A scanning electron micrograph of MRSA, via Public Health Image Library
Over the past 60 years, human beings haven’t been good stewards of their own environment and technological innovations. The proliferation of automobiles and other oil-dependent technologies has changed our weather patterns and, if we don’t alter our behaviors soon, the future of our planet. In the same way that we’ve augmented our climate through human interference and irresponsibility, we’ve also irrevocably changed the landscape of both beneficial and harmful bacteria through the use and overuse of antibiotics.
Now the same doom-and-gloom rhetoric used so frequently by environmentalists regarding climate change is being applied to our antibiotics future. If there’s a coming, man-made apocalypse, it might be the little stuff, rather than the big, that gets us in the end.
Last week, Britain’s senior medical advisor, Dame Sally Davies, warned MPs that the combination of rapid bacterial resistance paired with the lack of next generation antibiotics coming down the line would result in severe global repercussions unless something is done about it. In fact, she recommended the threat of a coming antibiotic-resistant bacterial Armageddon be added to the register of civil emergencies.
Penicillin saved untold lives
Antibiotic resistance isn’t a new phenomenon, exactly. Natural selection obviously plays a role in the development of antibiotic resistance; if a gene that confers antibiotic resistance occurs in 0.01 percent of the population of an infectious bacteria, and you treat for the illness, then those bacteria will survive and go on to infect others. Bacteria are also capable of transferring genes through their plasma, thus the resistant bacteria may pass their genetic good fortune on to others.
Some types of bacteria are more adaptable and respond more quickly to the evolutionary pressure of antibiotic use. Famously, multiple resistant strains of Staphyloccocus have evolved in the antibiotic age. In fact, Staph was the first bacteria to develop resistance. In 1947, only four years after penicillin began to be mass-produced, penicillin-resistant Staph had already made an appearance. Methicillin, a second-line antibiotic, was then used to treat Staph infections, but MRSA (methicillin-resistant Staphylococcus aureus) is now the most common drug-resistance bacterial infection in the United States, and acquiring MRSA is a real threat is many hospitals, especially for patients with compromised immune systems. New research suggests how Staph superstrains create their resistance, but there's still a long way to go to develop a cure.
In addition, our creation of super bugs, or bacteria resistant to most or all drugs. In many cases, the last line of defense are broad spectrum antibiotics, which also indiscriminately kill many of the beneficial bacteria living in our bodies. This includes those that help us do things like fend off infection and digest foods properly. Disrupting our internal bacterial biome can have serious consequences, including a wide array of diseases and gastrointestinal dysfunction. Restoring that balance requires measures as drastic as fecal transplants.
Reestablishment of the proper balance of gut bacteria is proving such an effective treatment that scientists have developed a delivery system that no longer involves transplanting someone else's poop into your body, an idea that no doubt some find bothersome. RePOOPulate, a laboratory-created substance that stands in for the poop of fecal transplants had recently been developed to help move bacterial transplant treatments into the future.
Clostridium difficile, a common bacteria responsible for diarrhea, can be treated using rePOOPulate
Healthy gut biota are crucial to our health. In an article forthcoming in the February 1 issue of Science, researchers discovered a frightening impact of unhealthy gut biomes in a study on African children in Malawi. Malnutrition is the leading cause of death for children worldwide, and a specific form of malnutrition known as "kwashiorkor" is prevalent in Malawi. In a study on twins between ages three and five years old in which one twin had kwashiorkor and one was healthy, researchers found that gut microbiota of acutely malnourished children differed significantly from those who were healthy.
The bacterial makeup of their guts was effectively changing their ability to absorb nutrients, and though the bacterial makeup changed when they children were fed therapeutic food, becoming more normal, they reverted when the children were taken off of it. Scientists transplanted the fecal matter of the twins into healthy mice and, sure enough, the mice transplanted with the kwashiorkor poop developed malnutrition.
But even broad-spectrum drugs don't always work. Gonorrhea has also been in the news due to emergent strains resistant to Ceftriaxone, an antibiotic medication of the most recent generation and the last known defense against the steadily mutating disease. That is effectively a dead end; right now, there's no way antibiotic to treat resistant strains of gonorrhea. There’s also no effective pipeline of antibiotic innovation to deliver to us new medications to use up with abandon and then cast aside once they become ineffective.
This is due, in large part, to the evolving landscape of the pharmaceutical industry and the ways in which we are sick today. Because of the way the patent system functions in the United States, and because of the way that human beings need and purchase prescription medications, pharma R&D isn’t now chiefly concerned with developing a fourth generation of antibiotics, which are only used in short bursts.
The new pharma sweethearts are the so-called “blockbuster drugs,” drugs that create billions of dollars in profits each year, drugs that must be taken everyday for things like arthritis, cholesterol modification, and mental illness. Sure, we may feel snug in our current position as lords over the microbial world, but we can't forget that only 100 short years ago people died of common bacterial infections all the time. If Dame Davies’ apocalyptic warning is as urgent as she claims, those times might be returning sooner than we think.
Image via CDC
The impact of bacteria on our lives -- both good and bad -- is becoming more evident. It seems the responsibility of doctors and patients to reduce their antibiotic usage; this can decrease evolving resistance and protects the delicate balance of individual gut microbiomes. Unless there is swift change in the drug development for antibiotics, there likely won't be another line of defense when more bacteria begin to overpower our most advanced drug treatments. If the apocalypse is coming, perhaps it's not in the form of an asteroid or storm or huge, spectacular event, but instead will result from the invisible action of these tiny, powerful creatures.