Transcript for the Piece Audio version of Death by Infection: Bacteria in a Post-Antibiotic World

Reporter: Robert Frederick
The drug-resistant bacterium is Clostridium difficile, which had been considered a hospital problem because that’s where most people were getting infected.

Interviewee: Archie Clements
However, it’s becoming much more of a community problem.

Reporter: Robert Frederick
Archie Clements is an infectious disease epidemiologist at Australian National University. Clostridium difficile is a real problem in Australia, too.

Interviewee: Archie Clements
There are a lot more cases of Clostridium difficile being identified in the community — in people who are not in hospital, haven’t been in hospital — which suggests that there is a lot of transmission of Clostridium difficile happening out there in the community.

Reporter: Robert Frederick
The reason that’s happening isn’t exactly clear. What’s known for certain: transmission happens via spores, and people infected with Clostridium difficile suffer from diarrhea — lots of it — that just doesn’t stop.

Interviewee: Archie Clements
So the bacteria lives in your gut. Spores are passed out in the stool, in the feces. And then those spores disseminate in the environment. And those spores are highly resilient to the environment. They can survive for decades.

Reporter: Robert Frederick
And so spores may be found absolutely everywhere. In part, that’s also because it’s normal for Clostridium difficile to be inside of people. The bacterium colonizes about 5% of the adult population and around 30% of babies, though without causing the infection. So people who are colonized — it could be you, or me — aren’t suffering, but still spread the spores and wouldn’t even know it.

Interviewee: Archie Clements
And in fact, the emergence of epidemic strains of Clostridium difficile in the hospital could be an indicator of events that are happening out in the community.

Reporter: Robert Frederick
Unfortunately, community events include an epidemic strain that evolved its drug-resistance here in the United States, first identified in an outbreak 15 years ago in Pittsburgh, found again the next two years in Atlanta, then in Montreal, Canada and has now spread around the world. So epidemiologists like Clements are studying how the disease spreads in the community.

Interviewee: Archie Clements
Things like the interaction between humans and animals in the community, food production system — the way that they operate — and exposure to antibiotics in the community.

Reporter: Robert Frederick
Yes, antibiotics, and especially broad-spectrum antibiotics, which kill lots of kinds of bacteria. At first it sounds paradoxical, but killing lots of kinds of bacteria in the body also kills the beneficial bacteria that otherwise keep Clostridium difficile under control. Because of this, the usual course of treatment for a Clostridium difficile infection is for the patient to stop taking antibiotics for any other reasons they might be prescribed. If that doesn’t work, or for those who weren’t taking any antibiotics in the first place, there are other, more specific, narrow-spectrum antibiotics for treating a Clostridium difficile infection, but those don’t always work, either. Unfortunately, says Joy Greene, that’s becoming more and more the case for more and more bacteria. Greene is a clinical professor of pharmacy at High Point University in North Carolina.

Interviewee: Joy Greene
You see what’s happened over the years is many times patients are not taking those antibiotics appropriately, they do not finish the full course of therapy, so many times these bugs have become resistant to those narrow-spectrum antibiotics.

Reporter: Robert Frederick
And, Greene says, there’s no way of monitoring patients to ensure that they do finish the full course of therapy and so kill off the harmful bacteria that’s infecting them.
?Interviewee: Joy Greene
So now there are many community pharmacies who will have their pharmacist call the patient three or four days after an antibiotic has been picked up to say: “How are you feeling? Remember your antibiotic full course of therapy is 10 days. Make sure you finish the full course of therapy.” But really, we leave that up to the patient.

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Reporter: Robert Frederick
Proper antibiotic stewardship is now a national priority in the United States. And one of the declared goals of the federal government is a 50% reduction in the incidence of Clostridium difficile infections by the year 2020 compared to the year 2011. That year, half a million Americans were sickened and of those, an estimated 29,000 people died from a Clostridium difficile infection. So far, the efforts to curb Clostridium difficile have been focused primarily on hospitals, but there’s been no monitoring system put in place to better monitor the use of antibiotics. There’s certainly no system now, says Greene.

Interviewee: Joy Greene
Unfortunately, no. Now, if we were talking about controlled substances, which in society is considered more dangerous than antibiotic use, then I would say yes, many states have a state registry. However, you know, antibiotics are still considered pretty harmless, and for physicians, they’re not as concerned about someone abusing antibiotics, and so we don’t have a monitoring system in place.

Host: Robert Frederick
Improper use of antibiotics may not seem to be as dangerous to the individual patient as controlled substances are — the steroids, narcotics, and pain relievers that have been highly regulated in the U.S. since passage of the 1970 Controlled Substances Act. But it is becoming increasingly clear that we, as a society, have been misusing antibiotics, which is also dangerous to the individual in the form of widespread, drug-resistant bacteria, meaning many of them are again deadly — like they were before antibiotics existed. To cut down on antibiotics misuse, though, it will take coordination of all the world’s governments, because drug-resistant bacteria are global problems. Again, Archie Clements of Australian National University.

Interviewee: Archie Clements
You know, the fact that the environment, people, animals, are all interrelated, and if something goes wrong in one area of the Earth system, that can impact on other areas of the system. So we probably need to be thinking a bit more broadly than we do now with traditional epidemiology, and not so focusing so much on diseases as clinical problems but as manifestations of planetary problems. These are planetary systems problems, and we should probably be focusing on the big picture.

Host: Robert Frederick
But focusing on the big picture has been hard to do for the world’s governments. The one time there was global coordination was in limiting chlorofluorocarbons, or CFCs, which scientists had shown were causing a hole in the Earth’s protective ozone layer. Substituting CFCs with other chemicals, though, still allowed people to refrigerate their food or spray other chemicals about such as hair products. But there’s no such substitute for antibiotics, and scientists are already telling us that unless there’s real change in antibiotic stewardship, future bacterial infections will be just as deadly as they were in the past.

I’m Robert Frederick.