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Winter is coming.
Already, we can see things start to unravel. Dangers unknown for most of our lives have returned, threatening us and our families. The long-standing comfort is waning and our defenses are useless. Anybody can die, many already have. Nobody is safe.
You might think we’re talking about the book and television series Game of Thrones. We’re talking about something even more epic and frightening, with even more senseless death than a Red Wedding. We’re talking antibiotic resistance.
We take antibiotics for granted. When they were first introduced, they were considered a miracle. Previously, the only way to treat an infection was to either let the body heal itself or cut off the infected area. Deaths abounded from infections caught during such now-benign things as childbirth, minor injury, or unsafe food. Surgery was a last resort.
In 1928, penicillin was discovered and by World War II was in clinical usage. This drug disabled bacteria of all kinds, from those that caused eye infections to Staph infections in burn victims. From this seemingly simple ability to quickly, easily and harmlessly reduce or remove the threat of infection came much of modern medicine. All modern surgery relies on antibiotics to reduce healing time and prevent complications (in addition to other antiseptic procedures). So does dentistry, livestock farming, autoimmune treatment, and oncology, to name a few.
We have a problem, though. Bacteria that cause infection are living things like us, complete with DNA. Like all other living things, they are constantly evolving. Because of how quickly bacteria can multiply, they evolve quickly, and it turns out that setting up a hostile environment in their home (the human body) leads to them adapting to survive it and when the old, non-adapted cousins die off it gives them lots of room to multiply.
When it happens to the Staphylococcus we normally carry around on our skin and nose, it’s what we call multi-drug resistant staphylococcus aureus, or MRSA, which is responsible for billions of dollars of healthcare costs per year in Canada. To our otherwise well-tolerated gut bacteria Clostridium difficile? All that freedom to move results in diarrhea so horrible it kills fourteen thousand per year in the United States alone.
It’s easy to get lost in this negativity, after all one reason that Game of Thrones is so popular is that there is so much intrigue, pain and suffering. It makes a great story! There is hope, however.
We are vigilant – we have our own version of The Wall, watched over by those sworn to protect us. Those are the epidemiologists who have been ringing the alarms for a while now. Knowing that we’re at risk means that at least we’ve got several ways to help protect ourselves:
Hand Hygiene – This should go without saying, but is so sadly overlooked that the World Health Organization and local infection control organizations dedicate a great deal to raising awareness every May 5th. Hands can spread bacteria – and very few bacteria can resist an ethanol hand rub for long!
Smart Prescribing – Antibiotics should be a secret weapon, not the opening salvo. Saving these drugs for the worst cases will slow down the rate at which these organisms evolve to combat them.
Public Help – Awareness, awareness, awareness. If the average person in the street knows that selfishly forcing your MD to prescribe you antibiotics will eventually lead to medicine regressing to the year 1890, maybe they just might, you know, not do that.
Sorry if the first paragraph sounded a bit dire, but that’s only because it is dire – if we don’t go and do anything about it. Winter is coming, but we’ve learned how to bundle up a bit and will hopefully survive it.
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