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Our Struggle Against Antibiotic Resistant Bacteria

"A War We May Never Win"
Dr Kadiyali M Srivatsa

A new report from the American Academy of Microbiology begins: The struggle against antibiotic
resistance is "A War We Will Never Win". My prayer "Oh Lord, give me the strength to fight a battle that I
may never win" published at Medica 2006, was not answered because medical device and drug
manufacturers never understood the gravity of this threat. I warned them that all invasive practical
procedures, operations, plastic surgery, transplant surgery, hip or knee replacement, open heart surgery,
bypass and minor surgical procedures will soon come to a grinding halt. The very technology we’ve created
to help us live more comfortable and, yes, often healthier lives will turn around and bite us-hard. This
proves just how vulnerable we are despite all our scientific know-how and advances in medicine.

What I said then does not sounds like a B-movie on the Sci-Fi Channel anymore because President Barack
Obama and Swedish Prime Minister Fredrik Reinfeldt, representing the European Union (EU) Presidency,
have now establishing a transatlantic task force to address antibiotic resistance, an urgent and growing
problem that threatens patient safety and public health worldwide. They joined forces to address the
urgency of the problem and the need for solutions by signing an international agreement that seeks
cooperative ways in which to help combat the global health crisis.

Assistant Secretary for Health and Surgeon General David Satcher, of U.S. Public Health Service U.S.
Department of Health and Human Services said Antimicrobial Resistance: Solutions to a Growing Public
Health Threat. The World Health Organization (WHO) has identified antimicrobial resistance as one of
the three greatest threats to human health.

I am probably been one of the first few to warn about the threat
that will bring an end to our medical profession. My colleagues
and friends told me that I am paranoid, pessimistic and
negative. I feel sad and cry in pain because my worry was true.
We are now forced to watch this drama unfold and will see our
children suffer. There is no place to hide and we pay for the
atrocities and arrogance for playing God.

In 1989, we were talking about Staphylococcus but now we have more than ten bacteria and viruses that
will bring medical profession down on our knees and threaten our existence on this planet. Enterococcus
faecium, Staphylococcus aureus, Klebsiella species, Acinetobacter baumannii, Pseudomonas aeruginosa,
Enterobacter, TB, Salmonella, E Coli, Gonorrhoea, Syphilis, Polio, Malaria species are now said to be
resistant to most antibiotics and antiseptics.
"Our life is in their hands"
Our politicians are adviced by members of medical community based on
research conducted in the past and call them "Evidence Based
Medicine". They solution they promote and monitor is "Good Hand
Washing Technique" . These bacteria are not simple, they are smarter,
faster and are armed with eight enzymes that kill us in minutes. They
have the knowledge, power and have the technology to manupulate their
genes rapidly and help defend themselves. We may take more than
twenty years understand how they can restructure their genes in twenty
minutes. Resistant bacteria are also capable of transfer information to
other harmless bacteria making them lethal killers.

Recently scientist published a disturbing paper, they discovered
antibiotic-resistant bacteria growing in alcohol. Ethanol (Alcohol)
producer, used Penicillin to eliminate the growth of bacteria during
fermentations for half a century. Now they are using higher dose to
increase better ethanol yield. Using alcohol wipes to clean wound, prepare
skin before injections and operations may now do more harm than good.

Fabric softeners, disinfectants, shampoos and other household
products are spreading drug-resistant bacteria around Britain,
scientists have warned. Detergents used in factories and mills are
also increasing the odds that some medicines will no longer be
able to combat dangerous diseases. Over entusiastic hand wash
will have negative impact because bacteria will develop resistance
to antiseptics. These bacteria have bio-film to protect and efflux
pump to spit out chemicals that threaten them.

Water, soil, rivers, sewer and beaches were found to be saturated with antibiotic resistant bacteria. Using
water , salt water or alcohol to wash hands or clean wounds may not be safe as you think.

Mississippi State University researchers found 162 different species of bacteria, including E. coli,
Salmonella, Staphylococcus, and Vibrio in frozen, ready-to-eat shrimp products that were imported from
four different countries. Many had become resistant to one or more antibiotics.

Scientists have warned that resistant bacteria from agricultural environments may be transmitted to
humans, in whom they cause disease that cannot be treated by conventional antibiotics. Research at UGA
College of Veterinary Medicine, found that chickens raised on antibiotic-free farms and even those raised
under pristine laboratory conditions have high levels of bacteria that are resistant to common antibiotics.
Researchers at Birmingham and Warwick University have discovered a link between the antibiotics used to
treat farm animals - in particular pigs - and the spread drug resistance bacteria in the soil.

I think your scientists are very short sighted and
are still debating about finding good evidence
based medical research to answer their
questions and come out with solutions to combat
this threat. Unfortunately, this is unlikely to
bring in result because the problem is far beyond
their reach. The strength of these micro-
organisms, combined with the global warming
will inevitably encourage their spread.

In 2008, flu epidemic in USA 64% children who died were infected with Multi Resistant Staphylococcus
aureus (MRSA) pneumonia. The deaths were very rapid: 45% of the children died within 72 hours of their
first symptoms and 75% died within a week.
My Story

Working as a Registrar in Paediatrics in 1989, I encountered a healthy boy aged fourteen years
brought into hospital with tummy pain but soon deteriorated to shock because. He had no white
cells in his blood to fight infection and so no antibiotics worked. He died the same evening and
when all that we could do was to stand by and just watched him

I felt sad and very worried, because we failed to alleviate pain and
suffering by failing to manage a simple bacterial infection. The mother
trusted us because she we as doctors who boost about organ transplant,
test tube babies, growing human organs in lab, miracle cure and wonder
treatment failed to manage simple bacterial infection. WHO now accept
this as one of the worst threat to humankind in this planet.

I could see the danger of allowing this "Normal Commensal"
(Staphylococcus aureus) spread in our community. I knew nature has
found a simpler method to clean the universe using these scavengers. The very organism which converts a
dead cadaver placed in a coffin to simple soil is now ready to clean this world and help start life all over
again. This is sad, but how can we expect the world to cope with this population explosion? there must be a
way to control us and am sure the nature has found a way.

Since I saw how a simple bacteria could kill a healthy boy in twelve hours, I have
been tirelessly campaigning, publishing articles to warn people and help reduce
the spread. I have spent hours trying to figure out how this common bacterium
that does not know how to infect human has suddenly become a lethal killer.
After days of observation, learning about bacteria and virus, I noticed how some
practical procedures we perform in hospitals are associated.

As doctors, we passionately believe it is our “Ethical Duty” to help reduce introducing bacterial infections
that kill patients. To help reduce introducing bacteria into patients body, I invented devices that reduce
infections in our hospitals and so strived hard to prevent them spreading in our community.

Our contributions may have helped or given us more time to
think and act. We had the knowledge; found solutions and
warned manufacturers but did not receive help or support.
Manufacturers of devices did not want to believe in what we
were saying nor were the microbiologist forceful enough to
bring in changes. As clinicians, we identified some contributing
factors after years of observations and understanding the way
the bacteria behave. I feel it's now late but still have some hope
that "We May Win This War With Bugs".

The scientific community talk about evidence based medicine,
proved hypothesis and clinical trial. They also believe they can find a new treatment to fight this threat.
Unfortunately, scientists were encouraged to find long term treatment and not antibiotics in the last twenty
years. We have not seen any one encouraging or developing new antibiotics or techniques that help.

Since 1960s, doctors were encouraged to use disposable medical devices. Infection has increased in tandem
with the use of plastic disposable medical devices. The number of nosocomial device-related bacteremia
raised eight folds in ten years (1980-1990). These contained plastic devices discarded from hospitals are
polluting our environment and encourage spreading infections.
I worked with medical device manufacturers and have warned them about the situation we will be in if we
don’t bring in changes. Accepting our hypothesis was not in their interest and they were interested only in
protecting their own investment and so missed a great opportunity. Unfortunately, the problem still exists
and the infection rate has escalated to catastrophic proportions and will kill millions.

Now we know our contribution will not save the world nor will it reduce the spread but we still hope this
may make some difference to lives of few people especially children.

We have been discarding bacteria and viruses locked in medical
disposables (syringes, tube, catheters and cannula) in our environment.
These bacteria are living organisms and so are now returning to haunt
us. I anticipated this "Threat to humankind is likely to be greater than
war, terrorism or global warming. The only solution I could see was to
try to slow their growth and multiplication by reducing them spread in
our hospitals and community.

I feel sad because my “Hypothesis” has been proved to be almost right, but due to lack of support and
encouragement I could not avert a major disaster that may kill millions of innocent healthy adult and
children in the near future. I did not expect people to believe in what I said, but as a doctor and a father, it
was difficult for me ethically to conceal the truth.

"Time may come when Penicillin can be bought by any one in the
shop, then there is a danger that an ignorant man may easily
under-dose himself making microbes resistant to penicillin"
Alexander Fleming; Inventor of Penicillin, 1940

Thanks to Martina Benzing, Bruce Pullmen, Anna McKay & Monica Rafique for believing and helping me with my mission to fight this threat