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When We Lose Antibiotics, Here’s Everything Else We’ll Lose Too

Nov.20.13 – in WIRED

This week, health authorities in New Zealand announced that the tightly quarantined island nation — the only place I’ve ever been where you get x-rayed on the way into the country as well as leaving it — has experienced its first case, and first death, from a strain of totally drug-resistant bacteria. From the New Zealand Herald:

In January, while he was teaching English in Vietnam, (Brian) Pool suffered a brain hemorrhage and was operated on in a Vietnamese hospital.

He was flown to Wellington Hospital where tests found he was carrying the strain of bacterium known as KPC-Oxa 48 – an organism that rejects every kind of antibiotic.

Wellington Hospital clinical microbiologist Mark Jones (said): “Nothing would touch it. Absolutely nothing. It’s the first one that we’ve ever seen that is resistant to every single antibiotic known.”

Pool’s death is an appalling tragedy. But it is also a lesson, twice over: It illustrates that antibiotic resistance can spread anywhere, no matter the defenses we put up — and it demonstrates that we are on the verge of entering a new era in history. Jones, the doctor who treated Pool, says in the story linked above: “This man was in the post-antibiotic era.”

A colony of an Actinomycetes bacteria taken at 140x magnification. Image courtesy /Flickr

“Post-antibiotic era” is a phrase that gets tossed around a lot these days, most of the time without people stopping to consider what it might really mean. A year ago, I started wondering what life would be like, if we really didn’t have antibiotics any more. I was commissioned and edited by got research support from (editing to make clear that they didn’t give me a grant; they don’t do that) the fantastic Food and Environment Reporting Network , and today Mediumpublishes our 4,000-word report, “Imagining a Post-Antibiotics Future” — a view from the far side of the antibiotic miracle.

If we really lost antibiotics to advancing drug resistance — and trust me, we’re not far off — here’s what we would lose. Not just the ability to treat infectious disease; that’s obvious.

But also: The ability to treat cancer, and to transplant organs, because doing those successfully relies on suppressing the immune system and willingly making ourselves vulnerable to infection. Any treatment that relies on a permanent port into the bloodstream — for instance, kidney dialysis. Any major open-cavity surgery, on the heart, the lungs, the abdomen. Any surgery on a part of the body that already harbors a population of bacteria: the guts, the bladder, the genitals. Implantable devices: new hips, new knees, new heart valves. Cosmetic plastic surgery. Liposuction. Tattoos.

We’d lose the ability to treat people after traumatic accidents, as major as crashing your car and as minor as your kid falling out of a tree. We’d lose the safety of modern childbirth: Before the antibiotic era, 5 women died out of every 1,000 who gave birth. One out of every nine skin infections killed. Three out of every 10 people who got pneumonia died from it.

And we’d lose, as well, a good portion of our cheap modern food supply. Most of the meat we eat in the industrialized world is raised with the routine use of antibiotics, to fatten livestock and protect them from the conditions in which the animals are raised. Without the drugs that keep livestock healthy in concentrated agriculture, we’d lose the ability to raise them that way. Either animals would sicken, or farmers would have to change their raising practices, spending more money when their margins are thin. Either way, meat — and fish and seafood, also raised with abundant antibiotics in the fish farms of Asia — would become much more expensive.

And it wouldn’t be just meat. Antibiotics are used in plant agriculture as well, especially on fruit. Right now, a drug-resistant version of the bacterial disease fire blight is attacking American apple crops. There’s currently one drug left to fight it. And when major crops are lost, the local farm economy goes too.

If you’ve been reading here a while, you’ll know that I write about antibiotic resistance, in human medicine and in agriculture, all the time (and wrote a book about it). But something personal propelled me into this story. By random chance, I received a copy of the obit of my great-uncle, my grandfather’s younger brother Joe.

I’d heard about Joe as I was growing up, because everyone said my father resembled him. All I knew was that he was good-looking, and died young, and there was something about his death that was tragic. He was a New York City fireman, and I always assumed he’d died in a fire. I was wrong. He died of an infection, 5 years before penicillin came on the scene.

Joe’s death was protracted, and terrible, and it changed my family forever. Seventy-five years later, we would like to think that deaths like his are impossible. But they aren’t; as the story from New Zealand shows, they are happening again. We have a few chances left to turn back the tide of resistance — but only a few, and not much room for mistakes.  I hope we take them.

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