“After an experimental antibiotic for a drug-resistant infection in his leg, George Semakula is learning to walk on his own again” (IDSA). A 57-year-old independent truck driver by the name of George Semakula was taking a walk in a village in Moshi, Tanzania. During his stroll, he “was mugged, pushed into a ditch and broke his left ankle so badly that the bone was protruded.” After traveling back to the United States, he was sent to Duke University Hospital in Durham. His procedures consisted of scraping infected flesh from his wound and fixing his bone utilizing pins and plates. Doctors discovered that the wound was infected with three types of distinctive bacteria. Acinetobacter baumanii—one of the types of bacteria—appeared to be resistant to practically every commercially viable antibiotic.
Semakula states, “The infection was spreading fast, and they said if they couldn’t stop it, they would have to amputate my leg.” To take action sooner than later, the epidemiologists who treated George endlessly researched internationally and eventually discovered an antibiotic that would fulfill the job: cefiderocol. Although this drug had not yet been approved by the Food and Drug Administration (FDA), the Japanese experimental drug could potentially be the cure to prevent the amputation of George’s leg.
“I have a medical background that I never imagined that there would be an infection that was so resistant. We kept our hopes high, but in the back of our minds we knew amputation was a possibility, which was pretty scary,” George’s wife, Miriam claims. A “compassionate use” approval was mandated by the FDA due to the fact that the drug was not yet commercially available for use. Because of Samakula’s extenuating circumstances, he was able to receive three IVs (intravenous infusion) of cefiderocol consecutively for four months.
After months of extensive treatment, the infection has regressed and George is on his way to a healthy recovery. He is participating in physical therapy twice a week to strengthen his ankle as well as walking for at least twenty minutes a day to further build his stamina. With all of this, he is no longer taking any medications or antibiotics. Ecstatic about his health improvement, George says, “The antibiotic really worked, the infection is gone and the healing is going well. Now I can cook, do laundry, and Miriam and I go out to dinner and parties. I’m anxious to get back to work, hopefully in a few months.”
Dr. Vance Fowler, an infectious disease specialist at Duke University School of Medicine who treated George, states that “with infections caused by aggressive and highly resistant bacteria such as Acinetobacter, there are no guarantees of such a good outcome. He would have lost his leg, and possibly his life if the bug had entered his bloodstream. Without the antibiotic from Japan, it would have been almost impossible to treat Mr. Semakula.”
In this case, professionals note how the significance of the development of new antibiotics is a necessity. Furthermore, infections that are either untreatable or only treatable with antibiotics with major side effects are becoming exceedingly frequent: “Infectious disease doctors are seeing infections such as these [George’s] in the United States daily, some coming from exotic points of origin, but many homegrown,” Dr. Fowler notes. “Staying a step ahead of these infections requires a multi-pronged situation, including careful stewardship of our remaining antibiotic resources and providing incentives to pharmaceutical companies to be sure they stay active in antibiotic development.”
The story of George Semakula is one perspective of the controversial dilemma regarding antibiotic development. As of 2017, “six companies have abandoned antibacterial development or declared bankruptcy, and two other companies have announced massive layoffs.” With this case in mind, Dr. Fowler exclaims that “antibiotics underpin modern medicine, and the fact is we desperately need new ones.”
Despite this remarkable treatment for Mr. Semakula, antibiotic usage is a tremendous concern with respect to modern environmental applications. Concentrated Animal Feedlot Organizations, commonly referred to as CAFOs, are locations where animals are concentrated in an enclosed region and fed grain or fish meal (which is not as suitable as grass). They are used as a way to quickly get domestic livestock ready for slaughter and tend to be crowded. The use of these feedlots is less expensive than other methods, which can keep costs to consumers down. Regardless of the efficiency of CAFOs, a significant drawback is the overuse of antibiotics and growth hormones. These aspects make the livestock live longer and grow larger, but may lead to antibiotic resistance.
To put it succinctly, antibiotic resistance is somewhat of a positive feedback loop, which can be compared to what is referred to as a pesticide treadmill. For example, pesticide use and genetically modified crops with pesticides have led to genetically resistant pests. Because the pesticides are then ineffective, companies develop newer pesticides. As predicted, the pests become more resistant, which causes newer pesticides and so on and so forth. Just as this occurs with pesticides, the same exact regiment is apparent with antibiotic usage.
Relative to infectious disease, nonetheless, antibiotics have allowed for a drastic decline around the world. Precaution is a necessity when utilizing these antibiotics, though, because infectious disease still poses a serious threat strictly due to antibiotic resistance. This can be caused by the rapid rate of bacterial reproduction, global transmission, the transfer of resistant genes to non-resistant bacteria, and most notably, the overuse of antibiotics. Bacteria have been around for roughly 3.2-3.5 billion years, whereas human ancestors have only been on the planet for about six million years—let alone modern-day humans being around for ~200,000 years. Bacteria can reproduce so quickly because they reproduce by dividing, thus causing their population to grow at an exponential rate. In spite of the majority of bacteria being successfully exterminated, it only takes that one bacteria that can be resistant to the solution. Every major disease-causing bacterium now has strains that resist at least one of the 160 antibiotics used.
With all of this, there are current growing threats to a multitude of both infectious and non-transmissible diseases. For instance, tuberculosis (TB) is on the rise. Tuberculosis is a disease that infects the lungs. It is spread by breathing in bacteria from bodily fluids of an infected person, also known as a respiratory transmission. As more patients take drugs and other effective antibiotics for TB, genetic resistance occurs in response to the majority of them. Not to mention, those infected must take antibiotics for twenty months respectively.
An infamous case study that is still relevant today is worldwide malaria. Approximately one-fifth of the human population in the world is at risk of contracting an infectious disease. Most of the higher-risk groups are located in lower demographic areas of Africa. Malaria is a parasitic disease from infected mosquitoes. These mosquitoes have become more insecticide-resistant while the plasmodium parasite has evolved a resistance to antimalarial drugs. Similar to the other infectious diseases, another development of more antibiotics will be implemented, creating a positive feedback loop. Even so, there are potential solutions to the malaria case such as vaccines, biological controls, and aiding those living in poverty. To further elaborate on biological controls, genetically engineered malaria-resistant mosquitoes are being administered in order to outbreed those that are carriers. Thus, proper antibiotic use is a necessity, whether it be in medical, environmental, or biological realms.
Inappropriate antibiotic utilization became distinctly extensive in the early 2000s, so much that the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) had to become involved. In 2015, an international action plan was implemented and was extended until 2020 in order “to address urgent antimicrobial-resistance issues” (Monnet & D’Atri). TATFAR published a scientific study regarding the matter in European Union Member States, Norway, Canada, and the United States. Out of those surveyed, nine countries already began integrating a reduction in antibiotic usage in the human population; moreover, seventeen of the surveyed countries mentioned how they were in the first steps to slowing down usage. This scientific inquiry has led to a great first step in battling this modern-day issue.
References and Further Reading
“George Semakula.” IDSA Home, www.idsociety.org/public-health/patient- stories/george-semakula/.
“How Do Bacteria Grow?” Module 2, seafoodhaccp.cornell.edu/blackboard/module2/mod2-09.html#:~:text=Bacteria%20do%20not%20grow%20and,temperature%2C%20adequate%20moisture%2C%20etc.
McGowan, Kat, and substantive Quanta Magazine moderates comments to facilitate an informed discussion. “Did Bacteria Drive the Origins of Animals?” Quanta Magazine, www.quantamagazine.org/did-bacteria-drive-the-origins-of-animals-20140729/.
“Targets for the Reduction of Antibiotic Use in Humans in TATFAR Partner Countries.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 12 Aug. 2019, www.cdc.gov/drugresistance/tatfar/news/targets-for-reduction-antibiotic-use.html.
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