Antibiotic resistant bacteria are a fact of life for those of us in the medical profession. In my 25 years of practice this has gradually morphed from a very manageable problem to one that is increasingly difficult if not frightning. We are now at the point where previously healthy people can contact a lethal infection that we cannot cure with antibiotics. Many others have to be treated with courses of expensive, inconvenient and even toxic antibiotics because resistance has made much cheaper and safer old standards useless. MRSA has become a household 'brand' in the medical world.
Well, this scary situation is about to get a lot worse. Follow me if you dare.
We frankly do a pretty lousy job of managing antibiotic usage here in the United States. More than half of all yearly antibiotic production tonnage (yes, we're talking thousands upon thousands of pounds) goes into animal feed to permit BigAg to make a few more pennies per pound on hogs and cattle jammed together shoulder to shoulder on massive factory farms. That's just insane from a public health standpoint, and the Obama administration is finally taking some tentative steps to mitigate the stupidity.
The medical world is not a lot better. We are far, far too promiscuous in our use of antibiotics. Some of this is the result of harried, overworked primary care providers who find it easier to write a prescription for Amoxicillin than to spend the time required to explain to a patient why it won't help their head cold. Some is the crass overuse of very expensive broad-spectrum antibiotics for infections easily treated with something simpler and cheaper. Much of it is simply the result of far sicker people kept alive much longer on dialysis and with multiple surgical procedures or indwelling medical devices, where cascading infections and multiple rounds of antibiotics are the rule. And finally, we've become far too complaiscent about basic infection control procedures (like, for instance, simple handwashing) with antibiotics available.
This is all going to change, and probably quite soon. As you can read here, a new extremely resistant strain of bacteria is gaining headway, appearing initially among "medical tourists" returning from India after having surgical procedures. If you think antibiotic use and infection control procedures are lax here in the U.S., in the developing world it's a nightmare. There's virtually no surveillance for developing resistance patterns, no review or constraints on use of broad spectrum antibiotics, little systematic follow-up to ensure infections are eradicated. To put it bluntly, it's the ideal situation if your goal is to cultivate the development of extremely drug resistant bacteria.
This is really, really bad news. The resistance is mediated by genetic information that is easily transmitted to other strains, even completely different species, of bacteria. It is entirely possible that this resistance factor may leap to common strains of very virulent bacteria causing most serious infections here in America, making them overnight impmervious to virtually all antibiotics.
80 years ago, my grandfather began practicing pediatrics in the pre-antibiotic era. He once told me how diagnosing meningitis or a severe pneumonia was effectively a death sentence; all he could do was hold a child's hand as he or she died. When Penicillin arrived after 1941, suddenly he could cure these children. It was like magic.
My entire career to date has been in the era of antibiotics.
But I can see that in the coming years, I may be practicing in the post-antibiotic era. An era in medicine when antibiotics are largely worthless, and we're back to quaranteens and hand-holding.