Antibiotic-Resistant Infections Threaten Modern Medicine
August 1, 2021 at 9:09 p.m.
By Max [email protected]
Medical science would be greatly hampered and unable to safely offer life-saving advances. Until the first antibiotics, medicine remained the oldest art. Antibiotics moved from experiment to application even faster; all the great families of antibacterial therapies — the sulfa drugs, beta-lactams (like penicillin), chloramphenicol, tetracycline, erythromycin, streptomycin and the cephalosporins — appeared in a span of less than 10 years.
A hundred characters figured in the birth of antibiotics: physicians who weren’t scientists, scientists who weren’t physicians, government bureaucrats, philanthropists and industrialists both venal and visionary. Their story played out in university laboratories, agricultural research stations, battlefield hospitals, and the boardrooms of huge multinational corporations. The origin story of antibiotics, and of modern medicine itself, was centuries in gestation. The war between Homo sapiens and infectious disease, after all, was under way for untold millennia before humanity was able to fight back.
Now, however, we are reaching a crisis and a possible return to yesteryear. The major danger lurking concerns resistance to yeast or fungi. (Yeasts are a type of fungi.)
One example is Candida albicans, an organism that preys on people with weakened immune systems, and it is quietly spreading and virulently affecting severely ill patients in nursing homes in the United States and across the globe.
Yeasts and fungi are much different than bacteria. They are multicellular, eukaryotic organisms, while bacteria are single-celled prokaryotes. The cells of fungi and yeasts have nuclei that contain the chromosomes and other organelles, such as mitochondria and ribosomes. Bacteria are much smaller than either yeast or fungi, do not have nuclei or other organelles and cannot reproduce sexually.
Today, in addition to C. Albicans and others, there is another fungus to worry about and it is proving even more deadly. The organism, C. auris (the latin name for ear), is a species reported in Asia as a rare cause of ear infections in 2009; it had not been found among large repositories of samples collected prior to 2013. Retrospective review of Candida strain collections found that the earliest known strain of C. auris dates back to 1996 in South Korea. Its virulence is particularly life threatening because bacterial resistance to antibiotics now includes a worldwide emergence of similar development for drugs used to treat fungal diseases.
The inability to control these infections presents a grave risk for both human and animal health. Like C. albicans and COVID-19, C. auris preys on people with weakened immune systems, and it is quietly spreading across the globe.
According to the New York Times, over the past five years it was found in a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and taken root in France, Italy, India, Pakistan and South Africa. Cases of C. auris have been identified in 33 countries across five continents. C. auris has reached New York, New Jersey and Illinois and at least nine other states, leading the federal Centers for Disease Control and Prevention (CDC) to deem it an emerging threat. The outbreaks in the New York area have involved four different varieties, suggesting that the strains were introduced from other countries seeking medical care. Once the organism is introduced into a facility, transmission of single C. auris strain is efficiently spread from patient to patient.
In a new study, the CDC has reported that the development of C. auris that has been spreading through nursing homes and hospitals is becoming even more dangerous. For the first time, researchers have identified several cases in which the fungus was completely impervious to all existing medications. Federal officials reported the C. auris has spread more widely during the coronavirus pandemic, with hospitals and nursing homes struggling to keep up with the surveillance and control measures needed to contain local outbreaks.
As of July, five of more than 120 cases were resistant to all three classes of antifungal drugs. Nearly a third of the patients died within 30 days, according to the CDC, but because they were gravely ill, officials said it was unclear whether their deaths were caused by the fungus.
Over the past eight years, the CDC has identified more than 2,000 Americans colonized with C. auris — meaning the fungus was detected on their skin. Between 5 and 10 percent of those colonized go on to develop more serious blood stream infections.
According to Dr. Cornelius Clancy, an infectious disease doctor at the VA Pittsburgh Health Care System, “An untreatable fungus infection would pose a great threat to all immunocompromised, transplant recipients and critically ill patients in the I.C.U.”
Final Thoughts
For many health experts, the emergence of drug resistant C. auris is a sobering reminder about the threats posed by antimicrobial resistance, from superbugs like MRSA to antibiotic resistant salmonella. Such infections sicken 2.8 million Americans a year and kill 35,000, according the CDC.
Max Sherman is a medical writer and pharmacist retired from the medical device industry. His new book “Science Snippets” is available from Amazon and other book sellers. It contains a number of previously published columns. He can be reached by email at [email protected].
Medical science would be greatly hampered and unable to safely offer life-saving advances. Until the first antibiotics, medicine remained the oldest art. Antibiotics moved from experiment to application even faster; all the great families of antibacterial therapies — the sulfa drugs, beta-lactams (like penicillin), chloramphenicol, tetracycline, erythromycin, streptomycin and the cephalosporins — appeared in a span of less than 10 years.
A hundred characters figured in the birth of antibiotics: physicians who weren’t scientists, scientists who weren’t physicians, government bureaucrats, philanthropists and industrialists both venal and visionary. Their story played out in university laboratories, agricultural research stations, battlefield hospitals, and the boardrooms of huge multinational corporations. The origin story of antibiotics, and of modern medicine itself, was centuries in gestation. The war between Homo sapiens and infectious disease, after all, was under way for untold millennia before humanity was able to fight back.
Now, however, we are reaching a crisis and a possible return to yesteryear. The major danger lurking concerns resistance to yeast or fungi. (Yeasts are a type of fungi.)
One example is Candida albicans, an organism that preys on people with weakened immune systems, and it is quietly spreading and virulently affecting severely ill patients in nursing homes in the United States and across the globe.
Yeasts and fungi are much different than bacteria. They are multicellular, eukaryotic organisms, while bacteria are single-celled prokaryotes. The cells of fungi and yeasts have nuclei that contain the chromosomes and other organelles, such as mitochondria and ribosomes. Bacteria are much smaller than either yeast or fungi, do not have nuclei or other organelles and cannot reproduce sexually.
Today, in addition to C. Albicans and others, there is another fungus to worry about and it is proving even more deadly. The organism, C. auris (the latin name for ear), is a species reported in Asia as a rare cause of ear infections in 2009; it had not been found among large repositories of samples collected prior to 2013. Retrospective review of Candida strain collections found that the earliest known strain of C. auris dates back to 1996 in South Korea. Its virulence is particularly life threatening because bacterial resistance to antibiotics now includes a worldwide emergence of similar development for drugs used to treat fungal diseases.
The inability to control these infections presents a grave risk for both human and animal health. Like C. albicans and COVID-19, C. auris preys on people with weakened immune systems, and it is quietly spreading across the globe.
According to the New York Times, over the past five years it was found in a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and taken root in France, Italy, India, Pakistan and South Africa. Cases of C. auris have been identified in 33 countries across five continents. C. auris has reached New York, New Jersey and Illinois and at least nine other states, leading the federal Centers for Disease Control and Prevention (CDC) to deem it an emerging threat. The outbreaks in the New York area have involved four different varieties, suggesting that the strains were introduced from other countries seeking medical care. Once the organism is introduced into a facility, transmission of single C. auris strain is efficiently spread from patient to patient.
In a new study, the CDC has reported that the development of C. auris that has been spreading through nursing homes and hospitals is becoming even more dangerous. For the first time, researchers have identified several cases in which the fungus was completely impervious to all existing medications. Federal officials reported the C. auris has spread more widely during the coronavirus pandemic, with hospitals and nursing homes struggling to keep up with the surveillance and control measures needed to contain local outbreaks.
As of July, five of more than 120 cases were resistant to all three classes of antifungal drugs. Nearly a third of the patients died within 30 days, according to the CDC, but because they were gravely ill, officials said it was unclear whether their deaths were caused by the fungus.
Over the past eight years, the CDC has identified more than 2,000 Americans colonized with C. auris — meaning the fungus was detected on their skin. Between 5 and 10 percent of those colonized go on to develop more serious blood stream infections.
According to Dr. Cornelius Clancy, an infectious disease doctor at the VA Pittsburgh Health Care System, “An untreatable fungus infection would pose a great threat to all immunocompromised, transplant recipients and critically ill patients in the I.C.U.”
Final Thoughts
For many health experts, the emergence of drug resistant C. auris is a sobering reminder about the threats posed by antimicrobial resistance, from superbugs like MRSA to antibiotic resistant salmonella. Such infections sicken 2.8 million Americans a year and kill 35,000, according the CDC.
Max Sherman is a medical writer and pharmacist retired from the medical device industry. His new book “Science Snippets” is available from Amazon and other book sellers. It contains a number of previously published columns. He can be reached by email at [email protected].
Have a news tip? Email [email protected] or Call/Text 360-922-3092