WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health

The nightmare bugs are multiplying because our antimicrobial team has no real leadership and has shockingly inadequate funding. We don’t have much data on what is really happening, but my guess is the deaths-from-resistant-microbes curve is increasing at an increasing rate. Every year more patients discover that the post-antibiotic world has already arrived for them.

A new report by WHO–its first to look at antimicrobial resistance, including antibiotic resistance, globally–reveals that this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. Antibiotic resistance–when bacteria change so antibiotics no longer work in people who need them to treat infections–is now a major threat to public health.

“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” says Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security. “Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.” 

Globally we are falling further behind. Every year more resistant bacteria are discovered, more people die. The most recent data I have shows 2 million U.S. cases of antimicrobial resistance, resulting in 23,000 deaths. We know the actuals are higher because there is no requirement for hospitals to report cases or even outbreaks of resistance. Here is an example from the transcript of the PBS special “Hunting the Nightmare Bacteria”:

Nationally, most hospitals aren’t required to report outbreaks to the government, and most won’t talk publicly about them. (…snip…)

Dr. BRAD SPELLBERG: It’s not that the government agencies are not aware of the problem and are not— and are not doing anything. It’s that we have not had a comprehensive plan for how to deal with antibiotic resistance. We don’t have reporting mechanisms, like they do in Europe, to know where resistance is occurring, who’s using the antibiotics, are we overusing them?

DAVID E. HOFFMAN: Wait. You’re telling me we don’t know the answers to the extent of the problem?

Dr. BRAD SPELLBERG: That’s correct.

DAVID E. HOFFMAN: We don’t have the data?

Dr. BRAD SPELLBERG: That is correct. I do not know how many resistant infections are occurring right now. I don’t know what the frequency of resistance in different bacteria are. We do not have those data.

NARRATOR: FRONTLINE requested an interview with the secretary of Health and Human Services, Kathleen Sebelius. We wanted to ask about the lack of data and the about the priority the department is giving to the new superbug crisis. But she declined to be interviewed.

The “nightmare bacteria” have caught governments and public health authorities napping. They didn’t seem to notice that over the past twenty years the development of new antibiotics has collapsed. From the 2013 report by the CDC Antibiotic Resistance Threats this graphic illustrates that there is now almost no new antibiotic development.

Antibiotic development collapse

The fundamental reason for the collapse in new antibiotics is the pharma marketplace doesn’t reward developers enough to pay for the R&D and the drug approval process (USD $600 million to $1 billion for a new drug). Those numbers inhibit every kind of drug – but let through those that sell to the chronic patient markets (cholesterol, hypertension, …). A successful new antibiotic may be sold to a patient for 10 days, not 30 years like a hypertension drug.  And sadly there is nearly no high level level focus on the new antimicrobial market failure.

Resistance is an everyday process – microbes begin exhibiting resistance as soon as a new compound is deployed. There was already penicillin resistance when the drug was first commercially introduced. This issue didn’t start making the headlines in at the beginning of the 21st century because there were still a lot of drugs in the cabinet that could be tried when a new resistant bug surfaced. Today, for an increasing number of infectious diseases, the antibiotic cabinet has fewer effective drugs every year. From the  CDC Antibiotic Resistance Threats report, this graphic illustrates key resistance events:

Timeline of antibiotic resistance

The PBS Frontline special is a useful introduction to this subject — with video, audio, transcript and a number of useful resource links. The CDC report Antibiotic Resistance Threats is an excellent, well-researched overview as of 2013. CDC has a Antibiotic / Antimicrobial Resistance websitethat can be your home base for researching and tracking progress on this issue. CDC is asking congress for $160M [Antibiotic Resistance Solutions Initiative — $160M: A Comprehensive Response].

So what can you do? Most important is to make it clear to your representatives that you expect them to support a major government focus.  In the U.S. there should be at least an NIH Assistant Secretary devoted to antimicrobial resistance, whose mission should be new antimicrobial drug research and development, high-efficiency testing to fast-track diagnosis of new cases, case tracking/reporting, and OBVIOUSLY to radically slash the agricultural misapplication of antibiotics at sub therapeutic doses (about 80% by mass of US antibiotic sales).

To give you an idea of how inadequate the US response is read Can a New White House Plan Catch Up to the “Superbug” Threat?

Although that initiative represents the government’s first-ever attempt to broadly address the issue of antibiotic resistance, the plan has been quickly dismissed by some scientists and lawmakers for not going far enough. In an interview with Politico, Rep. Louise Slaughter (D-N.Y.), the only microbiologist in Congress, said that goals set for 2020 are too far off to make up for lost ground.

“I’ve said to people, ‘Right now your government is not going to protect you,’” said Slaughter. “They’re about 10 years behind.”

PS – if you have some elective surgery on your horizon, say a knee or hip replacement, you might want to think about getting that done while there are still a few antibiotics that could help save your life (or your leg).

Re-Examining the FDA Antibiotics Decision: Banning Growth Promoters Won’t Be Enough

Denmark weaner pigs experience

Chart via Hagan Vigre, Danish Technical University, 2009

Further to the Denmark experience, Maryn McKenna has a new essay at Wired

The object lesson in changing antibiotic patterns is Denmark, which in 2000 made farm antibiotics prescription-only, and banned nontherapeutic uses altogether. It’s often pointed out, on the ag side, that Denmark had an increase in deaths among weaner pigs immediately after that ban was rolled out; but within 3 years, weaner pig survival improved and returned to where it had been before the ban.

What reversed the trend was Danish farmers’ understanding that it wasn’t enough just to remove antibiotics from meat production. What was necessary was to change the conditions in which meat animals were raised, so that the welfare threats which the antibiotics had addressed no longer existed.

That seems to me to be the lesson that meat production in America needs to learn, if the FDA’s intention to remove growth promoters is going to be meaningful. Simply reducing antibiotic use (if that does indeed happen) isn’t adequate; by itself, it may even be a threat to welfare. Changing the livestock practices that made antibiotic use necessary will improve animal and human health both.


How to protect effective antibiotics: a conversation with Doc Ricky

MRSA

I believe that the rapid spread of antibiotic resistance should be recognized as an urgent public health priority – possibly the #1 priority. E.g., CRE [1].

After reading Betsy McCaughey [2] “U.S. Lacks Will to Fight Superbugs” [3] I tweeted the citation for her op-ed

CRE the “nightmare bacteria”: U.S. Lacks Will to Fight Superbugs j.mp/1au0EbR

Shortly Doc Ricky replied:

@stevedarden I’m kind of perplexed by the media repetition of “fighting superbugs” – what do ppl expect anyway? Some secret weapon?

What an excellent framing question! I replied with some suggestions:

  1. Transparency of hospital performance on sanitation standards.
  2. No excuses policy on resistance cases e.g. Israel
  3. Strict limitation of agriculture use to disease, no routine NTA dosing
  4. Transparency on physician prescribing by doctor

Shortly Doc Ricky replied:

“@drricky: @stevedarden but problem is most of these are preventative, what is expected when MDR {Multi Drug Resistance} is detected?”

I replied over several tweets: By #2. what I meant is that the CDC publishes “best practice” on procedures to execute upon every identified case of MDR[4]– beginning with effective quarantine and decontamination. The “best practice” level of response is mandated to be the minimum response. It should be the top priority of the hospital to eliminate the detected microbe from the institution. I appreciate that is a statistical goal, as we have no way to validate that “we killed it”.

For examples of such best practices consider the 2011 NIH Clinical Center response to a CRE outbreak [5], and of Israel 2006 (from Betsy McCaughey):

When CRE invaded Israel’s hospitals in 2006, public health authorities launched a military-style campaign requiring reports from all hospitals, which were ordered to test patients and undergo rigorous cleaning efforts. This reduced CRE by 70 percent in one year. Israeli researchers just announced a drug that may protect patients exposed to CRE from becoming infected.

My personal bias is that regulation is a blunt and ineffective tool in complex, fast-changing domains like this one. My question: How to incentivize hospitals to succeed?

Suggestion: first try transparency. E.g., if the Johns Hopkins data, such as MDR cases, hand hygiene and infection-control scores are published on the web every month – that is a powerful incentive to improve – to be ranked among the very best institutions globally.

Meanwhile Doc Ricky tweeted a critique of my first try on agriculture:

@stevedarden The agriculture issue is more nuanced than that, after all, how does one exactly limit the use?

Exactly:

@drricky Legislating detailed Rx rules not practical. How about transparency of farm usage per animal-KG? Is public shame effective?

I am thinking of the Denmark experience beginning 1999 where they succeeded to eliminate NTA use in agriculture. See my 2010 Denmark: results of stopping NTA (non-therapeutic antimicrobials)

Doc Ricky moves the discussion to the next level, biology:

@stevedarden only skirts around the real problem, which is biology. We culture animals with similar physiology to ours

The microbes shared by humans and pigs, chickens, beef are why we are so concerned about agricultural applications of antibiotics. Agriculture uses roughly 80% of the antibiotics effective in the human population – but in vastly larger quantities. If we were all vegetarians that would eliminate the whole worry about agriculture.

Doc Ricky is truly the expert in this topic – I’m looking forward to learning from him. We agreed to shift the conversation from Twitter to a long-form-friendly fora.

@stevedarden clearly a complicated topic, and hope you’ll continue to discuss.

NOTES:


  1. The CDC on CRE Carbapenem-Resistant Enterobacteriaceae.  ↩

  2. Betsy McCaughey founder of Committee to Reduce Infection Deaths  ↩

  3.  (…snip…) CRE was first uncovered in North Carolina in 1999. By 2008, it had spread to 24 states and was “routinely” seen in certain New York and New Jersey hospitals. But hospitals kept quiet. Now it’s in at least 43 states.
    (…snip…) Two months ago at a press conference, CDC Director Thomas Frieden dubbed CRE the “nightmare bacteria,” warning that “without urgent action now,” superbugs like CRE will prevent patients from getting joint replacements, cancer therapy and other treatments. The risk of incurable infections will make these treatments too dangerous. Yet, where’s the urgent action?
    The CDC doesn’t even have accurate data on how many CRE infections are occurring and where, because according to the director of the CDC’s Office of Antimicrobial Resistance, Steven Solomon, the government agency has never reached out to state officials to make CRE a reportable disease. Only 12 states require hospitals to report cases. Astoundingly, New York State did not require reports until July 2013, despite CRE menacing some of its hospitals for a decade.  ↩

  4. I am using the shorthand MDR to represent all the emerging multi-drug resistant microbes.  ↩

  5. This is what happened at the National Institutes of Health Clinical Center in Maryland in 2011. A 43-year-old woman known to have CRE was admitted from a New York City hospital. The NIH treated her, using CDC infection-control precautions, but three weeks later, a male cancer patient who had had no contact with her came down with CRE. Week after week, more and more patients contracted the infection introduced by the New York woman. Six of those patients ultimately died, one of whom was a 16-year-old boy. To stop the outbreak, NIH investigators double-cleaned rooms with bleach and misted hydrogen peroxide in measures far beyond what the CDC recommends.  ↩

The File Drawer Effect

This is not an academics-only esoteric debate. It is about whether new, effective drugs are released. It is about how accurate is our knowledge of reality. Here is astronomer Phil Plait quoted in this excellent essay on Survivorship Bias:

For far too long, studies that fizzled out or showed insignificant results have not been submitted for publication at the same level as studies that end up with positive results, or even worse, they’ve been rejected by prominent journals. Left unchecked, over time you end up with science journals that only present the survivors of the journal process – studies showing significance. Psychologists are calling it the File Drawer Effect. The studies that disprove or weaken the hypotheses of high-profile studies seem to get stuffed in the file drawer, so to speak. Many scientists are pushing for the widespread publication of replication, failure, and insignificance. Only then, they argue, will the science journals and the journalism that reports on them accurately describe the world being explored. Science above all will need to root out survivorship, but it won’t be easy. This particular bias is especially pernicious, said Plait, because it is almost invisible by definition. ”The only way you can spot it is to always ask: what am I missing? Is what I’m seeing all there is? What am I not seeing? Those are incredibly difficult questions to answer, and not always answerable. But if you don’t ask them, then by definition you can’t answer them.”

We subscribe to the AllTrails network – I can’t recommend their work highly enough. See also Publication bias in Wikipedia and All Results Journals.

 

FDA: stop buying antibacterial soap products

Every day, consumers use antibacterial soaps and body washes at home, work, school and in other public settings. Especially because so many consumers use them, FDA believes that there should be clearly demonstrated benefits to balance any potential risks.

In fact, there currently is no evidence that over-the-counter (OTC) antibacterial soap products are any more effective at preventing illness than washing with plain soap and water, says Colleen Rogers, Ph.D., a lead microbiologist at FDA.

Moreover, antibacterial soap products contain chemical ingredients, such as triclosan and triclocarban, which may carry unnecessary risks given that their benefits are unproven.

“New data suggest that the risks associated with long-term, daily use of antibacterial soaps may outweigh the benefits,” Rogers says. There are indications that certain ingredients in these soaps may contribute to bacterial resistance to antibiotics, and may have unanticipated hormonal effects that are of concern to FDA.

(…)

In addition, laboratory studies have raised the possibility that triclosan contributes to making bacteria resistant to antibiotics. Such resistance can have a significant impact on the effectiveness of medical treatments.

Source

 

FDA restricts antibiotic use in livestock

This is the best news in a long time.

WASHINGTON — The Food and Drug Administration on Wednesday put in place a major new policy to phase out the indiscriminate use of antibiotics in cows, pigs and chickens raised for meat, a practice that experts say has endangered human health by fueling the growing epidemic of antibiotic resistance.

This is the agency’s first serious attempt in decades to curb what experts have long regarded as the systematic overuse of antibiotics in healthy farm animals, with the drugs typically added directly into their feed and water. The waning effectiveness of antibiotics — wonder drugs of the 20th century — has become a looming threat to public health. At least two million Americans fall sick every year and about 23,000 die from antibiotic-resistant infections.

“This is the first significant step in dealing with this important public health concern in 20 years,” said David Kessler, a former F.D.A. commissioner who has been critical of the agency’s track record on antibiotics. “No one should underestimate how big a lift this has been in changing widespread and long entrenched industry practices.”

The change, which is to take effect over the next three years, will effectively make it illegal for farmers and ranchers to use antibiotics to make animals grow bigger. The producers had found that feeding low doses of antibiotics to animals throughout their lives led them to grow plumper and larger. Scientists still debate why. Food producers will also have to get a prescription from a veterinarian to use the drugs to prevent disease in their animals.

Federal officials said the new policy would improve health in the United States by tightening the use of classes of antibiotics that save human lives, including penicillin, azithromycin and tetracycline. Food producers said they would abide by the new rules, but some public health advocates voiced concerns that loopholes could render the new policy toothless.

Health officials have warned since the 1970s that overuse of antibiotics in animals was leading to the development of infections resistant to treatment in humans. For years, modest efforts by federal officials to reduce the use of antibiotics in animals were thwarted by the powerful food industry and its substantial lobbying power in Congress. Pressure for federal action has mounted as the effectiveness of drugs important for human health has declined, and deaths from bugs resistant to antibiotics have soared.

Under the new policy, the agency is asking drug makers to change the labels that detail how a drug can be used so they would bar farmers from using the medicines to promote growth.

The changes, originally proposed in 2012, are voluntary for drug companies. But F.D.A. officials said they believed that the companies would comply, based on discussions during the public comment period. The two drug makers that represent a majority of such antibiotic products — Zoetis and Elanco — have already stated their intent to participate, F.D.A. officials said. Companies will have three months to tell the agency whether they will change the labels, and three years to carry out the new rules.

Additionally, the agency is requiring that licensed veterinarians supervise the use of antibiotics, effectively requiring farmers and ranchers to obtain prescriptions to use the drugs for their animals.

“It’s a big shift from the current situation, in which animal producers can go to a local feed store and buy these medicines over the counter and there is no oversight at all,” said Michael Taylor, the F.D.A.’s deputy commissioner for foods and veterinary medicine.

 

Recommendations for the control of Multi-drug resistant Gram-negatives> carbapenem resistant Enterobacteriacea

Australian Commission on Safety and Quality in Health Care. Recommendations for the control of Multi-drug resistant Gram-negatives: carbapenem resistant Enterobacteriaceae (October 2013). Sydney. ACSQHC, 2013.

(…snip…) Gram-negative bacteria have now emerged that are resistant to most types of antibiotics, including a key “last resort” class of antibiotic, the carbapenems. These organisms are referred to as carbapenem resistant Enterobacteriaceae (CRE). Multi-resistant Gram-Negative bacteria, such as CRE, place Australian patients at greater risk of potentially untreatable infection and increased mortality. CRE is of particular concern because Enterobacteriaceae cause infections at a high frequency and resistant infections are associated with high mortality.

Patients in residential aged care facilities are also potentially at increased risk. Multi-drug resistant Gram- negative organisms have been isolated more frequently in overseas long term care facilities than some other Gram-positive multi-resistant organisms.

Over the past 2 years there have been an increasing number of cases of CRE in Australian patients. Some patients contracted the infection overseas and unfortunately some within Australia. In November 2011, the National Healthcare Associated Infection Advisory Committee of the Australian Commission on Safety and Quality in Health Care discussed the potential implications of CRE in Australian hospitals. A taskforce was established in partnership with the Australasian Society Infectious Diseases, Australasian College of Infection Prevention and Control, Public Health Laboratory Network and Australasian Society of Antimicrobials to develop recommendations for the management and testing of patients with CRE.

This paper incorporates recommendations for patient management that are contained in the Australian Guidelines for the Prevention and Control of Infection in Healthcare and the National Safety and Quality Health Service Standards. These include the use of standard and transmission based precautions, especially for patient placement, patient movement, cleaning and disinfection and antimicrobial stewardship. There are also additional recommendations for laboratory screening methods. 

The bottom line is there is no place to hide. Not even Australasia.

Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them

Maryn McKenna cited this book, so after reading hair-curling reviews I just bought the Kindle edition. Maybe no sleep tonight…

Antibiotic-resistant microbes infect more than 2 million Americans and kill over 100,000 each year. They spread rapidly, even in such seemingly harmless places as high school locker rooms, where they infect young athletes. And throughout the world, many more people are dying from these infections. Astoundingly, at the same time that antibiotic resistant infections are skyrocketing in incidence creating a critical need for new antibiotics research and development of new antibiotics has ground to a screeching halt!

In Rising Plague, Dr. Brad Spellberg an infectious diseases specialist and member of a national task force charged with attacking antibiotic resistant infections tells the story of this potentially grave public health crisis. The author shares true and very moving patient stories to emphasize the terrible frustration he and his colleagues have experienced while attempting to treat untreatable infections, not to mention the heart-break and tragedy that many of these patients' families had to endure.

Dr. Spellberg corrects the nearly universal misperception that physician misuse of antibiotics and “dirty hospitals” are responsible for causing antibiotic-resistant infections. He explains the true causes of antibiotic resistance and of the virtual collapse of antibiotic research and development. Most important, he advocates ways to reverse this dire trend and instead bolster the production of desperately needed new and effective antibiotics.

He also warns against complacency induced by the decades-old assumption that some miracle drug will always be available to ensure the continuation of our “antibiotic era”. If we do nothing, we run the risk of inviting a bleak future when infectious diseases will once again reign supreme. Then many of the medical breakthroughs that we now take for granted from routine surgery and organ transplants to intensive care and battlefield medicine might all be threatened.

 

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

Maryn McKenna has a terrifying “report from the field” of the fast-approaching post-antibiotic world. That we are living in New Zealand amplifies the report only slightly, because this reality is happening everywhere — and the origin of the particular KPC-Oxa 48 bacterium was Vietnam, not NZ.

This week, [health authorities in New Zealand announced][1] 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:

[1]: http://m.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11159413

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.”

(…snip…)

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.

Read more..

The last paragraph I quoted bumps the priority on my todo list – to understand better the realities of agricultural antibiotics. I’m carrying around the idea that the Danes have demonstrated on the farm that pigs could be raised without antibiotics at lower cost, higher productivity and healthier pigs. Yes, the farmers did have to innovate and adopt new husbandry methods. But there must be more to the story than my simple memory.

More important, do not miss Maryn’s new in-depth report “Imagining a Post-Antibiotics Future“.

Maryn McKenna on the post-antibiotic planet

…our post-antibiotic grandchildren will be less healthy than we are: more likely to die young or spend their lives crippled by disease. In the face of such a large problem, it’s an amazement that our public-health experts have any time to spare on any other problem.

Megan McArdle:

I imagine how our descendants will look back on our world. Unless something is done about antibiotic resistance, I’m very much afraid that they’ll look upon us the way 19th-century science fiction writers viewed Atlantis: as a lost paradise of magical technology — in this case, one in which you could go to a child coughing her life out with pneumonia, stick a needle in her arm, and watch the disease melt away almost before your eyes. The first doctors who treated patients with antibiotics felt like they were witnessing miracles. Our grandchildren may feel much the same way about the ease with which we cured disease. At Wired, Maryn McKenna outlines all the medical miracles that antibiotics have made possible:

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.

We are, she writes, on the brink of the “post-antibiotic era.” Already, some bacteria are resistant to everything we can throw at them. They’re mostly confined to hospitals at the moment, but they’re increasingly seen “in the community” – i.e., in all the homes and stores and workplaces where we like to spend our time.

Read more…