Each year, superbugs -- viral bacterial infections resistant to common antibiotics -- infect more than two million Americans, killing at least 38,000. As the list of antibiotic-resistant bacteria grows, so have the extraordinary efforts to prevent the spread of infection from patient to patient. Science correspondent Miles O’Brien and economics correspondent Paul Solman team up for a report.
But, first, we are beginning a special series on the growing concerns around antibiotics, why there is more resistance to the drugs from so-called superbugs that can be dangerous and even fatal, and why it has been difficult to create a newer class of drugs to solve this problem.
It is a story that involves the worlds of science, medicine, business and economics.
So, we asked our science and economics correspondents, Miles O'Brien and Paul Solman, to team up. Their coverage will continue over the next couple of weeks.
We start with Miles' report.
It's part of our weekly series on the Leading Edge of science and technology.
Every Sunday night, I put up the pills for a week at a time.
Thirty times a day.
Amlodipine, that's a blood pressure medicine.
Each and every day.
Prednisone for rejection.
Jane Tecce takes a pill.
This is hydralazine. That's another blood pressure medicine.
No complaints from her. She's just grateful to be alive.
I'm grateful. I wouldn't have gotten to see my grandkids being born and, you know, just see life. So you sacrifice things. So that's how I look at it. It's a tradeoff.
In 2011, after years of battling a rare genetic disease, Jane received the heart and kidney of an 18-year-old man at Tufts Medical Center in Boston. Her daily pill regimen is designed to stop her body from rejecting the organs, but it was another drug, an antibiotic, that fueled an infection that nearly killed her. A month after her transplants, she contracted pneumonia.
They put me back in, and I was very sick. I knew I wasn't doing well at all, and a lot of pain. I had pain as if the ribs were affected and things like that, so they started pumping me through the I.V. with a lot of the antibiotics, and I think that was the beginning. By February, I had been diagnosed with the C. Diff.
C. Diff, clostridium difficile, is a so-called superbug, meaning a bacteria that is not easily stemmed by antibiotics.
In fact, it thrives in people taking the drugs. Each year, superbugs infect more than 2.25 million Americans, killing at least 38,000.
The first thing you do is, you put on your yellow gown.
At Tufts, doctors who come in contact with patients infected with superbugs like C. Diff must take great precautions. As the list of antibiotic-resistant bacteria grows, this has become a much more common routine.
So have some extraordinary efforts to prevent the spread of infection from patient to patient. Here, they bombard rooms with ultraviolet light, which causes genetic damage to bacteria, rendering them unable to reproduce.
Shira Doron is the physician director of the anti-microbial stewardship program at Tufts.
DR. SHIRA DORON, Tufts Medical Center:
We are seeing patients with infections that cannot be treated by any antibiotic on the market. And we're having to tell patients, we don't have anything for you.
And so that makes it really scary and really concerning.
Antibiotics are organic compounds that attack and kill bacteria. They are often derived from microbes found in soil and from mold. That's where Scottish scientist Alexander Fleming discovered the first true antibiotic, penicillin, in 1928.
It, and a host of others developed in the decades that followed, revolutionized medicine. But it was no surprise that these miracle drugs would eventually lose their potency. In fact, when Dr. Fleming received the Nobel Prize, he warned of the danger that the ignorant man may easily underdose himself, and by exposing his microbes to non-lethal quantities of the drug, make them resistant.
Doctors began using penicillin to treat patients in 1942. Only three years later, they encountered the first resistant bacteria.
Helen Boucher is a professor of medicine in the division of infectious diseases at Tufts.
DR. HELEN BOUCHER, Tufts Medical Center:
Resistance happens naturally. So, bacteria have various mechanisms to survive.
It is survival of the fittest, evolution at warp speed. Bacteria adapt very quickly in the face of the assault. They can learn to strengthen their cell walls to repel the antibiotics. They can develop pumps to expel them. Or they can make enzymes that destroy them.
DR. HELEN BOUCHER:
So, they figure out ways to evade the effect of the antibiotic. And this happens in nature, and it happens faster in the presence of antibiotics.
You sort of make it sound like bacteria are smart.
DR. HELEN BOUCHER:
They're very smart.
And they are adapting very fast, creating a big public health crisis.
KIRTHANA BEAULAC, Tufts Medical Center:
Unfortunately, these bugs mutate faster than we can come up with new drugs. So, the only realistic strategy is to use the antibiotics that we have better.
Kirthana Beaulac is the pharmacist director of the Anti-Microbial Stewardship Program at Tufts. We met in the central pharmacy, where they store the vast majority of their medications for patients. Here, they see themselves as a last line of defense.
Prescriptions for antibiotics are carefully scrutinized, particularly the drugs that attack a broad spectrum of bacteria.
It requires constant evaluation of the way we do things, and constant reminders, and really a critical assessment of everything we do every single day to make this — to really make any headway on this battle.
You sound like you're at war.
Kind of. Yes, this is. This is — we call it the arms race.
In her laboratory, Dr. Boucher and her team are constantly analyzing cultures of bacteria from patients in the hospital, always on the lookout for another mutation, another superbug.
DR. HELEN BOUCHER:
The infection preventionists come to our meetings every day at 11:30. And they are tuned in to be looking for anything, any one case that's new that requires them to go do investigation. And that's how we prevent anything from becoming a bigger problem.
The longer bacteria see an antibiotic, the more likely they are to develop resistance. It poses a conundrum for doctors as they weigh the health of an individual patient vs. society as a whole.
DR. SHIRA DORON:
I think there has been a general feeling that it's better to err on the side of caution, and that caution equals prescribe. And I am trying to impart the message that caution might actually be not prescribing.
The hunt for new drugs to prescribe is not easy. Scientists say they have already picked the low-hanging fruit. New microbes that lead to new antibiotics are no longer easy to find.
So, we are running out of antibiotics quickly.
My colleague Paul Solman met with a woman in London who could be the poster child for a post-antibiotic world. Eight years ago, Emily Morris was hospitalized with a E. coli superbug, the first of eight serious bouts with resistant bacteria.
EMILY MORRIS, Antibiotic Research UK:
So, I could have had antibiotics when I didn't need them, and also because I had so many.
When she was young, she was prescribed antibiotics frequently because of a hereditary condition that makes her prone to urinary tract infections.
I was just very lucky, very lucky that a last-resort antibiotic did work. A lot of the time, it doesn't work. It kills thousands of people a year. And these superbugs, I have been told, they are going to kill more than cancer by 2050.
After we finished shooting, I sat down with Paul Solman to compare notes.
Emily's story, that's a tough one. And I think our heart goes out to her, anybody watching that, thinking this could happen to any one of us. And as I was shooting the story, I was thinking an awful lot about how close I was getting to these nasty bugs. Were you thinking the same thing?
Yes, I'm a little hypochondriacal to begin with. I was now becoming germophobic, washing my hands all the time. I mean seriously.
As a good American, I assumed going into this series that there had to be some kind of silver bullet solution that will get us out of this. But it's not as simple as that. The drugs just aren't there, are they?
You would think there's enormous, essentially insatiable demand for the product, so, obviously, the market is going to provide it.
But it turns out, it's not anywhere near that simple. And that's what the next installment of this series is about.
All right, we will go to the dismal science next time.
For the PBS NewsHour, I am science correspondent Miles O'Brien.
And I'm economics correspondent Paul Solman.