Superbugs with no more superdrugs
‘I had a small fall, a graze below the right knee, I didn’t think anything of it.’ Vanessa, a mother of three, looks up as she tries to remember the details of where it all began. Eight years ago she was infected with an aggressive bacteria after grazing her knee. But it wasn’t just a regular bacterial infection. Vanessa had a superbug. Emma Ceccato reports.
Vanessa is a lively lady; that was obvious as soon as we met. She flutters around, chatting about her morning at the school where she works as a tuckshop convenor and fixes me a drink. Her home is filled with memories; family portraits covered every wall and sentimental knick-knacks lined each surface. After some brief small talk, I ask her about her superbug infection. Suddenly the mood changes and it becomes apparent just how difficult this time was for her and her family. She starts from the beginning, when a small fall quickly turned into something more serious, ‘About a week [after the fall] I started getting flu-like symptoms… I just had a 40 degree temperature [I was] in bed, and I think I vomited for 12 hours straight.’
After a multiple visits to the local GP and a home-visit from her doctor, Vanessa was sent to the Mater Hospital diagnosed with a bacterial skin infection and suffering from severe dehydration.
Despite antibiotic treatment, which should have cleared up the infection, her symptoms only got worse, ‘I spent a week totally in and out of [consciousness] with this kind of infection in my leg…Everything seemed to get worse. That’s the only time I was really blurry. I was incredibly sick. I didn’t know what was going on’. After two weeks, Vanessa was sent home before being readmitted to the Wesley Hospital about 48 hours later, where she was finally diagnosed with having a Methicillin-resistant Staphylococcus aureus (MRSA) infection, a bacteria known as a superbug.
‘Superbugs are essentially a normal bacteria which have developed resistance to being killed by antibiotics,’ explains Mark Blaskovich, senior research chemist at The University of Queensland and one of the leading academics joining the fight against superbugs. Since the golden age of antibiotic drug discovery began in the 1930s, we have relied on antibiotics to cure us from bacterial infections that would otherwise be lethal. This proliferating range of antibiotics has helped us combat deadly bacteria, and reduced death by infection from 43% to just 7%. Because of this drastic decrease in disease causing bacterial infections, antibiotics earnt the title of ‘superdrugs’. As Mark explains, ‘Antibiotic drugs are one of the few drugs that can actually cure you; save your life.’
But what happens when antibiotics stop working? After the golden age of antibiotic drug discovery, encroaching darkness has followed, where antibiotic resistance has increased and the antibiotics available to treat the resistant bacteria have become scarce. Bacteria are quickly becoming resistant to antibiotics, the most powerful weapon we have available to combat them. Although antibiotic resistance has always existed in bacteria, this resistance becomes more common in bacterial populations when they are exposed to a concentration of antibiotics that is too low to kill them. Instead this low level of exposure can lead to some bacteria adapting to the antibiotic they came into contact with, and developing resistance.
These conditions of low level exposure are created when people misuse antibiotics. This misuse typically occurs when people take antibiotics when they do not actually need them, for example when they have viral infections like the common cold, or when people do not complete the full course of antibiotics.
Widespread misuse of antibiotics leads to the development of bacteria that are resistant to many known antibiotics, known as ‘superbugs’. And when antibiotics fail, what options do we have left?
Once Vanessa was diagnosed with a superbug infection, her doctors realised her treatment would require a more aggressive approach. Specialised infectious diseases doctors were called in, and Vanessa was treated with every antibiotic they had. ‘They were treating me with every single antibiotic they could think of… so [I was] losing my hair, and it damaged my liver, [and] my kidneys. ’ As Vanessa’s condition deteriorated, her doctors were resorting to increasingly toxic antibiotics, as the safer antibiotics they would normally use were failing, one by one.
Despite the increased antibiotic treatment, there were little signs to show they were working, and Vanessa and her family grew more desperate. She recalls the helpless feeling of being confined to her hospital bed when all treatment efforts were failing, ‘I am lying there at like two in the morning, and my drip is stuck and the machine is beeping, my antibiotic machine is beeping at me, and the nurse comes in to try and undo it, and I’m thinking “look how bad my leg is, you know, surely they can do something about it.”’
But unfortunately there wasn’t anything they could do. Following the failure of the antibiotic treatment, Vanessa underwent surgery. Unable to rely on antibiotics, doctors were forced to resort to pre-modern medicine methods. This involved opening up Vanessa’s leg and scraping out as much of the infection as possible, with the hope that her immune system may be able to fight off the remaining bacteria. The doctors warned Vanessa, and her husband, John, that if the surgery was unsuccessful in reducing the infection, she might lose her leg ‘I just thought if I was going to lose the leg, then I was going to lose the leg. I’d just have to deal with it’, she shrugged matter-of-factly.
Fortunately the surgery was a success, and Vanessa’s condition improved. Slowly her body was fighting back against the infection that had taken hold four weeks ago. She showed me the photos of her leg post-surgery, with the tissue removed and bone exposed, ‘Yep, it was a beauty’, she laughed.
Vanessa spent a total of nine weeks in hospital following the fall that exposed her leg to the superbug, and it took a further three months for her to fully recover. She celebrated her son’s tenth birthday in hospital. She laughed as she recounted having to buy his gift from the cart that would pass by her hospital room. When I asked how her children dealt with her time in hospital, a bubbly Vanessa suddenly went quiet for the first time since I met her. It was clear it had been a hard time, for not only Vanessa, but for her young family. Her usual matter-of-fact recount changed as she revealed the hardest part of the whole ordeal, ‘putting my family through that, they were only very young’, she sighed.
With the ever-increasing rate of antibiotic resistance, Vanessa’s story is likely to become more common. The rise of antibiotic resistance is an issue the World Health Organization has deemed one of the biggest current threats to global health. Mark and the rest of the team of superbug researchers from The University of Queensland are busy searching for the next antibiotic to help win the arms race against bacteria, by screening chemical compounds that already exist for antibiotic properties through their global initiative, Community for Open Antimicrobial Drug Discovery (CO-ADD). ‘Screening for new antibiotics is going to be very important for the future as there is a long lag time between discovering new compounds and being able to use them clinically.’
With a projection of 10 million deaths to occur annually due to antibiotic resistance by 2050, it is no wonder politicians and researchers alike are starting to worry about this issue. It won’t just be a case of further research and drug discovery, our use of antibiotics needs to change. Misuse of antibiotics is still a large contributor to the problem, with antibiotic resistance currently costing approximately $942 million per year through hospital-acquired infections in Australia alone. These figures are not surprising, as it was revealed that in a survey by the National Prescribing Service that one in five Australians expect doctors to prescribe antibiotics even when they are diagnosed with viral infections.
Vanessa was never one to misuse antibiotics and swears by bed rest and fluids when her children get the flu. Yet despite her careful use of antibiotics, Vanessa contracted a superbug; and it very nearly beat her.
Vanessa’s story might become more common place in the near future, as antibiotic resistance continues to rise and superbug infections become more prevalent. Mark warns that we have spent too much time talking about the issue, and instead something needs to be done,
‘In five years time, when superbug outbreaks become more prevalent, and people start becoming really scared, potentially it’s too late.’
Emma Ceccato reports, firstname.lastname@example.org