcerting, the documentary notes, is the fact that the great majority of pharmaceutical companies are not interested in developing new antibiotics. There is not enough profit in it for them. There is little incentive for a drug company to develop a medicine that can cure a patient fast. There is much better profit in developing drugs—such as Lipitor—to treat symptoms related to chronic conditions—such as high cholesterol. Once a patient gets started on these type of regimens, the drug company is guaranteed a steady flow of cash until the patient dies, from that ailment or some other, many years later. It is a sad yet veritable aspect of business. The best chance for the development of new antibiotics is in universities and research facilities. Profit is not the main impetus in academia.
Finally, the documentary raises some key points regarding what we can do to thwart the blitzkrieg of the superbugs. Public health interventions must be implemented that aid in the establishment of guidelines for infection control measures. Procedures for prevention must be established, especially in the poorer regions of the world where superbugs are evolving at lightning speed. Protocols for the proper cleaning of hospitals—e.g., using bleach—must be created. Regulations on appropriate antibiotic use must be instituted in places like India and these regulations must be enforced. The documentary states that “defense may become our best offense.”
The documentary, “Rise of the Superbugs,” is relative to what we have been studying in Public Health 4102. In the text, Introduction to Public Health, Schneider has pointed out that there has been an emergence of more virulent strains of bacteria that are resistant to antibiotics (p. 160). She has raised many of the same concerns that were mentioned in the documentary. She has cited an example, regarding group A streptococci. These bacteria are not only becoming more prevalent, but are also becoming more deadly (p. 160).
Echoing the documentary, Schneider also has revealed that lethal bacterial genes are jumping from species to species among bacteria. She has cited the example that a gene--coding for a toxin found in bacteria that cause dysentery--has made its way into the Escherichia coli genome. The new virulent strain is called E. coli O157:H7. She has remarked that more and more often this new strain is now being found in our ground beef. She has reiterated public health officials’ recommendations that beef be thoroughly cooked before it is eaten (p. 161). In other words, one can prevent the risk of exposing one’s normal gut microbes to the antibiotic-resistant-conferring plasmids of pathogenic superbugs simply by cooking meat thoroughly. (In my view, there is a whole host of reasons to avoid all animal products altogether and eat a plant-based diet instead, but that’s beyond the scope of this discussion.) Schneider has also remarked on the dangers of doctors over-prescribing antibiotics for inappropriate reasons, such as for viral infections (p. 162). And she has also raised a red flag toward patients not taking the entire course of an antibiotic regimen and seeing it through to the end (p. 162). Not doing so enables more virulent strains of bacteria to evolve. Finally, we have learned from the Schneider text that the extensive incorporation of antibiotics into the feed for animals throughout our agricultural industries has contributed to the rise of the superbugs (p. 162). Agricultural industries do this so that their animals can be healthier and get bigger faster, so that they can be slaughtered sooner and get to our shopping carts and dinner plates quicker. It is obvious to see why these industries fight against the regulation of this irresponsible practice since doing so would cut into their profit margins. Therefore, unless we do something to stop their misuse of antibiotics, superbug strains will continue to infiltrate our meat, spread their superbug plasmids to other bacteria, and eventually transform all of our gut microbes into ticking time bombs. And these microscopic yet H-bomb deadly superbugs are super costly to our healthcare system. Schneider has estimated that it costs us a punishing twenty billion dollars per year to treat nosocomial infections of the superbug variety, and the death toll is a staggering 99,000 victims per year (p. 162). It seems that public health authorities are aware of the major contributing factors of the superbug epidemic, yet it is imperative that all of the American public put pressure on the folks down in Washington to legislate and enforce better regulations, enabling preventative measures. In the meantime, it is my opinion that we should all vote against this agricultural industry menace by utilizing the power of the mighty American consumer dollar and not purchase animal products.
"antibiotics still work and we still have the upper hand".... are they mad? There will be no new antibiotics against resistant gram negative bacteria and as far as I can tell, the treatment of the future is amputation. The writing on the wall has been there for decades.... overuse of antibiotics was a bloody stupid thing to do. And we have known it for decades.
As usual, you don't know what you are talking about, but again what can be expected from an ignoramus such as you've shown yourself to be? You and those like you are as dangerous as the quacks they promote.
The antibiotic resistant TB sounds like a job for the Rife machine. Of course, this machine is banned in the US (so it must work!). The machine is basically a square wave transmitter that transmits into a plasma tube. Royal Rife painstakingly catalogued the resonant frequencies for various disease cells. He cured terminal cancer patients, witnessed by physicians who testified to the results, many with just one treatment.
Rife was another hero whose life was destroyed then swept under the rug by the medical mafia.
Perhaps there is more to curing than inserting foreign substances into the bod?. The future of medicine is energy, not drugs!
many years back when I was ignorant of health I had a gallbladder surgery. When I got to the hospital I was forced to sign a waiver and that waiver said they had several superbugs inside the hospital. Furthermore, that they could not get rid of them and would not be responsible if I caught any of them. hmmm A tidbit of history before antibiotics hospitals burnt herbs like rosemary in France for its antiseptic properties was used by the ancient Greeks, and Egyptians
this is very disturbing...facing the facts this will be the next cause of 'genocide',if this term fits casually....at least it feels appropriate.
if ever external entities visit this planet in the future, they would class our race as hostile beings at war with their own natural surroundings...
never grasping how futile their efforts are/were due to not knowing how majestic their opponent is/always was !
I have a problem. Perhaps someone can help me. I said I had/have two superbugs. The one almost killed me (see post below), but the other I'm still suffering from. I think it's a fungus (not 100% sure however), but it's the most persistent pernicious resilient infestation I've ever dealt with. I guess fungi can adapt just like bacteria, right? My wife used to do pedicures before we got married. She got a fungus on her fingers and then passed it to me, and both kids, and at least one of our nannies. The doctor said it was genetic because I and my kids still have it on our hands. I said, "Doctor, I'm not related to the nanny and she has it too." Nothing cures it. No multiple creams, antibiotics, antifungals, Nada! Olive oil (holy oil) helps, we've found, but not entirely. My wife accidentally poured boiling water on her hand and it cured the infection for her. That seems to help--but I can't bare very hot water (certainly not BOILING water), and it comes back quickly. The only other thing that helped (and I think saved my foot) was a weed in the Philippines. The native people said it was good for skin diseases. It was growing wild in my yard. I tried it; burned like fire! but dried up the infection on my foot. It saved my foot, I think. Thank God. Now my foot is totally better, but the kids and I have it on our hands--may daughter gave it back to me holding my hand. I need to go back to the Philippines for a month and get that weed! Burns like fire, but stops burning when the infection is gone. I wonder if I were wealthy and smart enough if I could find out what's in that weed and market it. It's got to be an antifungal, unless we have a strange bacterial infection, but antibiotics of all types made it explode, rather than get better. This has been a seven year quest now. If I can only kill it all and on all members of our family, then I think we'll be free of this "superbug". Hope that nanny is ok. She's a niece. I'll ask. Some people seem to be more resistant to it than others--she wasn't the one that quit with TB, however. Any advice for me that I haven't already tried? The hot water treatment really works temporarily (it kills it thermally rather than chemically), but you know you can't do that to a 4 year old--it's pretty painful--makes her cry. Here's hoping I can spend a month back in Manila and find some more of that fire weed. We call it weedweed. I just want to be healthy before I immigrate to the U.S.A.
This movie misses one of the biggest source of antibiotics abuse: China. Just check the keywords on google, it is a total disaster, and doctors are giving patients antibiotics on every possible issues, even it is absolutely clear that has nothing to do with bacteria, such as common cold.
After watching this movie, I will never take a boat or a plane to Australia or India. The sponsors of all those commercials wasted their money on this one. I am never eating out again, and I am staying home.
humanity is overdue for a good plague
I think that viral phages are the answer. For every bacteria, there is a viral phage that will kill it--we just have to find it. Superbug? No problem! Since phages are "living" they also adapt and become superphages. The Russians had it right decades ago, and I just don't understand why we don't pour even a fraction of the money we spend on antibiotic research into phage research in the West.
an informative and well done doc. it did however focus om problems and issues that need doctors, government and industry to solve for the most part. antibiotic resistance can be slowed by those of us who take the antibiotics and have access to proper medical treatment. please if you take antibiotics follow these tips (and any others from your doctor or pharmacist)
- finish the prescription even if you feel better
- if it says take with food or water then do so
- take the recommended dosage and at the recommended times
- do not share prescriptions
- if refrigeration requires please do (do not freeze)
- do not store in bathroom medicine cabinet or any where with temperature/humidity variations
- if you take other medicine vitamins, supplements or natural remedies ask your doctor or pharmacist if they affect the prescription
- if you are sick avoid contact with others as much as reasonably possible (going to work while sick does not make you a hero)
- cleanliness makes worlds of difference
- get recommended shots before travel and put medicines in carry on
- before travel educate yourself on how to protect yourself from illness before leaving (in places where people should not drink tap water many still brush their teeth with it or use ice cubes made from it)
- this list is not all encompassing but a good start