THE BLOG

Superbugs, Humans and the G8: A Global Reckoning

Let's ask the G8 to consider the case of Ms. D.

She was a mother of six, her youngest child two years old. She caught a cold on a Sunday. The cold weakened her and led to a bacterial pneumonia. It was 1943, and the world was busy making war. Ms. D stood at the threshold of the antibiotic era. But she never crossed it: her pneumonia killed her, efficiently, by Thursday.

Now consider the case of Mr. S, a twenty-eight year-old software engineer. Seventy years after the death of Ms. D, he planned an adventure vacation in North Africa. While there, he was involved in a bus accident. His lower legs were crushed, resulting in several open fractures. He was airlifted to his home country, Switzerland, but not before spending three days in a Cairo intensive care unit. By the time he arrived in Switzerland, several "superbugs" had nested and were growing happily in his leg bones; two of them were fully resistant to all known antibiotics save colistin. Colistin is an old drug that had all but vanished during the antibiotic era's golden years: it is rapidly toxic to the kidneys and nerves. Mr. S would need continuously high levels of this toxic drug in his blood for at least half a year to reach the bacteria in his broken bones; this would almost certainly lead to the death of both kidneys. So he was offered a choice by his physicians: try to save the legs--with a high chance of going on kidney dialysis for the rest of a shortened life at the age of 28, and an unknown chance of actually curing the infection--or amputate the legs before the infection spread to the rest of his body and killed him.

Mr. S chose a double leg amputation. He lived.

Both of these patients serve as "book ends" to the golden era of antibiotics. Both are real. There are differences, of course. Ms. D's generation lived with stories like hers. In the battle of Medicine vs. Fate, the balance of power lay firmly on the side of Fate. In our generation, however, we have believed that Medicine can shape and change Fate, because for us it always did. The younger among us have seen only the vaccine, not the deadly and deforming disease: few doctors under the age of sixty have ever encountered a case of measles. We have taken the antimicrobial, and within a few days, our only worry became remembering to swallow the pills--not having to take leave of our children before they were old enough to remember us. It is never easy to accept the abrupt end of a young life, and the loss of Ms. D still reverberates in the covered--but open--wounds of her children, seventy years on. But it may be harder for our generation to accept these sudden disappearances of life and limb--to witness this alteration in the balance of power--because we never questioned Medicine's superiority.

We need to, though. There have been no successful discoveries of new classes of antibiotics since 1987. Meanwhile, the Centers for Disease Control and Prevention recently warned the public of a four-fold increase in one group of "nightmare bacteria" known by doctors as carbapenem-resistant Enterobacteriaceae (CRE) in just one decade; up to half of patients who get CRE bloodstream infections die.

The G8 Summit taking place now in Northern Ireland has rightly prioritized global antimicrobial resistance as a "major health security challenge of the twenty-first century." Science ministers of the eight countries are calling for intensive international collaboration to achieve the concrete goals of (1) avoiding the misuse of remaining antibiotics and (2) streamlining and facilitating the development of new antibiotics as well as (3) rapid diagnostics to accelerate the identification and treatment of these resistant organisms before they spread to others.

The key element to the success of such initiatives is of course international collaboration. Microbes have been globalized along with the rest of the world. In the history of the planet, there has never been such rapid and distant microbial spread. Thanks to mass travel, Dengue (also known as "break-bone fever") has returned to the U.S. and may soon become endemic in some states. The West Nile virus, never before seen in the western hemisphere, also arrived by plane and rapidly spread across the nation. CRE, the nightmare bacteria, were first identified in the US in 2001; they have now been reported in all but seven of the fifty states. Data sharing among international infection control experts, institutions, and the biotechnology and pharmaceutical industries is essential. Facilitating the exchange of ideas for novel measures to combat the global threat of antimicrobial resistance is also essential.

Here in Geneva, will start in a few days the second biennial conference of the International Consortium for Prevention and Infection Control, made up of physicians, nurses, scientists and other personnel who have dedicated their lives to infection control in humans. From June 25th through the 28th, over 1,200 experts from eighty-four countries will gather to exchange ideas, strategies and local outcomes of recent and ongoing studies. What worked--and what didn't--will be discussed and scrutinized. Concrete strategies will be argued and debated; those that pass these tests will be laid down for further development and implementation. In these three days, the seedlings of international collaborative efforts--from laboratory experiments to multicenter clinical studies, both observational and interventional--will be planted.

Though we never knew her, we would like to think that Ms. D would be happy. Mr. S recently told us that he was.

Didier Pittet is MD, MS, CBE, Director of the Infection Control and WHO Collaborating Centre on Patient Safety at the University of Geneva Hospitals, Switzerland. He is also the lead advisor of the WHO first Global Patient Safety Challenge "Clean Care is Safer Care" currently active in 169 or the 194 UN countries member states. In 2007, he was awarded an honorary CBE by HM Queen Elisabeth II for services to the prevention of healthcare-associated infections in the UK.

Jean-Christophe Nothias is the founder, chairman and editor in chief of The Global Journal, a media dedicated to global politics, the new front line of politics. It covers global issues and decision-makers. It is circulated in 30 countries and thriving.

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