FRONTLINE asks: Has the age of antibiotics come to an end?
They’re germs so dangerous the nation’s top health official at the Centers for Disease Control describes them as “nightmare” bacteria. That’s hyperbolic language for the typically staid institution, but in this case it’s warranted, said CDC Director Tom Frieden earlier this year. More formally known as CREs, these “superbugs” resist most antibiotics, spread resistance to other germs and kill roughly half of the people who get bloodstream infections from them.
And they’re spreading. Nearly every state in the union has seen at least a couple of cases. If something isn’t done soon, public health officials warn, the world will be facing a “post-antibiotic era,” meaning, “in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill,” according to Margaret Chan, director general of the World Health Organization. This scenario is the subject of Tuesday’s episode of FRONTLINE on PBS: “Hunting the Nightmare Bacteria.” David Hoffman, the Frontline correspondent behind the documentary, will join PBS NewsHour senior correspondent Ray Suarez on Tuesday’s broadcast.
But first, a preview.
To tell the story, the program examines three notable cases, including that of Addie Rerecich, an 11-year-old girl in Tucson. After complaining of a nagging pain in her hip she ended up fighting for her life in the hospital in 2011.
Above is a clip from the film, beginning with her mother’s recollection. Below are excerpts from the NewsHour’s earlier discussion with Hoffman. It has been edited for clarity.
NEWSHOUR: David Hoffman, thank you for joining us. Let’s start by considering Addie’s story. A perfectly healthy young girl gets an infection, is taken to the hospital and deteriorates quickly from there. What does her case tell us about these bugs?
DAVID HOFFMAN: A couple things. One is she got the really resistant infection in the hospital. Hospitals are cauldrons of resistant infections. It’s a big part of the problem. Hospitals don’t like to talk about it very much. As you know, a big part of the film is what happened at NIH — a prestigious research hospital. So Addie’s story tells us that one thing that’s happening with these superbugs is they’re growing in these hospitals and the hospital environments are something we’ve got to work on.
Secondly, Addie was healthy. And in a very short period of time, she became very sick. She was at the edge of death. That could happen to anyone. And the real point of her story is — thank God she recovered — but she had to have surgery to remove the infection, which is a pretty radical, severe way to get rid of infection. There was just no other way besides a lung transplant to save her life. So part of the problem with these resistant bacteria is we don’t have tools to fight them.
NEWSHOUR: Let’s talk about these “superbugs” more generally. Why are they so dangerous? How are they developing anti-bacterial resistance and spreading?
DAVID HOFFMAN: A couple of reasons. First of all, there are different types of bacteria. These “nightmare” bacteria are called Gram-negative. And one reason they become so much trouble is they have certain characteristics in which they can fight off antibiotics — like an armored shell around the bacteria that defends it or the ability to pump out the antibiotics. Therefore, they resist and survive.
Second, a couple of these particularly dangerous bacteria have high mortality rates. Something like 40 or 50 percent of the people that get this in their bloodstream die. And thirdly — and most worrisome — is that several of these have the ability to literally coach other bacteria how to be resistant to antibiotics. So they’re beginning to transfer this resistance ability to other types of bacteria, spreading resistance even more. So those three factors — resistance to almost all antibiotics, high mortality rates, and the ability to teach others — are what led the director of the CDC to call them “nightmare” bacteria.
NEWSHOUR: How widespread are these bugs in the U.S.?
DAVID HOFFMAN: The CDC estimated on Sept. 15 that these resistant bugs have led to two million infections per year among Americans and 23,000 deaths. Now that’s more deaths than occur from HIV/AIDS in the United States every year. It’s a serious public health crisis. It’s also true that they come in waves. We had a long period coping with MRSA — Methicillin-resistant Staphylococcus. MRSA has been around for a while and it’s actually declining some in hospitals.
But these new gram-negative ones that I was talking about, this “nightmare” bacteria — 10 years ago, 12 years ago, they weren’t anywhere in the United States. And now they’re in more than 40 states. I think the director of the CDC said they spread widely — it’s not deep yet. But what concerns people here is the trend. From zero to 15 miles an hour, you know? It’s the beginning of an acceleration. So that’s why the CDC is issuing this alarm and why, in my own reporting, I became alarmed.
NEWSHOUR: What are the options when a bacteria is found to be resistant to drugs? Do we have any treatment possibilities?
DAVID HOFFMAN: One of the things that comes through loud and clear in our film is that even the most modern, last-resort antibiotics — a class of antibiotics called Carbapenems — are not working against these gram-negatives. And that leaves a doctor in a really difficult position. If you’ve got a blood infection with one of these things — let’s take, for example, a patient at NIH, because the very first one had this dangerous bacterium in their blood. One of the things they can do is use one of the oldest and earliest antibiotics. It’s called Colistin; it’s really toxic.
It basically destroys your renal system — destroys your kidneys. So here you’re getting to the point where it’s sort of a “Hail Mary.” Frankly, as we show in the film, there’s more than one case where they had to stop the Colistin because it was just too toxic. So you’re putting the clinicians sort of on their back heals because they’re running out of options. In the era before antibiotics, when someone got an infection, like an infected arm or infected finger or toe, it was just cut off. So are we going to go back to that age when we just had to just cut off infections? There are people, including the director of the World Health Organization, Margaret Chan, she said that a post-antibiotic era means in effect an end to modern medicine as we know it.
NEWSHOUR: We’re hearing this phrase more often — “post-antibiotic era.” How close are we to that?
DAVID HOFFMAN: It’s a question I can’t answer. I don’t think anybody knows. But you can look at it this way — after antibiotics were discovered, just before World War II, we had a couple of decades where we called these “wonder drugs.” They said they were miracle drugs. It was kind of a golden age. More than 150 types of antibiotics were discovered in those decades. And death by infection was reduced dramatically.
In the 90s particularly, but in the 80s and 90s, we began to see the bugs learning how to adapt — becoming more and more resistant. And at the same time, the pharmaceutical companies began producing fewer and fewer antibiotics. So today, we have a situation where there’s more resistance and fewer and fewer new antibiotic drugs to fight it. So it’s a little bit of a perfect storm of difficulty. Historically, we’re essentially seeing a rollback of the great “wonder drugs.”
NEWSHOUR: Is the government doing anything about this?
DAVID HOFFMAN: I think there are a lot of smart people in the government who see the problem. But one of the things that occurs to me is that there has not been a sense of crisis that is anywhere near the level of what it should be when the director of the CDC says we have “nightmare bacteria.” If the top public health official says we have an “urgent crisis” — his words — do we have a policy response that’s up to that? I don’t think so. If you think back to public health crisis of HIV/AIDS — it was slow in coming and very slow in being recognized, but ultimately, the United States responded to a public health crisis with a huge program of research and development that got results.
NEWSHOUR: What can people do to protect themselves and their families?
DAVID HOFFMAN: I think the first line of defense is hand-washing. Wash your hands, pay attention to hand hygiene. Cook your food properly. But the second thing is to use antibiotics properly. Don’t take them when you don’t need them. Have that discussion with your doctor. If you have to go to hospital, go to hospital. But have that discussion with doctors and ask them to wash their hands.
And I think thirdly, all of us have to break out of a complacency about antibiotics. Just as a mindset and a political thing, I think we need to tell politicians this is a crisis, “an urgent crisis” in the words of the head of the CDC, in the words of the head of the World Health Organization, in the words of the head of the United Kingdom’s top medical body. And policy is lagging way behind the warnings.