‘Major threat to human health’ as even toughest antibiotics are now failing

About 700,000 people die each year worldwide from bacterial infections but that toll could rise to 10 million by 2050 if people do not wake up to the reality that overprescription of antibiotic drugs and failure to complete a course of medication are key drivers of antibiotic resistance.

A microbiologist reads a plate to check a bacterium’s resistance to carbapenem, an antibiotic of last resort. David Goldman / AP Photo
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An organism that claimed a woman's life in Nevada last year and is invulnerable to every known antibiotic has been found in the UAE. Such bugs thrive on our complacency.

The doctors had seen nothing like it. Their patient was succumbing to some kind of primordial organism that had invaded her body and begun multiplying – and they were powerless to stop it.

Nothing worked and death was inevitable. When it finally came, the doctors reported what they knew about their patient and triggered a global alert.

A melodramatic trailer for a science-fiction film? Not at all. These events took place in Nevada last year, and have recently been reported by the US Centres for Disease Control and Prevention (CDC) in Atlanta, Georgia.

The news is causing alarm in medical circles – not least in the UAE, where the organism responsible has been found.

Known as Klebsiella pneumoniae, it is a bacterium, a form of life that has been on Earth for billions of years.

First identified in the 19th century, K pneumoniae has long been implicated in deadly infections among hospital patients. That is not normally a cause for concern because there are dozens of antibiotics available for treatment.

The problem is that K pneumoniae has mutated since it was first identified. It can now defeat virtually every known antibiotic – including all those approved for use against it in the United States.

The fate of the patient in Nevada is the latest wake-up call about one of the biggest threats to global health in the 21st century: antibiotic resistance.

According to the latest estimates, about 700,000 people die each year worldwide from bacterial infections that were once treatable by antibiotics.

A report by Rand Europe and the consultancy KPMG last year estimated that the toll could rise to 10 million by 2050.

Antibiotic resistance is a threat that demands the kind of urgency seen among the heroes of a sci-fi movie. For without it, we risk seeing the return of the much-feared “sepsis wards” in hospitals, where patients were left to fight infection alone while their doctors looked on, powerless to help.

The CDC report gives a glimpse of such a future.

The patient in question was an elderly woman who had returned to the US last summer after a long trip to India.

While she was in India, she had been in hospital several times for treatment for a fractured leg. Within a few weeks of returning home she developed a fever.

Suspecting an infection, the doctors gave her the standard antibiotics, which attack the bacteria as they multiply in the body.

None of the dozen or so available antibiotics at the hospital worked – not even carbapenem, an antibiotic of last resort.

It is now thought that while she underwent treatment in India, the woman became infected with a strain of K pneumoniae that has evolved a way of producing an enzyme that undermines carbapenem.

With nothing available to slow the spread of the bacterium, within a few weeks the patient died.

A CDC investigation found that not one of the 26 antibiotics approved for use against the bacterium in the US would have worked.

Like patients in the sepsis wards of the past, the woman’s only hope lay in her own disease-fighting immune system. Tragically, it was not enough.

If this seems like just a bad-luck story from a distant land, think again.

The emergence of untreatable K pneumoniae has been declared "a major threat to human health" by the World Health Organisation, and cases of it have already been found in the UAE.

In 2014, a team led by Dr Nihar Dash, at the University of Sharjah, reported that analysis of cultures at one hospital had shown that resistance to carbapenem had become “a fast-emerging problem”.

Already, about half of the patients infected by the bacterium do not respond to carbapenem.

On the face of it, the answer seems simple: find new antibiotics that K pneumoniae cannot defeat.

In fact, it is already clear that even a major breakthrough in antibiotics would bring only temporary respite.

Carbapenem is a case in point. Developed by scientists at the pharmaceutical giant Merck in the mid 1970s, it gave doctors a new way to attack bacteria that had become resistant to the first generation of antibiotics, which began with the development of penicillin in the 1940s.

But Darwinian evolution, with its combination of chance mutations and natural selection has led to the emergence of strains that can defeat carbapenem.

And in this bacteria have benefited from a powerful ally: ourselves.

Faced with patients demanding pills for every ailment, many family doctors cave in and prescribe antibiotics even for viral conditions such as the cold – against which they are useless.

Meanwhile, many patients stop taking their antibiotics as soon as they feel better.

This increases the chances of some bacteria surviving the treatment and thus being able to replicate, producing new generations of more resistant microbes.

Inappropriate use and failure to complete the course of medicine are key drivers of antibiotic resistance. They have also proved hard to stamp out.

Many countries, including the UAE, require that patients have a doctor's prescription before getting antibiotics. But as a recent investigation showed, pharmacies are willing to flout the rules – even at the risk of having their licences revoked.

The cavalier use of antibiotics by farmers has also fuelled the rise of bacterial resistance to antibiotics. Last month, reports emerged of carbapenem-resistant bacteria on a pig farm in the US.

Tackling such issues is far from easy – not least because globalisation makes us all vulnerable to the worst practices of everyone else. But there is one science-based strategy that guarantees instant and lasting results: better hygiene.

More than 150 years ago, the Hungarian physician Ignaz Semmelweis showed that the simple act of washing hands in disinfectant can dramatically reduce infection rates.

Since then, many studies have shown that basic cleanliness has lost none of its power to defeat bacteria.

Ironically, the very success of antibiotics is proving to be their undoing. They have encouraged a belief that modern science has found the final answer to the threat of infection. Darwinian evolution makes a mockery of such conceit.

If we are to avoid an epidemic of cases like that witnessed in Nevada, we need to recognise that bacteria are deadliest whenever they can find complacency.

Robert Matthews is visiting professor of science at Aston University, Birmingham, UK.