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September 20 - October 5, 2023
For me, the most salient—and sobering—fact was that there was no “right” answer to this dilemma.
Davey explained that lying in bed with no exercise causes “deconditioning,” a weakening of the muscles that makes it hard to walk.
Tending to the details was something I could do. It gave me courage to soldier on.
“You’d be surprised. We have several patients in here who are in their prime, battling severe cases of the flu. People think it won’t happen to them. It happens every winter.
“His Acinetobacter is now resistant to the last three antibiotics, including the ones we use as a last resort, meropenem and colistin.
“If the antibiotics aren’t working, then what are those for?”
Chip looked me in the eyes as he stood up to leave. “Those,” he said curtly, “are to make us doctors feel better.” Oh, shit. The desolation in his voice trumped any hint of hope I’d held out.
The reality was that, on a societal scale, health leaders had buried their heads snugly in the sand, ignoring the growing peril of antimicrobial resistance (AMR).
Chip told me that in the US, there were no reporting requirements for A. baumannii.
We couldn’t track who had it, how they got it, or worse, learn lessons from patients that been treated.
Several high-level reports that were intended to mobilize a meaningful public health response had somehow failed to do so.
Even as a scientist who knew how dicey the microbial landscape could be, I generally considered bacteria to be inferior to viruses, less threatening.
Nature equipped them brilliantly for the task: to detect threats, adapt quickly to defend themselves, and pass along their genetic playbook to their progeny and other bacteria.
Antibiotic resistance can spread via two routes: reproduction and ordinary contact.
“The thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism,” he wrote, after he and his colleagues received the Nobel Prize that year.
It fell on deaf ears among industry, physicians, patients, and policymakers who were not keen to cut back.
what if bacteria were developing resistance? the thinking went. We’ll stay a step ahead by continuing to develop new drugs. So they said. They were wrong.
Instead, no new antibiotic drug class has entered the market since 1980, and no new class of antibiotics has been discovered to treat Gram-negative bacteria like A. baumannii since 1962, before I was born.
These days, most Big Pharma companies have shut down their antibiotic research labs or laid off researchers.
Global health experts have long called for antibiotic stewardship, which includes using antibiotics sparingly and saving some as a last resort.
One expert compared pharma’s reticence for investing in new antibiotics to the public’s disinclination to buy fire extinguishers.
The CDC estimates that one in five antibiotic-resistant infections in humans originate from food and animals.
The year Tom fell ill, a major medical news story would report the discovery that lens maker Olympus, which manufactures medical equipment, knew that its endoscopes could not be adequately disinfected.
In Tom’s case, some of his doctors speculated that the source of his A. baumannii infection was the nasogastric tube inserted in the Luxor clinic to siphon the bile from his stomach to reduce vomiting. We’ll never know.
“It’s ICU psychosis. It happens to most people who end up in the ICU, or anywhere in the hospital really, for an extended period. You can’t tell day from night, so your brain gets mixed up.
“Tom’s pseudocyst drain slipped and dumped all of the crap inside it into his abdominal cavity. This is what I was afraid of,” he said. “The Acinetobacter is now everywhere in his body. He is now fully colonized.”
In a struggle that was so isolating in so many ways—we still couldn’t touch Tom without protective gear—it seemed that he and we were at a vortex of caring, loving, healing energy and presence. It was like nothing I’d ever experienced before.
“Good morning,” I said to him with a smile. “Do you know who I am today?”
“Mi amor…” Tom croaked, and blew me a little kiss. My heart melted.
But despite each battle won, it felt like we were losing the war. And for good reason: we were.
Left unchecked, an estimated 10 million people were going to die from superbug infections each year by 2050.
The pharmaceutical industry’s rote assurances that new antibiotics were on the way ignored the reality that millions of people could die in the years needed to develop new drugs and move them from lab experiments to clinical trials.
One complication and a medical intervention to fix it often lead to another.
Tom was quickly becoming the poster child for the dystopian future of the post-antibiotic age.
I am in a terrifying world that no one else can see. And I am untouchable. A sign says: INFECTIOUS AGENT. I am the pariah.
You’re stuck on the wrong question. The operative question isn’t whether you know that he’s dying. It’s “How do you save this man’s life?” Who cares if you’re not a doctor! You’re a scientist, for god’s sake—think like one!
didn’t have the answers—nobody did. But I sure knew how to look. And even if looking was all I could do, it was somewhere to start.
That left only one treatment, phage therapy—now that was interesting. This was the treatment of bacterial infections with bacteriophages, viruses that attack bacteria instead of people.
But there are an estimated 380 trillion viruses in our body, making up our virome.
These include billions of peacekeepers, phages that quietly go about their work munching on bacteria, maintaining the balance of power among the ranks of organisms in our various microbiomes.
Bacteriophages are a specific kind of virus that “eat” bacteria by injecting their DNA into them and turning them into phage manufacturing plants.
If you’re hoping to wipe out a bacterial infection quickly, you want the lytic kind that goes from zero to phage-rage fast.
At the hospital the next morning, I strode through the atrium feeling bathed in the light and the energy of possibility.
knew that he knew this. In the still pause, I watched as a single tear welled up in the corner of his eye and spilled across his eyelashes.
I squeezed his hand gently. “If you want to try it, can you squeeze my hand?”
He seemed to stiffen but… nothing. And then—he squeezed back, hard. No retreat.
First, they must evade the body’s immune system and defensive responses.
In the same way bacteria have developed adaptive strategies to resist antibiotics, they use a host of tactics to fend off phages, including their own kind of immune systems, called CRISPRs.
The task for researchers is to find the ones that match up with a target bacterium, purify them so they’re safe to use, and then deliver them into the body—in this case, Tom’s.
This means that they largely disappear once their job is done.
