History not only shows us our errors but also predicts our future. So, we don’t need to speculate about what a world full of superbugs and useless antibiotics would look like, we just need to recall the pre-antibiotic era (before the 1930s).
Our trajectory into the past is compounded by an ageing population that’s more susceptible to infections, overcrowded hospitals where infected and uninfected patients share facilities, a complacency toward basic hygiene principles and globalisation and its attendant increase in medical tourism that provides a free flight for any superbug seeking a new home.
In the absence of effective antibiotics, management of infected patients will be reduced to cleaning wounds and applying topical antiseptics. And removing the focus of infection, which could be a whole limb. The problem is that many of the infections we see in hospitals are actually acquired in the hospital itself and affect patients who are at their most vulnerable, having had heart surgery or other urgent procedures.
Exacerbating this is our reliance on intravenous tubes and catheters that measure blood pressure or deliver drugs to patients, particularly in intensive care units. These provide a veritable freeway, allowing superbugs to gain direct entry into our bodies.
The rise of superbugs could herald an era of deferring all non-essential surgery and caring for the sick outside of hospitals or with minimal intervention wherever possible. Perhaps quarantine hospitals and sanatoriums will be needed to separately house infected patients in the hope that good nutrition and rest will enable their immune systems to tackle the infection.
Technical and medical advances may provide new hope but let’s not forget the lessons of the past, which clearly demonstrated that simple hygiene has a huge impact on controlling infections. All hospitals should be able to provide patients with individual bathrooms and place a greater emphasis on physically separating patients who have resistant infections from people who are uninfected but highly susceptible.
We will need to prioritise cleaning of hospital areas to ensure that superbugs don’t persist in the environment. And novel immune therapies may hold some promise for the infected patient in the era of failing antibiotics.
Immune therapies try to boost the body’s natural defences against microbes because our immune system has evolved to eradicate infecting microorganisms. Some immune cells are dedicated to engulfing and killing invading microbes while others find and kill any resident cells that are infected with microbes.
Each cell in our body is equipped with a suicide program that’s activated if the cell senses that it’s infected. Some microorganisms have developed mechanisms to counter immunological onslaughts, either by switching off the suicide program or by exhausting or paralysing immune cells. Research into the immune system has provided insights into how we can enhance immunity to eradicate infections, regardless of whether the infecting organism is resistant to antibiotics.
The advantage of boosting immunity is, of course, that it offers a common platform to tackle many bugs. Traditionally, antibiotics only kill one type of microorganism or group of microorganisms. The advantage of immune therapies is that they can be used against many – maybe all – infections. This would also make it very difficult for microorganisms to become resistant because that would take many years of evolution.
Immune therapies can take the form of administering additional immune “hormones”, which are natural proteins in our bodies that facilitate immunity. By giving additional quantities of these “hormones”, we can promote the function of immune cells. Animal studies have indicated that these types of therapies hold much promise and human studies are underway. Another type of immune therapy is administering drugs that switch on the suicide program in infected cells where the program has been disabled by the infecting microbe.
Most importantly, we mustn’t forget the great success of vaccines, which promote immunity to prevent infection. Basically, they arm the immune system by providing it with a clear picture of the enemy, so that immune cells are at the ready. Indeed, vaccination is the most successful medical intervention of all time because it has facilitated the eradication of several viruses. We must now try to apply this success to bacteria.
At the height of the antibiotic era, we felt secure that the microbe was conquered. Our lack of insight and complacency has made us look foolish and arrogant as microbes are retaking their position as the major cause of human suffering and death.
The lessons we’ve already learnt, along with pioneering research, will hopefully provide us with an advantage in combating infections so that, in the future (tempered by greater wisdom), we can feel more secure that microbes and the diseases they cause can be conquered with novel therapies and good management.
This is the seventh article in Superbugs vs Antibiotics, a series examining the rise of antibiotic-resistant superbugs. Click on the links below to read the other instalments.
Part nine: New antibiotics: what’s in the pipeline?