When Antibiotics Don't Work (full documentary) | FRONTLINE

We are now seeing the emergence globally of some forms of bacteria that are effectively untreatable. Every year, at least 2 million people are infected with drug-resistant superbugs. They asked me to sign the papers to let her go and I did, and at least 23,000 died because of them, it had some bugs they had never seen before, we immediately went into high alert, the equivalent of defcon 5. No matter what we did, the bacteria was still spreading. The front line continues to report on how we got here in the overuse of these

antibiotics

that we have. we are preparing for the scenario we are in now we are running out of

antibiotics

the new threats where it came from we don't know exactly where this bacteria came from the economic realities there is a growing recognition that antibiotics are not good to run away from a purely capitalist market and what is happening now much of what we are doing requires resources if there is less money you have to make difficult decisions it could happen to your next door neighbor it could happen to your child it could happen to anyone those bacteria are out there hunting to nightmare bacteria this is the story of three seemingly unconnected events that begin at the same time what each has in common is a type of infection that is becoming impossible to treat a type of infection that has triggered deadly outbreaks even in one of our most prestigious hospitals, is a crisis that is spreading alarmingly quickly and threatens everyone, even the healthy.

Our first story begins in Tucson, Arizona, in May 2011. When I think of that time, I think of spring and just. how do you know how busy she was and how beautiful she was she was 11 and a half years old and she was physically perfect beautiful from head to toe slim you know white blonde hair from being in the sun a little freckles on her nose bright blue eyes, paying attention to what his clothes looked like, his hair, he never stopped talking, he talked a mile a minute, that was more, that, you know, a month before he got sick, journalist david hoffman began reporting on the threat of superbugs for the front line more than four years ago new and extremely dangerous covering what government officials have called a nightmare is a deadly nightmare bacteria even the cdc has called it a nightmare a type of dangerous bacteria that is increasingly more resistant to stronger antibiotics that's what brought us to tucson arizona in 2013 to find out what happened to addie raerasich after she complained to her mother about pain in her hip I thought, well you know she just finished softball, had been in the track meet, you know, everything's fine, it could have been an injury.

I gave her some ibuprofen as the night progressed her pain got worse. She didn't sleep much that night. She woke me up a couple of times asking me if she could take a hot bath or take another ibuprofen the next day. Tanya Rarosich, nurse for 16 years. They took Addie to a local hospital where they said she had symptoms of a virus, but in the days that followed the pain spread and the fever worsened. She was scared at that moment. I remember being very scared, so I packed a suitcase and we left. to another hospital that had specialized in caring for children.

I remember thinking she looked bad, this is bad, something is really wrong, she was put on antibiotics, her blood pressure was going down, you know, they were making room for her in the ICU the next morning, she needed oxygen . Through her mask they observed part of her lungs and diagnosed her with pneumonia. I remember sitting there watching the sun rise and thinking how did she get so sick, how did this happen so quickly, I met Addie in a hospital bed in the intensive care unit. She was lying there breathing rapidly, she was scared, she had small infected boils all over her body, what really seemed most likely

when

I saw her was staph bacteria causing septic shock and Addy fit a pattern I recognized with community associated mrsa

when

You say community.

I mean, this is what you mean by a child getting it on a playground from a scraped knee to correct the spread of MRSA, a staph bacteria that causes infections resistant to many antibiotics and has long been a big problem within hospitals, but in recent years. For two decades, it has also been found outside in the community, in Eddie's case she picked at her skin, like many children, she picked at the little scabs and that was probably what introduced the staph infection, but the staff was just the beginning of Addie's problems she already had. She evidenced early pneumonia and she looked like she was about to get much sicker.

I asked her what the chances were of her recovering. What did she say? She said 30, but she had to think about it for a minute and she knew. he was lying to me, I learned that when your blood has bacteria you are in real trouble, the staph infection had damaged her lungs so much that the doctors had no other option to save her life, they put her on a lung bypass machine called ecmo. I remember saying ecmo in a squeaky voice like no you're not really talking about ecmo. This was total life support, it has huge tubes that go into an artery into a vein and the patient's blood leaves their body, goes through the machine and the machine does what your lung does, the tubes present a whole new set of dangers. those tubes can harbor bacteria and one of the dilemmas of modern medicine the interventions that can save you can also put you at serious risk any patient we give ecmo to has a much higher risk of having additional infections, that's the nature of the beast , what happened here is correct and she received a particularly unpleasant one, it was called stenotrophomonas.

Stenotrophomonas is a completely different type of bacteria than the ones found in hospitals and can live inside by breathing. tubes and it is extremely difficult to treat the problem with stenotrophomonas, even from the beginning it is already a very resistant bacteria, normally there are only four or maybe five antibiotics that are able to treat that particular bacteria. Addie was facing the scary new face of antibiotic resistance. group of bacteria called gram-negative, can you explain to me why these gram-negative bacteria are so stubbornly unpleasant? Gram-negative bacteria is a medical term and actually refers to the armor that surrounds gram-negative bacteria.

That armor makes it very difficult for normal antibiotics. get into the bacteria and kill it, so cenatrohimonis is incredibly difficult to treat because it has that serious body armor surrounding it, are you guys going to come out and go that route? Well, the ability of gram negatives to aggressively fight off antibiotics was now In Addie, first she was prescribed an antibiotic that is good for stenotrophomonas and it

work

ed for a while and then guess which antibiotic doesn't

work

anymore, let's give her a different one and then you'll know it'll work a couple of weeks and three. weeks and then the stenotrophomonas would bloom again and rear its ugly head so to speak and you are doing very well finally one day they said something I never thought I would hear that the stenotrophomonas is pan resistant which means resistant to everything What a scenario Addie and her mother had entered the post-antibiotic era I had to go to her and say I don't have I don't have options based on medical science I'm out of options I don't see a way I remember this happening one weekend.

It was a long week and they had asked me to sign the papers to let her go and I did, there was only one hope left to save Addie's life by surgically removing the infection. I remember asking the doctors then about the lung transplant. and they said no, it couldn't be done, it would be too dangerous, the problem was that she was too sick to be transplanted, that sounds a little strange because you think that a transplant is the last thing you have to save lives. but due to this resistant stenotrophomonas, the expected survival when transplanted was not good; in fact, you could say it's close to zero, you're not going to make bubbles.

Doctors were faced with a question of medical ethics about whether to risk such a valuable resource as a young set of lungs when Addie's chances of survival were so low that tipped the balance. I think it was Tanya, Addie's mother, who was a strong advocate and she didn't give up, and it was also the fact that this was not an unresponsive body lying on the table right now. She was a child who communicated with us and she had tantrums and sparks of life that we could all see in the ecmo machine. I mean, how can you say no to this living human being communicating with you, but Addie would still do it?

I had to wait in the intensive care unit hoping to get a new set of lungs while Addie fought for her life. A 19 year old American named David Ricci was about to face another threat on the streets of India, so after 30 hours on a train we finally ended up in Calcutta. Here the gram negatives were spreading in terrifying ways and coming from unexpected places. . He wanted to experience another culture and put me in an environment where he was serving and helping people. I think India ended up changing me. much more than he could ever have changed India he had come here with a missionary group to work in orphanages one morning the group headed to work in one of those orphanages a mother teresa house was in the slums of the slums really where this orphanage was so we had to walk through all these narrow streets that I had never walked before and we basically took a shortcut through the train station to cross the tracks and then we walked along the train tracks and as we were going under an overpass, I was in the back walking and suddenly, you know, out of nowhere a train passed and I realized, I remember thinking in my head that it happened, wow, it happened very fast, The impulse of speed caught my sleeve and ran me over and dragged me under the train the wheel went over my leg and I started losing a ton of blood I started bleeding everywhere they pulled Ricci out from under the train lucky to be alive He was rushed to a local hospital.

A doctor came in, reached up to the top shelf and pulled out this leather package and then, you know, he pulls out a big knife, you know, a big serrated knife that looks like a machete and starts counting. everything you know. The nurses grabbed me and held me steady and then he started cutting into my leg, just cutting through it. We were standing outside and we could hear him screaming the whole time and then I passed out within 24 hours. Ricci was transferred to another. hospital and his condition deteriorated quickly Hi everyone, I spoke to the doctors, they said I don't have much longer left, but I'll put it to them, Richie was barely hanging on and when his family arrived in India, there were new complications, they just told us we had We had to take them again for another surgery, another surgery and we didn't understand why, they operated on him almost every day, and they told us, you know, we have to clean up the infection. and then, you know, I thought it was just an infection, you know, I didn't really realize what they meant by infection.

What Richie and her family didn't know was that they were on the front lines of a superbug crisis that simply The beginning of the study that found the superbug ndm-1 in water samples from Delhi is causing the Indian health establishment to panic. turn red. Researchers had discovered a new danger. Bacteria carrying the gene that produces this ndm1 enzyme are resistant to very powerful antibiotics. It was absolutely a bomb. it was unexpected the journal of infectious diseases landsat discovered that the ndm1 enzyme in 11 different types of bacteria ndm1 is not a bacteria it is actually a resistance gene that can turn bacteria into superbugs ndm1 is resistant to almost all antibiotics even scarier is promiscuous resistance gene can jump from one bacteria to another, making treatable infections suddenly untreatable, but there was more ndm1 was not only in hospitals, to everyone's surprise, it was also discovered in the environment.

From a scientific point of view, we didn't realize this could be done. so easily meant that in places where water and sanitation was poor, where there would be a lot of bacteria sitting next to each other, you could have a very rapid spread of resistance information between unrelated bacteria found in the environment, which is an enormously higher risk than if it only occurred inside the bodies of patients who had these infections, so you are saying that the bacteria were exchanging this information on the street without being in the right person to be able to transfer resistance genes.

Even when they were in the same pool of water with the spread of ndm1, a much broader population is at risk and what is of particular concern to health officials around the world is that ndm1 is abundant and travels after twoweeks in an Indian hospital. I was flown home to Seattle and taken to the trauma unit at Harborview Medical Center. I first heard about David's case in July 2011. He was sitting in my office working and one of my colleagues, orthopedic surgeon Dr. Doug Smith, called me. and he asked me if he knew a patient on one of our intensive care floors with several drug-resistant pathogens.

I opened up his medical record and saw a lot of drug resistance, drug resistance that we don't normally see in everyone. These r's mean that the bacteria is resistant to that antibiotic knowing that David had come from India. I was immediately concerned, even before I saw David, about the bacteria in the wound containing this new type of drug resistance. The lab results confirmed Lynch's worst fears. Ricci had brought ndm1 to the United States was one of the first cases identified here and Lynch had little to base it on. There is not much clinical experience in treating these bacteria anywhere in the literature.

There are no books. There is no information about it, so we had to find out. What to do for David? At that moment, I knock on my door and they open the door and there are these doctors telling me that we have to isolate you, we have to quarantine you alone. Ricci was in the middle of the ndm one nightmare. the gene was spreading resistance to other infections in his leg, they showed us the list of them, there were about five bugs and they said all these infections are resistant to antibiotics and when they said that, that's what worried me because I'm like?

How are you going to get rid of them? Lynch tried several powerful antibiotics but they didn't work. You did something? new antibiotics the problem now is that we don't have many new options and we are going to go back to some of our older antibiotics. The hardest part was watching what the antibiotics did to him. I began to devour my organs. the inside, you know, I could feel it, just this poison running through my blood, the treatment was too toxic, we had to stop the only medication we had left to treat the gram-negative bacilli that were in his wounds, you telling me? that he had these bugs and he had nothing to treat it with right now, we had nothing to treat them with, he just couldn't believe there wasn't an antibiotic to fix it, to tell you the truth, they would have.

To remove more infection by cutting off more of Richie's leg, but it would be months before they knew if all of the ndm1 was gone. A decade ago, hospitals in the New York City area became the epicenter of another highly resistant and deadly type. gram negative bacteria this superbug did not come from abroad this was homegrown it lives in the digestive system and since ndm1 is a gene that can spread its resistance to other bacteria it is called kpc no one knows exactly how many patients there are in new york city area has been infected with kpc or how many have died nationwide.

Most hospitals are not required to report outbreaks to the government and most do not speak publicly about them, but as part of the investigation by Frontline, one of the most prestigious hospitals in the country. National Institutes of Health Clinical Center, the NIH agreed to tell how it handled a major KPC outbreak that began in the summer of 2011, when a woman carrying KPC was transferred from a New York City hospital here to the NIH in Bethesda. , maryland, talking about Hospital infections are really difficult for a hospital because what you're saying is we all know that when you come to the hospital there are certain risks, but now we've laid bare what those risks are.

The NIH had never before treated a case of kpc. and when the patient was taken to the ICU, the staff was determined to prevent kpc from spreading to other patients, we immediately went into high alert, the equivalent of hospital epidemiology defcon 5, we tried to implement as many things as we could think of at the time to prevent further spread of the organism in the hospital they called it kpc and then we learned it was klebsiella pneumoniae carbopytamise and that's a mouthful but we didn't really know what it meant the patient was placed in what we call enhanced contact isolation which means everyone entering the room, including visitors, had to wear gloves and gowns, the room was at the end of the hallway, separate from the other patients, let me check your blood sugar, okay, but this was the intensive care unit where patients are very sick and highly vulnerable and present the greatest risks is the type of place where bacteria can spread easily people are very busy and a lot is happening patients get sick very quickly and require intervention bacteria They can spread on hands, they can spread on pieces of equipment that could be passed from one patient to another, so you have to be very careful.

Their efforts to contain kpc seemed to work when other ICU patients were tested for kpc, we found nothing, so at that time we thought the bacteria had not spread, the New York patient eventually recovered and was discharged after four weeks in hospital. We really felt like we had dodged the bullet, but five weeks later, a big surprise, out of the blue, would you do me a favor? Could you get me a fair one? a tube fixator for outside the rt cabinet a kpc bacteria appeared in a respiratory culture and with it a mystery how this could have spread from the first patient to the second patient they were not in the ICU at the same time they did not have the same caregivers, no They had the same equipment, so we initially thought it might be possible that this was a second introduction from another KPC body.

I was extremely concerned because infections with these bacteria had a high mortality when they started researching. By looking for kpc on the equipment and testing the patients once again, they realized the problem was much bigger. We began to find other patients in the intensive care unit to whom the bacteria had spread. They had an outbreak. The kpc was spreading. Patients were getting sicker and the antibiotics were out. It didn't work and we tried combinations of five six antibiotics, we tried to convert oral antibiotics to intravenous antibiotics, we even got an investigational antibiotic from a pharmaceutical company, an experimental one, a trial one, an experimental antibiotic and that didn't work either.

Desperately to contain the outbreak. the hospital took unprecedented measures they created a separate ICU for kpc patients they brought in robots to disinfect the empty rooms they had monitors here reminding us to wash our hands they built an entire wall on the other side we moved all the patients in the ICU we cleaned it completely We moved the patients back and no matter what we did the bacteria kept spreading, we didn't know what was happening with the hospital in crisis. The genetic researchers in building 49 next door were struggling to figure out how the kpc we had now was spreading.

They got to the point where they were identifying one patient per week and it was unclear how these patients could be related to each other. Julie Segre and her colleague Evan Snitkin began comparing KPC DNA samples taken from patients. Are they all of these? DNA, yes, these are all the DNA that each patient had, so this shows, based on the DNA sequences, how we believe the bacteria spread throughout the hospital by matching the DNA, they discovered something that none of them knew about. Three, four and eight were all silent carriers. The scary thing is that they can be transmitted to other patients without anyone knowing that they have the bacteria themselves, so this bacteria seemed to have been all over the hospital before they tested positive and the hospital didn't know they had it.

I don't know, because this bacteria has the ability to live in the stomach of patients without causing infections. For me, the data was surprising. Why was I surprised? Because it became very clear that we had missed the broadcast sequence. High-tech genomics revealed disturbing information. The truth is that the outbreak would be much more difficult to contain and to stop it they needed to find out exactly how the kpc was moving around the hospital, whether it was on the hands of workers or visitors or on hospital equipment, and then, while urgently searching for carriers silent In the rest of the hospital, his worst nightmare came true.

The outbreak had spread beyond the ICU. It's a very scary moment. Suddenly, you're in the general patient population. The staff panicked as they watched helplessly. Patients began to die. We feel responsible for ourselves. You are responsible for the patients You walk into a room and maybe there is a hole in your glove It is a very complex environment Alarms set Did you miss something? Did you forget to tell the doctor something? Did I forget to wash my hands between Mr. X and Mrs. Y? That's why Mrs. Y got KPC, there were few options left. Dr. Gallon asked me if we needed to close the hospital or if we needed to close the hospital to admissions.

In the end we decided not to close the hospital, but it was an absolute possibility. Instead, they expanded the testing. throughout the hospital and isolated, everyone who encountered kpc eventually six months after patient one first arrived, the outbreak subsided almost as suddenly as it had begun by then, 18 patients had been infected with kpc and the tragedy end six people had died from it, many inside nih I remained worried Do you think KPC has disappeared from your hospital? Oh, no, absolutely not, I think we have to be extremely vigilant in the coming years, because of the increasing increase, the increasing prevalence of KPC in the United States, the increase.

The prevalence of threats like kpc became the focus of a five-year study at the world's largest medical center in Houston using cutting-edge genomic researchers who analyzed infections from nearly 1,800 patients and in May 2017 announced a surprising discovery. We were very surprised when we discovered a new type, a bacteria that had never been described in great abundance anywhere in the world. This new type is called cg307 and it can be deadly. It has killed people. People die with this organism. Sometimes the rare superbacteria is. found in a third of the samples Taken from patients now the question we don't know the answer to is why it is abundant, but clearly it has been abundant here and no doubt in other Houston hospitals as well, and there was a more troubling mystery of where it came from , we do not know.

We know exactly where this bacteria comes from, but many patients probably brought it to the hospital and we now know that it is a common organism in our community. The Houston study makes it clear and puts it in black and white: the threat of antibiotic resistance is dynamic and constantly evolving, not only is people's lives at stake, but as more resistance and I mean nationally, not just in our hospital, there is a greater chance of creating an organism that is now resistant to all antibiotics, the prospect of a life without antibiotics is barely imaginable. For a world that has had a plentiful and cheap supply of them since the end of World War II, they are a staple of modern medicine, it is difficult to remember a time without them when an infected cut could kill a young person. heals in a matter of days. but now it is clear that we are heading back in that direction, that the miracle of these drugs is fading.

Antibiotics are unique medications; they are not like any other class of medications. In 50 years, the cholesterol medications we have now will work just as well. just as they work today, the cancer drugs we have now will work just as well as they do today, that's true for all other classes of drugs, antibiotics are the only class of drugs that the more we use, the faster we lose them when they are they use. less effective for me and vice versa, that is the essence of antibiotic resistance, the more a bacteria is exposed to an antibiotic, the more likely it is to develop resistance to that antibiotic, so the more antibiotics we put on it people, the more we put them into the environment.

The more opportunities we create, the more opportunities we create for these bacteria to become resistant, but people forgot about the danger of resistance because the drugs were very effective and what they had forgotten was the warning that Alexander Fleming himself, the man who discovered penicillin, gave us in 1945 that resistance was already being seen and the more we waste penicillin, the more people will die from penicillin-resistant infections. Bacterial resistance is largely inevitable, but it's also something that we've certainly helped along the way, we've fueled this fire of bacterial resistance. These medications are miraculous. medications, these antibiotics that we have but we have not taken good care of them.

The officials ofPublic health estimates that one-third of all antibiotic use in the US is unnecessary or inappropriate, and by overusing them, we have set ourselves up for the scenario. where we are now, where we are running out of antibiotics, but the growing shortage of effective antibiotics is not only a problem of overuse, it has also been driven by what is happening within the pharmaceutical industry itself, the place where it started to get really challenging. I would say it was in the '80s and '90s that we started to see occasional bacteria that were very difficult to treat and it became less obvious that new antibiotics could be invented and new things just weren't coming along at the time.

At the same rate and then in the '90s, in the first part of this century, we started to see resistant bacteria that we really didn't have much or anything at all for and we had nothing to treat them, that's because most Major pharmaceutical companies were pulling out of the field of antibiotic research just as the gram-negative threat worsened, one of the last companies to stay was Pfizer, which had made a name for itself with antibiotics in the mid-2000s and had set its sights squarely on the gram-negative problem we thought existed. What really matters was medical necessity and we thought that given our history and our ability to develop penicillin, antifungals, you know, antibiotics, in fact, if we put our mind to it, we would be successful, but this is a highly risky undertaking and unpredictable despite the Risk Pfizer created a world-class research team in Groton Connecticut and hired a veteran of gram-negative research, John Quinn, in 1983.

By the time I finished my training, almost every pharmaceutical company had a development team of antibiotics and when I landed at Pfizer in 2008. We were really down to three big companies and some smaller companies in biotech, etc., and I think we all felt that we had a moral obligation to continue working in this area. There was a pressing clinical need. Most companies had abandoned the field. and we were still in the game we were proud to still be in the game quinn and his team believed they were on to something big several different compounds to treat gram negatives the potential breakthroughs caught the attention of the company's scientific advisors, including bradSpellberg I felt that their project was probably the most comprehensive and important antibacterial project in the world, focusing on the types of bacteria that we're really having serious problems with right now, which are the highly resistant gram-negative bacteria that would have solved the problems. and saved lives if they had been developed success

full

y, but bringing these drugs to market faced the economic paradox of antibiotics: if you need an antibiotic, you need it only briefly, in fact, that is the correct way to use an antibiotic, you use it alone briefly and from an economic point of view. from a developer that means you're not getting the return on the investments you've made because you've spent between $600 million and a billion dollars to bring that new antibiotic to market wait, I mean, it costs up to a billion dollars to bring a new drug to market, it can easily cost up to a billion dollars to bring a new drug to market and the initial reaction is great and the word let's not use it, let's use it as little as possible, so here is a big company that says I can make thousands of millions on cholesterol medications, blood pressure medications, arthritis medications, dementia, things that I know patients will have to take every day for the rest of their lives, why would I put my thousand dollars into the division of antibiotics?

It's not going to make me any money when I can put it here, so here's the deal that will make a lot of money for the company. I respond to the shareholders. That was the problem Pfizer faced in 2011. Don't kid yourself. his doctor's stock had plummeted on Wall Street and his successful cholesterol drug Lipitor was about to go off patent. I got an email on my Blackberry saying there was a mandatory emergency meeting in two hours, can't be good, so I called for the meeting and was told the announcement had been made that the Groton facility was going to close the company ended 70 years of leadership in antibiotic development leaving unfinished its search for a cure for gram-negatives the outside people I spoke to too many of our staff my friends told me, well, pfizer is just doing what other companies have done , there is nothing particularly wrong with that, it is not immoral, we are a capitalist society in 2013, we asked pfizer to explain the decision, I get the feeling that some very ruthless decisions have to be made about where to put the company's capital where invest where to put your emphasis and when you abandoned gram-negative research like that and moved on to vaccines, do you remember that and say you know we learned something about this?

These are not ruthless decisions. These are portfolio decisions about how we can best meet medical needs as we want to stay in the business of providing new therapies for the future that our investors require of us. I think society wants a pfizer to do what we do in 20 years we made portfolio management decisions in 2016 pfizer decided to re-enter the antibiotics market and bought several drugs in development like other large pharmaceutical companies, although is still not investing in research, there is a growing recognition that antibiotics are not a good thing To function with a purely capitalist market, okay, we have to move from a corporate business model in which sales are maximized to other mechanisms payment in which the objective is for society to be able to say that we want this type of antibiotics to be developed and that we are going to help them.

We're going to lower the cost and the risk in return, we're going to have a say in how it's used so it's not abused in Washington. The federal government has been increasing its involvement in the fight against superbugs for two years. Since the Obama administration unveiled a national plan coordinated by the Department of Health and Human Services, the key person for the effort is now Christopher Jones under the published national action plan to combat antibiotic-resistant bacteria. in 2015. Now we have an overall framework and structure. To address this issue across the federal government we have a plan that has specific actions that are being worked on every day and I think it reflects the investments we've been making around surveillance management, new product development, development of new diagnostics. and growing international collaboration on the issue, people have long been warning that the pipeline of new antibiotics is running out.

How's it going? We are investing $250 million over five years for the initial stage of antimicrobial development. I think the next phase, as we start to think about products that really show promise in the early phases is how do we continue to support their development and I don't think we're quite there with what that strategy looks like, but we do have to rethink how we reward companies and that's it. Talks are again ongoing, but some say the government should play a bigger role. Is there more to do? What we need to focus on now is using fewer antibiotics.

We need to create policies and regulations. If we publicly report the use of antibiotics. Impose requirements on hospitals. it should be reported that the public shaming effect will reduce antibiotic use and these are all m28, yes sir, even as the government's strategy is taking shape, the Trump administration has proposed funding cuts of up to 20 percent for programs and agencies combating antibiotic resistance. what would be the importance and impact of further budget reductions on antibiotic resistance, to your point, yes, a lot of what we are doing requires investments, requires resources, if there is less money to spend, difficult decisions have to be made, things What can be done?

It can't be done, I'm very worried about that and I think we all should be. I believe the gains we have made are largely due to investment and if we taper we will see an even faster evolution of resistance. and the spread of resistance and last year far fewer measures were developed to combat it the warnings became even more dire We are seeing bacteria that are resistant to the absolute last stop on the train, colistin, so for those patients there are no options left , so those patients have really gone back in time, are back in the pre-antibiotic era, and will recover. from those infections or you will die from those infections and there is nothing we can do for them, as we reported in 2013, NIH never completely got rid of the deadly KPC superbug.

A year after the outbreak, a young man arrived at the hospital due to complications from a bone marrow transplant while there he contracted KPC and died as the seventh victim of the outbreak. I guess if I had an important message it would be that it will never end, so this organism and organisms like it will be with us until the cows come home and we have to learn to deal with them, we have to change our culture in the hospital. KPC has been found in hospitals in all but two states and those are only the hospitals that voluntarily report it, as for David Ricci, it took three surgeries and another round of highly toxic antibiotics before doctors believed they had eliminated all the nbm1 of his leg.

You know, there's no muscle left and I only have about six inches left and the bone stops there and so far Ricci has stayed healthy. although I'm not completely free from the fear of ndm1 you know my doctors were pretty straight with me they were very honest and said you know there's a good chance this infection won't go away maybe it never will go away yeah yeah they said you know We don't have enough experience to know what's going to happen. ndm-1 has now spread to at least 70 countries and here in the US over 200 cases have been reported, so David was actually kind of a harbinger of something to come. an example of something that is already here so there are entire continents that have this big problem a public health problem and David was simply a sample of that population it is new for us and that is key because the hospitals in any city in the country are going to have patients from all over the world that globalization that mobility is happening now this is already here okay addie let there be light this is the day that the Lord has done addie rarisich was finally able to return home yes, but it's not fun, come on There was no any light.

She received the double lung transplant she had been waiting for. Hey, it was like bringing home a premature baby. We brought monitors home and she couldn't do anything by herself. She couldn't even turn over in bed. she couldn't turn from side to side, that's how weak, contracted and weakened she was, so how are you now? Basically, I'm fine. Nothing seems out of control right now. I look pretty, I feel pretty good, um, I look pretty good. like I did before I got all my friends back, did you understand what was happening to you? Did anyone talk about the infection and what the infection meant?

No, basically what they told me is that I would say I want to go home and she would say that she could never come home as if she was too sick to go home. It's okay, everything is hard for Addie. Now everything is a battle. Um. Recipes. She has to take a handful of pills twice a day. We have to worry constantly. you know, contracting a bacteria or a virus, she said pneumonia five times bacterial pneumonia that had to be treated with antibiotics and each time I wonder if this is the time we're going to run into bacteria that have nothing.

I think for lung transplants the survival rate is about 80 percent in one year and about 50 percent in five years and every year after that the risks just increase. People might say Addie's story is horrible, but that won't happen. What happened to my daughter? Could this happen to anyone? It happened to Addie, she was healthy. She could happen to anyone. She could happen to her neighbor. She could happen to her son. She could happen to anyone. Now I'm not here. to practice apocalyptic thinking, but those bacteria are out there and they are in healthy people in the community, if you don't mind standing up, you can walk around the county, please, gentlemen, the average person thinks, oh, I have an infection What do I take? an antibiotic, she got better, yeah, it's not that simple anymore, tomorrow, caleb, how are you, honey, I'm fine, thanks, eddie, she didn't get better, right?, she never got better, really, no, she had to undergo surgery and taking the infection came out but it may have saved his life for now it gave him time that's whatWhat happened we gave it some time and I'm grateful for every minute I remember you I know I've seen you somewhere Yes, you're my nurse too For more about this and other

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Front Line Hunting Nightmare Bacteria is available on DVD to order, visit shoppbs.org or call 1-800 Play PBS Frontline is also available for download on iTunes.