JANUARY 30, 1997
Strains of antibiotic resistant bacteria are springing up everywhere. These organisms are mutants, and some are able to beat all 160 antibiotics on the market. Tom Bearden reports.
TOM BEARDEN: In hospitals all over America doctors are now forced to put on protective clothing to go in the same room with some of their patients. It's because more and more people are turning up with infections that are all but untreatable. This man's body contains a bacteria called VRE. It's resistant to every antibiotic known. It hasn't made him sick yet, but if it becomes infectious and enters his bloodstream, his chances of survival are less than 50 percent because there won't be any drugs to treat it.
A RealAudio version of this NewsHour segment is available.
A recent conference held to discuss the biological basis of antibiotic resistance
The special isolation procedures are designed to keep the germs from spreading to other patients in the hospital whose immune systems have been compromised by transplants or disease. Dr. Stuart Levy is a leading researcher into antibiotic resistant bacteria.
DR. STUART LEVY, Tufts University: I would say that there probably is no hospital in the country that doesn't have a VRE problem of some sort. And that means that all these news precautions have to be taken; rooms have to be made as single rooms, gowns have to be available, globes, washings, it's all got to be new training.
TOM BEARDEN: New training because this is the first time since antibiotics were discovered that germs have gained the upper hand, and VRE isn't the only problem. Every one of the 160 antibiotics on the market today have been compromised by at least one resistant strain of bacteria, and the list is growing every day.
DR. STUART LEVY: I think it's very, very serious. This decade has seen the emergence of bacteria that are resistant to all but one drug or even bacteria that are resistant to every drug. We've never experienced that in the history of antibiotics, and certainly not in the United States. What it means, I think, is that we're just seeing a beginning and what worries me is that there are few patients suffering from these almost untreatable infections now, that the future will show us many, many more.
TOM BEARDEN: At a microbiology laboratory at Tufts University in Boston, Dr. Levy leads a team of scientists trying to find solutions.
DR. STUART LEVY: This is one way of determining whether a bacterium is susceptible or resistant to an antibiotic. You can test many antibiotics on a single plate. This is called the E test, and what happens here is that as you go through the center the lowest concentration is found, so you'll see in the background all this haziness are bacteria growing. And when you see the halo, it means you've reached a concentration of the antibiotic in which the bacterium can grow.
TOM BEARDEN: The reason that bacteria are now able to defeat powerful antibiotics is because they have mutated and developed ways to resist the drug's attacks. It's survival of the fittest at the most basic level.
DR. STUART LEVY: If you were to catch an infection today, its chances of being resistant to one, two, even three, four antibiotics is millions of times greater than it was even seven, eight years ago. So what it says is that the environment is now loaded with resistant bacteria. That's not the simple consequence of a single organism happening to be resistant. That means that there's been a whole change in our ecology.
TOM BEARDEN: The change occurred because one bacteria like VRE can transfer its resistance to another strain by sharing genetic information. Alan Proctor is head of infection disease research for the drug manufacturer, Pfizer, Incorporated.
AL PROCTOR, Pfizer: Bacteria are very promiscuous. They exchange genes one amongst the other, and these genes eventually get transferred around to other bacteria.
TOM BEARDEN: The potential consequences are troubling. For example, in some parts of the country, the organism that causes most common ear infections has become resistant. The risk of the bacteria migrating to the brain and causing potentially fatal meningitis is now markedly greater. The medical community fears that the organism will soon be completely immune to antibiotics and that it will spread across the country. Medical science finds itself facing these increasingly difficult bugs partly because of complacency.
ANNOUNCER ON FILM: In Atlantic City three thousand scientists convened for exchange of information on progress and experimental biology.
TOM BEARDEN: Antibiotics truly were miracle drugs when they were appeared. Penicillin was the first, isolated in the 1940's. Literally millions of people owe their lives to penicillin and the products that followed. They quickly and easily defeated infectious diseases that were once the scourge of mankind. Bacteria started to show resistance even then, but the drug companies were able to easily churn out antibiotic variants that remained effective.
The market for antibacterials soon became over saturated. Drug companies stopped developing new products because there was no apparent need. The National Foundation for Infectious Diseases says half of all drug companies completely abandoned anti-bacterial research in the 1980's. Alan Proctor's company, Pfizer, stayed in.
ALAN PROCTOR: The world became somewhat complacent about two decades ago because anti-bacterials were so effective, we had such a very sharp rise in the ability to fight disease that people thought the game was over.
TOM BEARDEN: Scott Rocklage, CEO of Cubist Pharmaceuticals, says the drug companies thought the future lay in fighting AIDS and HIV, diseases which ironically ended up adding to the bacteria problem.
SCOTT ROCKLAGE, Cubist Pharmaceuticals: As the pharmaceutical companies directed their infectious disease research budgets, primarily to HIV and other viral infections, at the same time that was happening, the bugs were becoming more sophisticated, and around the early 1990's the resistance trends increased dramatically as the advent and increase in the immune system compromised patient population came to the clinical setting. We ended up with a wonderful host for the growth of resistance organisms.
TOM BEARDEN: Dr. Levy thinks the public and the medical community also must bear some of the blame. In his book, The Antibiotic Paradox, Levy says antibiotics became too popular for their own good. Because they're successful drugs with few side effects, antibiotics tend to be overused and misused. People also often don't take the full course of medication, allowing the targeted organisms time to develop genetic defenses.
DR. STUART LEVY: I think we've bred the organisms, and it's not just the clinician that gives the antibiotic. It's the patient who demands them; it's the patient who stockpiles them; it's the patient who gives them as a good Samaritan to the neighbor, to a person who's on the same vacation trip. “Oh, I happen to have some leftover penicillin tablets; you ought to take them.” I mean, they're giving away antibiotics as if this is the thing we should do. It's really nice to do it. And, in fact, what it has done is to create an environment which is much more heavily populated with resistant strains of these bacteria than we had before.
TOM BEARDEN: Dr. Neil Kesselman says patients often press doctors for antibiotics. Kesselman is a pediatrician with the Health Maintenance Organization Kaiser Permanente.
DR. NEIL KESSELMAN, Pediatrician: It's a very difficult thing to know what the right thing is to do. It would be wonderful--I personally would like to take care of an ear infection by saying to a mom there is an ear infection, and the information I have, which is the experience in the Netherlands, is that most of the ear infections go away, or a significant number of them go away without treating. I've presented that to a few people.
I've had one person say, yes, that's worth the experiment, but on the other hand, I look at the mom and say, goll, this lady is working. She's going to have to come back in three days to see what that ear looks like, and the standard of care in the United States for so many years has been the antibiotics on day one, very, very difficult to buck the trend.
TOM BEARDEN: Sometimes antibiotics are prescribed when they can do no good, like for a patient who has a viral infection like a cold. The drugs kill off beneficial bacteria, turning patients' bodies into breeding grounds for resistant bacteria because they have no competition. But Dr. Kesselman says deciding whether an infection is bacterial or viral is not always a cut and dried decision.
DR. NEIL KESSELMAN: It's very difficult to tell viral versus bacterial in many instances. Typical examples are colds, trying to differentiate a cold from a sinus infection, trying to differentiate a red throat, viral versus strep, trying to differentiate conjunctivitis or pink eye, bacterial versus viral.
TOM BEARDEN: This little boy got an antibiotic in an emergency room where his parents had taken him because he was wheezing, but it turned out he had viral pneumonia, an infection that doesn't respond to antibiotics. Even so, Kesselman doesn't fault the emergency room physician for prescribing the medication.
DR. NEIL KESSELMAN: Pneumonia is another great example. Most of the pneumonias we know about are viral, but typically people will come in, they'll hear that word, the doctor will be a little worried, they'll go home with an antibiotic. So it's a dilemma. Are you doing the person a favor by giving the antibiotic, or are you doing--are you wasting their time and actually possibly endangering the rest of us in our public health with all the resistant bacteria that are around?
TOM BEARDEN: The only solution is to develop new antibiotics. Easier said that done. Research takes time and a lot of money. And the approval process takes years. But the new super bugs have created a whole new market opportunity, and drug companies are now scrambling for a cut of the estimated $26 billion profit to be made. But they know the old approaches won't work. Super bugs require more sophisticated weapons. Some of the most promising avenues appear to be in genetic engineering, something that big drug companies don't know much about.
DOCTOR: So the next step will be to isolate the gene, and then what do we do after that?
TOM BEARDEN: So several of them working to find new bacterial targets have gone into partnership with the biotech company Cubist Pharmaceuticals. Another biotech company, Microcide Pharmaceuticals, has also partnered with the drug giant Pfizer to attack what they believe is the Achilles heel of bacteria, their genetic structure.
ALAN PROCTOR: This machine allows us in a very short period of time to determine the DNA sequence; that is the ATGS, the code that makes up the information inside that specific gene. Our approach has been genetically directed to identify those weak spots in the bacteria which have through mutation we could eliminate for a while and then put back the bacteria will die. That's what we want a drug to do. You take the drug, the bacterium dies.
TOM BEARDEN: Early results from the genetic approach are encouraging, but even the most promising drugs can't be ready before the year 2000, despite the fact that the Food & Drug Administration has committed to a fast track for testing new antibiotics. Many doctors are deeply worried that in the meantime, a lot of people will get seriously ill and even die from infections that until a few years ago were easily curable.