Quote:Late on the night of December 26, just three days after I had given birth to my son and two days after receiving two blood transfusions for complications, I was back in the hospital. This time, I had gone straight to the emergency room. There we were: me, my days-old baby, and my husband. The ER doctors put us in a separate room to try to isolate us from the contagion filling the hospital floor. But a few hours in, my husband started vomiting. He was asked to leave if he did not wish to become a patient. My baby could not stay with me. It was dangerous just having him there. I was alone.
I had left the hospital with my baby on Christmas Day. As best I can recall, the discharge nurses had instructed me to call back if I developed a fever over 101˚ F. The day I checked into the ER, our thermometer had read just a few tenths of a degree over.
In many ways, a hospital acquired infection has become more serious than an uncontrolled bleed.
The doctors knew I had recently been in the hospital, and they knew that I had lost a lot of blood. But they had no idea which bacterial strain was causing the fever, so they hedged their bets, giving me two different antibiotics—one for MRSA (methicillin-resistant Staphylococcus aureus), a common antibiotic-resistant strain of staph bacteria, and another antibiotic for the common infection culprit E. coli. When my hospital roommate heard I was on a drug for MRSA, she requested to be moved. I lay in bed alone, ordered hospital food, and pumped tainted breast milk.
In the days that followed, I started eating ice in the hopes that it would trick the nurses’ thermometer and they would let me go home. I fooled no one. This low-grade fever would keep me in the hospital for twice as long as my massive blood loss did following birth.
My two hospital stays illustrate how the script for medical care has flipped over the last several decades. In many ways, a hospital acquired infection has become more serious than an uncontrolled bleed. Bacteria and other pathogens are developing multi-drug resistance, and our last, best strategies are failing.
You may have heard the rumblings. Doctors have been warned not to over-prescribe antibiotics. Consumers have been admonished against the antibacterial soaps and creams. We can now buy meat and dairy marked “animals not treated with antibiotics or hormones” in the supermarket. But those measures are only stop-gaps. They will only, perhaps, slow the pace of resistance.
For years, researchers and doctors have known this. Responsible antibiotic use isn’t enough to win the pathogen war—it “reflects an alarming lack of respect for the incredible power of microbes,” wrote a group of infectious disease experts from across the U.S. in a 2008 “Call to Action” paper. After all, they write, microbes have been evolving and adapting for 3.5 billion years. Thanks to their combination of genetic plasticity and rapid generation time—they can undergo as many as 500,000 generations during one of ours—they are especially good at overcoming evolutionary obstacles.
“We don’t have really a plan B.”
Antibiotic resistance is just another byproduct of those abilities. It has evolved because patients don’t complete a full course of drugs or because animals receive drugs they don’t really need or because a college kid slathers his apartment in antibacterial spray. Antibiotics kill most but not all of the bacteria they encounter. The strongest ones live. These reproduce and pass on their advantages, and sometimes they get together and swap genes. Eventually, the resistant types grow very, very resistant.
It wouldn’t be a problem if bacteria weren’t evolving resistance faster than we have been able to respond. New antibiotics are difficult to produce, and they don’t make as much profit as drugs for chronic disease, so there has been a dearth of investment. “Why it feels like it’s happening right now is that there aren’t really new antibiotics coming down the pipeline,” says Dr. Carmen Cordova, a microbiologist who works for the nonprofit National Resources Defense Council. “We don’t have really a plan B.”
Quote:In the Meantime
Of course these are not the only promising technologies being developed to prevent, fight, and treat antibiotic resistant diseases. Bacteria-targeting viruses, gene editing, nanoparticles, and shotgun-like strategies using multiple drugs are all brimming with potential.
But each of these needs time—time for research and development and optimization. In the meantime we will have to trust that our current technologies and common sense prevention provides the window we need. (Please, everyone, wash your hands.)
As for my brush with an antibiotic-resistant infection, I eventually returned home to my husband and children. On the fifth day, lab results revealed why the drugs were not working. I did not have MRSA. I did have E. coli, but the strain I had was resistant to the drug they were giving me. Neither of the antibiotics was having any effect.
The doctors had made their best guesses, but those guesses had been wrong. The hospital let me leave with new antibiotic and a tube inserted into a vein close to my heart. Don’t let that tube get dirty, they warned me, or the infection could kill you. Don’t get air in the line, they warned me, or that could kill you too.
To say I was careful is an understatement. Three times a day I fed my newborn, put him down to sleep, and followed the hour-long procedure. Years of work in a nanotech laboratory had taught me how be meticulous. After two weeks, a nurse came and removed the line next to my heart. The treatment had worked. The bacteria I acquired at the hospital had not evolved resistance to every weapon in our arsenal. At least, not yet.
The device is a gene sequencer called the MinION, which reads the bacteria’s genetic signature within minutes. It’s small enough to plug into a computer’s USB drive, and at around $1,000 for the necessary equipment, it doesn’t cost nearly as much as traditional laboratory-grade gene sequencers. Moreover, the device, when given another day or so to process the sample, can also identify which genes in an invading bacteria are responsible for the antibiotic resistance. “This would be a personalized medicine approach to antibiotic treatment,” O’Grady says.