May 16, 2014
Killer Bad Bugs And No ESKAPE
Now I don’t want to be alarmist (well maybe just a little bit) but, according to a new report by the World Health Organization (WHO), a whole range of disease carrying agents from “bad bugs”, like bacteria and viruses, to parasites and fungi is threatening to overwhelm us. There is a real danger of a “post-biotic era” where commonplace infections, minor injuries, and illnesses will become deadly and untreatable. As WHO puts it “Far from being an apocalyptic fantasy” it is “a very real possibility for the 21st Century.” The report describes the steadily growing threat of Antimicrobial resistance, or AMR and how the advances and achievements of modern medicine may be severely challenged.
The dangers of hospital infections like MRSA are well known and much has been done to tackle the problem. The last time I was in hospital I watched the intense deep cleaning of every square inch of the bed and surrounding area every time there was a new patient. Even the curtains around the beds are now disposable with “use by” type labels indicating their lifespan. In fact MRSA is in decline in many places but this is a tiny part of the problem. Killer “Bad Bugs” are on the increase everywhere and we are just not finding the drugs to control them.
What would this “apocalypse” look like and how near are we to such a scenario? For a start, diseases that we have long since considered to be eradicated or under control are fighting back in a big way. Take tuberculosis – TB – as an example. TB has traditionally been controlled by antibiotics like isoniazid and rifampicin. The patient usually experienced complete or good recovery within six months. Now there are three levels of TB resistance. First there is “multi-drug-resistant TB.” Then the even harder to treat “extensively-drug-resistant TB” (XDR-TB) which is present in over 90 countries. Now there is also “total-drug-resistant TB,” currently only found in India but with no known cure. TB has returned as a major threat to global health. In some countries patients are just discharged from hospital as there are no available effective treatments.
Then there is “ESKAPE,” an acronym of the six bacteria in a group of highly antibiotic resistant bugs – Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter. This nasty bunch is responsible for a whole host of serious and even life-threatening diseases. Klebsiella alone can cause a large number of illnesses including meningitis, diarrhea, urinary tract infections, septicaemia, and pneumonia. One of the big problems with the ESKAPE group is that they seem to love hospitals where they are causing increasing havoc.
Other conditions that have built up their defenses to most known antibiotics are gonorrhea, HIV and typhoid but the list is expanding all the time. Typhoid is typical of the bugs that are spread much wider due to the ease of global travel. With over 20 million cases worldwide this is a major problem for developing countries but around 5,000 cases turn up in the US each year. Medical science just cannot keep up. The tiny but deadly bugs are outwitting man’s best brains.
While the search continues for new drugs the fear is that the microbes will always leap one step ahead. In the meantime, controlling measures like improved hygiene, vaccination programs, and the careful and proper use of antibiotics can help. Let’s just hope that the “apocalypse” can be averted. The signs are not good. As WHO points out, there have been no new classes of antibiotics developed in the last 25 years – only variations on existing drugs. The battle is not just against the bugs but against the specter of resistance. Maybe we should remember that these organisms were here long before mankind and it is just possible they will be here long after we have gone.
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