Back in the 1980s and 1990s the medical thriller genre came into its own. Authors such as Robin Cook and Michael Palmer used the simple device of transposing some hitherto unheard-of apocalyptic medical scenario on to the everyday life of a hospital and letting the narrative flow from there.
If memory serves me, at least one of these books dealt with a superbug scenario, whereby patients contracted an infection with no known antibiotic cure. Cue a cover-up involving someone in the hospital laboratory, the frantic search for a cure, and thousands of happy readers lapping up every twist in the plot.
In those days antibiotic resistance wasn't really on the media radar. But that has all changed as a press release from the World Health Organisation (WHO) illustrated last week. Marking the first global examination of antimicrobial resistance, the WHO report pointed out the phenomenon was no longer a prediction for the future but was happening right now in every region of the world.
'Devastating'
"Without urgent, co-ordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries that have been treatable for decades can once again kill," said Dr Keiji Fukuda, the assistant director-general for health security.
“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics . . . the implications will be devastating.”
The report, Antimicrobial resistance: global report on surveillance 2014, focuses on antibiotic resistance in seven bacteria responsible for diseases such as bloodstream infections, pneumonia, urinary tract infections and gonorrhoea.
In the case of gonorrhoea, it notes that the treatment of last resort – antibiotics known as third-generation cephalosporins – is now failing to work in a number of European countries as well as Australia, Canada and Japan.
Klebsiella pneumoniae, a cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients, is now resistant to the carbapenem group of antibiotics in more than half of people treated for K pneumoniae infections.
We know that antibiotic resistance causes people to be sick for longer and increases the risk of a fatal outcome. For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64 per cent more likely to die than those with a nonresistant form of the infection.
Here in Ireland, researchers from Trinity College Dublin have found that between 2002 and 2011 there has been a 44-fold increase in circulating MRSA strains. Even more worrying is the six-fold increase in the number of MRSA samples resistant to multiple antibiotics.
Commenting on his research, Prof Coleman, professor of oral and applied microbiology at TCD, said: “There are definitely a lot more, and a lot more very diverse, strains circulating and becoming more antibiotic-resistant. It is not a phenomenon unique to Ireland – what is unique is we have so many.”
When you consider that his study was of MRSA strains in the community, which are known to survive on skin and work surfaces, and which primarily infect children, it is difficult not to feel a distinct chill down your spine.
Imagine re-entering a world where women regularly died from sepsis in childbirth. Or one in which TB once again stalked the land, becoming an infection with absolutely no known cure, the end result of the severely drug-resistant strains already challenging patients and specialists here. It may sound like good material for a novel, but it is unlikely to be a bestseller. After all, who is going to be hooked by a plotline so close to the bone?
mhouston@irishtimes.com
muirishouston.com
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