One of the big news stories today was about the death of Brian Pool, who according to Stuff’s Michelle Duff is
“believed to be New Zealand’s first victim of an aggressive superbug, caught while he was overseas, that is resistant to every type of antibiotic.”
One of the doctors who treated him, clinical microbiologist Dr Mark Jones appeared on Nine to Noon this morning to talk about the case and to warn listeners that the end of the antibiotic era is approaching. He also did a great live online Q&A on the Stuff website.
Here are some of points about the story that I thought might need clarifying:
1. Did this superbug kill Brian Pool?
No. Mr Pool did not die from a superbug infection. It sounds like Mr Pool died of complications of a stroke which he suffered while living overseas. It was while he was overseas that he became colonised with a strain of a bacterium called Klebsiella pneumoniae which is resistant to all known antibiotics. When Mr Pool was transferred to Wellington Hospital he was found to be carrying the strain and put into isolation to prevent the bacterium spreading to other patients.
2. Mr Pool died in July so why is this news now?
This week is Antibiotic Resistance Awareness Week, an annual campaign around the world to raise awareness of the misuse of antibiotics and the rise in bacterial resistance. Antibiotic resistance is one of the most pressing threats facing our world. It’s been said that we may have as little as 10 years left before we are back in the pre-antibiotic era, where a simple thing like a cut finger or stubbed toe could kill you.
3. Why did Mr Pool have this bacteria but it wasn’t making him sick?
K. pneumoniae and many other ‘superbugs’ can be carried on the skin, up the noses, in the throat or in the guts of perfectly healthy people, and not cause them any problems. However, if the person has an accident, or surgery, or perhaps visits someone in hospital, then the bacteria can become very problematic indeed. This is the reason Mr Pool was kept isolated, to stop the strain from spreading.
4. What’s so scary about Klebsiella pneumoniae?
It’s not really the K. pneumoniae that scares doctors and scientists, it’s the ability it has to share it’s antibiotic resistance genes. The strain that Mr Pool was carrying was resistant to every known antibiotic. This ability comes from the bacteria carrying genes that allow it to chew up certain antibiotics, or even pump them back out of themselves. What’s frightening about these genes is that they are carried on what scientists call ‘mobile genetic elements’, bits of genetic material that bacteria of different species can swap between each other when they have the bacterial equivalent of sex. So, we could end up not just with completely antibiotic resistant strains of K. pneumoniae, but perhaps E. coli, Pseudomonas aeruginosa…. You get the picture.
5. Where did these resistance genes come from? Were they made in a lab?
This is a common question, the idea that antibiotic resistant superbugs must have been engineered in a lab. But the scary thing is that these resistance mechanisms are developing out in the environment, in soils and water where bacteria like to live, and are then being transferred from species to species. One thing to remember about antibiotics, is that they are a weapon in the arms race going on out in the environment between different microbes. They are used by microbes to kill each other! A scary consequence of that fact, is that it is likely that out there somewhere are microbes that have developed the ability to resist antibiotics we haven’t even discovered yet! The misuse of antibiotics (for example, being available without prescription in some countries, being prescribed for viral infections, being used to prevent infections in animals reared in ‘battery’ conditions to give us cheap food, etc..) has certainly exacerbated the problem.
6. Should people be wary of traveling overseas for medical treatment?
The strain Mr Pool was carrying almost certainly originated either in India or Vietnam. About 5 years ago, a class of these resistant microbes appeared in Europe and North America and were traced back to travel to India. By the miracle of flight, resistant superbugs are spreading over the world. There is very little information on how prevalent these bacteria are in hospital overseas. Given that people can also be colonised, it may not even require people to be hospitalised overseas to become carriers. Travel may be enough.
6. Are we really approaching the end of the antibiotic era?
Yes. And for some patients, we may as well already be there. There are a number of bacterial strains circulating around the world that are now completely untreatable. And at the moment it’s not a particularly rosy outlook. Most, if not all, pharmaceutical companies have pulled out of antibiotic development, and much of the low hanging fruit has been picked. Many efforts are now focused on finding ways to prevent infections from happening in the first place or investigating how our immune systems could be harnessed to fight the bacteria. Another promising area is using phage – viruses which kill bacteria, which have been used with some success in the former Soviet Union and Georgia, and are now approved to spray on packaged meat to stop Listeria from growing.
I’ll leave you with this short little video from NPS MEDICINEWISE about the importance of preserving the antibiotics we do have left: