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Why we’re running out of antibiotics

As the head of infectious disease research at Hamilton's McMaster University, Gerry Wright looks for new antibiotics to fight off antibiotic-resistant bacteria. However, last summer, Wright contracted a resistant-strain of salmonella from food. Sick for months, he had to be treated with antibiotics intravenously. Co-host Erica Johnson visited Wright to talk about the fate of our current supply of antibiotics, his research, and how his own personal fight against a superbug inspired his research.


Erica Johnson: When [doctors] said the bug that you have is resistant to the antibiotic they'd been giving you, what went through your mind?

Gerry Wright: Well, it’s ironic, right? Because that’s what I do for a living. I work on antibiotic resistant organisms so it’s kind of like nature coming back to get me or something. I was struck by the irony and I was also, actually, pretty angry because I thought, this is something that we should have been able to test for right away. There should be no reason for us in the 21st Century not to have a point-of-care detection system that could tell if my organism was drug-resistant or not, or if I was infected by salmonella or campylobacter or E. coli. That should be pretty simple. And in the lab, it is.

Was there any concern that the next antibiotic they were going to give you might not work?

I had those concerns, for sure. The literature will tell you, and my experience will tell you, that the organisms collect these resistance elements by the threes, fours, tens so that you can be resistant to many different antibiotics. And salmonella, particular, is well known for having multiple drug resistant mechanisms, so I was quite fortunate.

Fortunate that the next antibiotic worked?

Yeah. In the spectrum of resistant organisms, mine was relatively wimpy because we were able to treat it with the next round of drugs. But certainly, it gives you pause because if it [didn't work] and it could have just as easily been not susceptible to the next drug. Then what? And I was, I gotta tell you, I was sick. I did not feel good at all. I had been sick for about 18 to 20 days. I lost ten pounds. You know, I couldn’t work obviously. It impacted my family life. It impacted everything.

You were really sick.

I was... and I pretty healthy guy, I’m in good shape. I exercise and I do all the right things.and this hit me. this hit me really hard. And so you think, things could have been much worse... it took a long time for me to get back to being what I would call 100 percent, where I could, you know, go back for a run.

Luckily, the second antibiotic they gave you worked.
And luckily, I had access to this infectious disease specialist who could help with this, you know. If I had been in [another] place, that would have been harder to do — not in Southern Ontario, but in some part of Canada where they don’t have a lot of specialists — I’d be in hot water.

What could have been the worse case scenario?

Well, you can die from sepsis. Death is the worst case scenario.

You might have died had the antibiotics not worked?

That’s correct.

Do you ever think about that? How close, how risky that was?

I did at the time. This is what it’s like when you don’t have antibiotics. One of my colleagues made this point. This is what it was like before we had antibiotics. Either you’re going to get better or you’re not. And in this case, if you have something growing in your blood stream, that means you’re going to die.

So this has moved beyond just a clinical test for you?

Yes, this is personal to me. With the salmonella, it’s very personal.

Part of what my lab does is we’re really interested in antibiotic resistance and mechanisms, and how to overcome resistance. We’re also really interested in finding leads for new antibiotics. It’s always been sort of an interesting thing, an academic question. But now this episode has really brought it to the forefront for me — just how important it is that we get some new drugs. The pipeline is getting really dry and I think a lot of this early stage drug discovery search is moving into labs and out of pharmaceutical companies. So, we’re going to try and do our best on the front lines to get rid of organisms like salmonella, and all the other ones that are causing us such problems these days.

So in this war between the bugs and the drugs — who's winning?

Definitely not us. And, it’s going to be one of these on-going continuous battles for, you know, until we either stop finding new antibiotics — which I don’t think is going to happen. We’ll always figure out ways to get around this. It’s just whether or not we’ll get them in time to deal with the problems we’re going to have right now.

If the bugs are winning and we're running out of antibiotics, why does that matter? What's the worst-case scenario?

It means we go back to what it was like pre-1930, when the largest cause of death was infectious disease caused by bacteria. Now it’s heart disease and cancer, those are the things we really worry about. We all live until we’re, you know, 80 years old — and it’s because we’re not dead before we’re 20, you know, from pneumonia.

Now we have antibiotics to fight a lot of diseases.

So we completely take them for granted, right? Imagine a hospital doing a heart transplant without antibiotics. Imagine a bone marrow transplant which wipes out your immune system without antibiotics. It’s impossible to have modern medicine without antibiotics, right? So when we lose those, we're not only getting ourselves into a situation where we can’t treat acute infections like mine, we’re preventing ourselves from doing all the things we take for granted right now. Hip replacements, you know? Cardiac surgery. You name it. I mean this is all dependent on our ability to control infectious diseases.

What's it like for you to know that we may be running out of the ability to control infectious diseases?

It’s frustrating because I think that there’s no good reason for that to happen. I mean there’s lot’s of opportunities. We are in the 21 Century with some of most remarkable genome scale tools you could imagine. But that’s not enough to get a new drug. It’s difficult to get new drugs. Drugs have to go through this long regulatory process. They have to be safe, of course. We don’t want to do things that aren’t safe. That process takes a very long time. It takes on average about ten, twelve years to turn a really good hit in my lab into a drug by some pharmaceutical company. And so, we are at the stage right now, where’s there’s not a lot of new things about to come on the market. I mean, there’s probably maybe one or two.

And how many are we losing?

Well, they’re all dying a slow death. Antibiotics are completely unlike any other pharmaceutical agent, and that’s because of the resistance. The minute we start to implement them, the clock starts ticking as to when we’re not going to be able to use them. And that’s just because of evolution. And it’s because of the way that organisms, you know, have been interacting with molecules, for you know, millions of years. Billions of years.

So it's really important to keep the antibiotics we have working.

Oh, absolutely. I mean, we have to be incredibly careful with these. These are natural resources that are absolutely essential for modern medicine. So, we have to be careful about how we use them. We have to keep investing and getting new ones. And we have to really make sure that we take this problem seriously.

Does what happened to you affect your commitment to finding any new antibiotics?

We’ve always been dedicated to doing this, but what it does is give me a rap over the head, to tell me just how close you can be to not being able to control an infection like this. It’s a bit of a reality check. It gives you a personal experience; a little bit of personal experience can actually help you work 17 hours a day instead of 16.

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My first reaction would be that it’s a damning indictment about how we’re dealing with this problem. The way that we grow chickens, the way that we get them ready for market, and expose them to a lot of antibiotics and stuff. In many cases, that just selects them for drug resistance.

On the one hand, it’s shocking, but given everything that we know about the use of antibiotics in agriculture, and the fact that we have less and less antibiotics available to us, it’s not that surprising.

It must be disappointing.

Yeah, well it is. It’s very frustrating that there doesn’t seem to be more interest in this area by drug companies, and by the government agencies that regulate this kind of stuff because it really needs to be seen as an impending crisis that your data just supports.

Would you go so far to say we're nearing crisis levels here?

Absolutely. We have organisms in our hospitals that are completely resistant to every antibiotic that we have available to give to them. So, we’ve already gone back to that pre-1930 area for some of these organisms. And while right now they’re rare, they’re not part of your sample, but five years from now, ten years from now, that might not be the case.

It takes ten years to get a new antibiotic to market. Right? So, if we don’t do it now, we’re really closing the door on our ability to control infectious disease over the next decade or two.

This is a list of all the antibiotics that the bug on the chicken was resistant to: amoxicillin, ampicillin — it just goes on and on. It's quite a long list of antibiotics that are not powerful against these bugs.

That’s right. Gentomicin — you don’t get gentomicin resistance without having some selection process that has done this. So, that means, when these organisms become resistant to a single antibiotic, often times we forget that they can actually do that by collecting packages of DNA that don’t just give resistance to one different antibiotic….but to many different antibiotics. And so even though you can say, I’m not going to use antibiotics A, B, C and D anymore for animal use. I’m just going to use antibiotic X. But antibiotic X, also has a resistance mechanism that comes with a resistance to A, B,C, and D, right? And so, you’re still selecting for the spread of these resistance elements all through out these populations. And so think of how big, you know, the agricultural industry is. Think of how many chickens we have every year. We’re using antibiotics like crazy, right?

Chicken farmers say they need antibiotics to promote chicken growth, to keep the chickens healthy.

Sure. So, I would say, if chickens are sick, then chickens deserve to get antibiotics. If chickens are not sick, then there’s no reason to do it.

You think they're being used without cause?

Yeah. I think there are standard practices, mostly in North America, that I think don’t warrant being practiced anymore. And I think it’s dangerous — as you’ve seen. I mean, you end up with a situation where these organisms are not treatable by what we have. I think it’s a bad idea. And I think most of the data out there, that’s available, clearly supports that. Many countries support that. North American countries don’t support that, in many cases. And that’s part of the problem.

We rely on these antibiotics.

Absolutely.

We need them to work.

Absolutely.

And you think the clock is ticking?

Well, you’ve shown that it is. Yes, the clock has stopped ticking for some of these. It’s really quite remarkable.