Outbreak: Resistance and Antibiotics

Outbreak: Resistance and Antibiotics

(CHILDREN CHATTER) Ellie Weight was 9 years old
when she developed MRSA, a serious Staphylococcus infection
caused by a bacteria known to be
resistant to antibiotics. (SCREAMS)
Daddy! Get them please! ‘We thought that it was just
an infection in the left hip. And then once the lab results came
back, they noticed it was the
superbug MRSA. There’s already been a change with
some common infections that can’t be
treated with oral antibiotics. And the ultimate risk is that the
person will either suffer damage
from the infection or die from the infection.
…a mumps outbreak in Auckland. …a global public health
emergency. …over 100,000 baby
deaths worldwide. ‘…putting themselves at risk
if they don’t get vaccines.’
‘…there have been 300 cases.’ ‘…resistance now a global threat.’ (SOMBRE MUSIC) Bugs and bacteria surround us. We barely think of the risks of
infection until we get sick. For years, we’ve relied on a suite
of antibiotics to treat infections
that just a few decades ago would have caused deaths. But as we’ve become reliant on
those antibiotics, bacteria
have become resistant. Antibiotic resistance is a slowly
developing environmental
catastrophe. But the environment that in which
the catastrophe’s happening is the germs that live in our
intestines and on our skin. And we’re gradually ending up with
more antibiotic-resistant germs on us and in us than
we used to have. It’s an arms race between us and the
microorganisms. And it’s a very hard
thing when you’re fighting against a foe that can essentially
mutate and change so fast. The World Health Organization
believes overuse of antibiotics and our bodies’ growing resistance
to their effect is one of the
biggest threats to our survival. There’s a risk that that will
quickly spread throughout the
community. And then we could actually end up
with a real outbreak of infection
that we can’t actually treat. You know, that could be
(CHILDREN CHATTER) I was, like, an active kid.
I did karate. I did netball. I loved running. Just being able to be free
is just the best. (LAUGHS) Ellie was your typical Kiwi girl, who was just full of
bounce and energy. She was very good at
long-distance running. And she was good at karate and
then anything to do with dance, so, hip hop, you name it,
she would do it. We’re a very outgoing family. So we
just love doing heaps of cool stuff. And she was in a cross-country
one day, running, healthy… (INDISTINCT CHATTER) (OMINOUS MUSIC) There was, like, these two pits
you had to jump over. The first pit I jumped over,
I got a cut on my big left toe. And then, the second one, I got
ground shock, but, like, way worse. As soon as I stopped
and started walking, I was just in agony. ‘We thought you strained a muscle.
You’ve done something like that.
It’s something banal. ‘It’s not gonna be a real big deal.
It’ll naturally heal.’ And so we weren’t really that
concerned, other than we felt
sorry for her pain. In the morning, she was in far too
much pain to put any weight on
that leg, so she couldn’t walk. So, I just took her into the A & E. And when I got in, they straight away saw her, and just started working on her. And
it was just— I was going into shock. We just thought, ‘We’re there
at the right place, and, yeah,
it’s all gonna be good.’ ‘And she’s gonna get better,
and we’ll go home.’ Bacteria had travelled inside
her body and rapidly taken hold. It was attacking and eating away
at her bones and cartilage. The infection was
in her knee and hip, and by the time she reached
hospital, it had spread to
her elbow. And then once the lab results came
back the next day, they noticed it
was the superbug MRSA. One in 50 people will have the MRSA
bacteria living on their skin. It’s only when it gets inside
the body that it’s deadly. MRSA stands for… Staph aureus is one of the most
aggressive bacterial pathogens when it’s in places where it
shouldn’t be, other than the nose. It causes clotting in the tissues.
It causes inflammation with redness
and tenderness. It can damage the tissues enough
to be at risk of dying from
the infection. Bacteria are everywhere.
We inhale thousands of minute
particles with every breath. Our hands are covered with more
than 150 different species. Each of us have our own
unique colony of bacteria. The difference between good bacteria
and bad bacteria isn’t actually that
clear-cut. We have others that live on
us quite happily; we have them
living in our nose and our throat. And they don’t under normal
circumstances do much damage. But if they get in the wrong place,
then they can also become damaging. And then, of course, we have ones
that we, kind of, call
professional pathogens. And then these are ones that,
once they get into our body,
they can produce toxins. They can do all sorts of
things to make us sick. So powerful was the bacteria’s hold,
instead of getting better,
Ellie was getting worse. She had a big collection of pus
in her hip from the infection. And they had to get it out
as fast as they can. So good to get that out of there.
(WHIMPERS) It is so important. Yeah.
I got a couple more
bits to clean, OK? And then we’re finished.
Ow! You’re doing so well.
(SCREAMS) So, we were thinking it’s gonna all
be good. And then they’ll come in,
and they’ll say, ‘Sorry, Ellie’s not good. We need
to go back and operate again.’
And it just carried on and on. And she would just be
screaming all the time. (GROANS) ‘There was just so many things
happening. I couldn’t break free.
I couldn’t go.’ And then just being in so much pain and looking over and seeing my
mum crying and my dad crying, and just wanting to… just go. Sometimes I wanted to die
because it was so hard. ROLF: You started getting some
bacterial growth on one of her
heart valves. And then the fellow in charge of
Ellie’s case called us into a
quiet room and just looked at
us and said to us, ‘Look, I just need to say that your
daughter is extremely unwell.’ Because he said, ‘I have to be
honest. I’m not very optimistic.’ ‘You definitely will need to say
your goodbyes to her now.’ (SOMBRE MUSIC) We were inconsolable,
and I remember exactly where
it was that we just broke down and we couldn’t move or anything. (SOMBRE MUSIC) For decades, we’ve been largely
ignorant of the tremendous harm that
can result from severe infection. A century ago, people
regularly died. With the advent of antibiotics
came complacency. We came to believe a prescription
from our doctor would
solve infection. But experts say it is our
overuse of the modern range of
drugs that has allowed bacteria to develop resistance —
effectively outsmarting us. We have used so much antibiotics
since the end of World War II. There have been more
and more bacteria become more and more resistant
to the antibiotics we have. And we’ve not had new antibiotics
become available in the last,
approximately, 20 years. (TYPEWRITER CLICKS) (SOMBRE FOLK MUSIC) Auckland grandfather Brian Kairau
lived for years as a diabetic,
undergoing regular treatment. Here, bubba! Ah, come on! Infection is one of the
life-threatening consequences
of diabetes. Hello! When Brian was 52, he developed
a bacterial infection so severe
doctors feared it might kill him. Brian required aggressive
treatment with antibiotics. I had fractured a bone connecting
my hip to my groin, and that
fracture had become infected over the two weeks
that I was ignoring it. That infection grew so much,
and part of the reason I was unwell
was because I had a bug in my blood. And you get lots of bugs
when you’re on dialysis. I have to take some antibiotics.
This is something I have
to do four times a day. So, this is my PICC line. Goes up
here and down where the artery
leads straight into— into the valve of my heart, so that
it can be pumped straight away
through my body as fast as possible. The bacteria that infected his hip
produced an enzyme known as ESBL, which has the power to break
down antibiotics, rendering
them ineffective. And it’s for life. It’s a bug you
can’t get rid of. They’ve found
no cure for it. And it’s in your bowel. And it’s a
bug that you catch from sharing a
bathroom. One that is most worrying doctors in
hospitals like ours are a group of
organisms called the carbapenemase-producing
Enterobacteriaceae. Which is a big,
kind of, name for a family of bacteria. It
includes E coli and another organism
called Klebsiella pneumoniae. And these are organisms that can be
carried by healthy people. So, we can carry them in our noses,
in our guts, on our skin. But if you’re in hospital or if
you’re a vulnerable person — you
might have some other disease — then these can cause huge problems. Staph aureus is a germ that lives
in the nose and on the skin and
most commonly infects the skin. And people who have frequent
injuries to the skin, say shaving, or other abrasions to the skin, or people who have skin diseases
like eczema or other diseases that make small cracks or injuries
in the skin are more likely to end
up with Staph aureus infection — whether it’s caused by
methicillin-sensitive or methicicillin-resistant
Staph aureus. (ETHEREAL MUSIC) With the home treatment not working,
Brian was readmitted to hospital. Both his feet were now grossly
infected by the ESBL bacteria. (GRUNTS) With the infection now resistant
to antibiotics, doctors had
run out of alternatives. The only way to stop infection
spreading was to amputate. So they had to debride all the
infected material that was there.
The same time they did that, they removed the fifth digit
on my left foot cos that had
become infected as well. And they wanted to catch
the infection before it spread
all the way up this leg, so it wouldn’t end
up like this foot. Diabetics are more susceptible
to developing infections. High blood sugar levels can weaken
the patient’s immune system. Some diabetics, like Brian,
have reduced blood flow
to the extremities. So, what the doctors have
said to me, basically, is that if that if they can’t bring
any of this infection in control, they have no option but
to take my leg off. (MELANCHOLIC PIANO MUSIC) Once you develop an
antibiotic-resistant bug, it can be very difficult to
eradicate that or get rid of it.
And that’s very common with MRSA. Fortunately for— Many of them still
respond to some common antibiotics. But increasingly, we’re getting
multiple resistant bugs which
won’t respond to any antibiotic. Antibiotic resistance is the ability
of microorganisms or especially
bacteria to be able to resist the medicines
that we normally use to kill them. And they have lots of
different ways of doing this. They can stop an antibiotic
from getting inside their cell. They can stop it from actually
working on the thing that it
needs to work on to kill them. They can chop it up.
They can do all sorts of things. Now we have these strains that are
essentially resistant to everything. (MELANCHOLIC MUSIC) So the first case happened earlier
this year. A lady in the USA died from a completely
untreatable organism. The doctors tried something like
26 antibiotics, and nothing worked. (MONITORS BEEP) Ellie remained in hospital
for more than three months. Every day raised new
medical concerns. Ellie’s infection was now systemic. Her blood was effectively
transporting the infection
around her body. ROLF: Because it had gone systemic,
it was dropping seeds in her elbow.
KAREN: And then in there, yeah. And you’re just worried that,
‘Where is it gonna attack next?’
Yeah. Cos wherever it attacks, it eats. It was right on the verge, and then
they managed to bring her round.
Oh, it was scary. Her clindamycin that she was on,
she wasn’t going forward. It was so slow, so they decided
to add rifampicin in and another
antibiotic. Happy, honey? Yeah? Sleepy. Isn’t it a nice feeling? They suggested it’s like
introducing a cannon in warfare. And the rifampicin has some
interesting side effects, because
it makes your tears go red. And then she had these incredible
bad itches that would just make
her scream and go crazy. It was like all these bugs
underneath her skin. (SCREAMS) Daddy! Please can you just get them now! Daddy! Daddy! There are plenty of infections
caused by bacteria that we’re
on our last antibiotics for. Those antibiotics are risky
to give because they can cause
damage to the person’s body. The World Health Organisation
says we need to change the way
antibiotics are prescribed. It’s become just the normal
thing to go to the doctor
and get antibiotics. Because it was like a miracle
when they first came out, you know? And you could treat all sorts of
things, and you got miraculously
better. And so, I think we’ve, sort of,
lulled into that sense of,
‘Oh well, a pill can fix anything.’ But actually in reality, it can’t.
And sometimes it can lead to
further problems developing. Thank you.
Rose, hi. Come on through. ‘I think a big part of why doctors
will often give a prescription ‘is that they sort of feel they
need to keep the customer happy. ‘Many customers would have a view
that if they don’t get an
antibiotic, ‘then they’ll go and see another
doctor that’s going to actually
prescribe it.’ Looking at her, she’s
got a really bad virus. So viruses don’t actually
respond to antibiotics. They’re a type of bug that causes
infection, but antibiotics won’t
make any difference. And so the key thing really is to
keep her hydrated and make sure
that she’s feeling comfortable. A recent study of a very large
number of children, about five
or six thousand children in the north of the North Island,
found that on average by the age
of 5, the number of antibiotic courses
that a child had had was about 10. And only about 3% of children had
not had not had an antibiotic course
by the time they reached 5. (SOMBRE PIANO MUSIC) In Auckland’s Middlemore Hospital,
Brian was acutely aware he was
losing his battle to the infection. They’re really disappointed with the
condition they found my heel to be
in. And he looked at me very
solemn-like, and then told
me that— He apologised. It wasn’t easy for him to say it,
but it looked like they would
have to remove my leg. A world where antibiotics are much
less effective than they are now
might look like a world where it’s difficult or
if not impossible to do
complicated surgery, because complicated surgery
often leads to severe infections. We might lose the ability to treat
people for leukaemia or other
cancers because our treatment tends to
make people more susceptible
to infections. And then we’d have people with
untreatable infections arising
in the community, like gonorrhoea, pneumonia
and urinary tract infections. And we’re seeing more and more
patients with infections that are difficult or very
occasionally impossible to treat. This is Ellie on her birthday.
Whoo, whoo! Meanwhile, the little girl
who had spent months in
Starship Children’s Hospital was finally well enough
to come home. Her young body had fought against
the invading bacteria, and despite
terrible odds, she had survived. But her recovery is
far from complete. She was still NG fed. She’s still
on antibiotics. She was on about
28 tablets a day, twice a day. One was 12-hourly. One was 6-hourly.
Oh, well done, lads. That’s it. She still couldn’t walk. She could
barely stand. She was so skinny. She’d been laying on her back
for four and a half months, and all her muscles had gone out
of her body, especially her legs. She still had her cast on, so she
couldn’t go and have a shower. So it
was 24-hour care, round the clock. But we made sure that Ellie never
felt like she couldn’t do anything.
No. (GIRLS CHEER) She said, ‘Oh, Dad, I’d love
to go for a ride on a horse.’
Put the two dollars in. And she was so skinny,
she didn’t have enough… She didn’t have the
strength to hold on.
…to hold on to the sides. Whee! (RHYTHMIC ELECTRONIC MUSIC) (THOUGHTFUL PIANO MUSIC) Brian’s advanced diabetes coupled
with the infection meant that within
months he was in hospital again. This time, doctors needed
to amputate his leg. They realised that the infection
around the tissue had settled
near the bone. They were concerned that that
infection has gone into the bone. To prevent the infection from
getting into the marrow and
making it’s way up. It’s really depressing. I think it’s safe to say
I’m pretty down about it. Brian reflected on his life. He decided to exercise his right;
he refused further surgery. I wasn’t gonna be cured
of this infection. This
infection was gonna continue. And I stand more of a chance of
fighting the contamination off if I stay on these antibiotics
for the rest of a life. So I believe that losing
this part of my body and
them taking the rest of my limb isn’t going to improve or lengthen
the amount of time dramatically. WOMAN: Hello.
Hello! Hello, my moko. Give us a kiss. Yeah. Hi, honey. (GRUNTS HAPPILY) When you’re hurting and when you’re
in pain, and that distraction of
just thinking about the love and the bond that you have
between your children and
your grandchildren, man, that’s been— It’s just
been so intense for me lately. And I apologise to them that I was
not as strong as they thought I was. But I said I just can’t fight it any
more. I’m ready to go. I’m just too
tired. (THOUGHTFUL PIANO MUSIC) Brian was discharged from hospital
with more antibiotics. See you, Bex.
WOMAN: See you later, Brian. See you, Rey.
Take care.
Bye. (CHUCKLES) See you, Lionel.
(LAUGHS) In 2016, just weeks after
his discharge, Brian died. (THOUGHTFUL MUSIC CONTINUES) (MUSIC SWELLS) There is hope. Scientists in
New Zealand and across the world are taking on the challenge
to find new antibiotics. The ideal antibiotic is one that
can kill all species of bacteria. In my lab, we are trying to find new
antibiotics from New Zealand fungi. And one of the reasons we think
there might be something
different there — we have plants and animals
that are not found anywhere
else in the world. So we’re hoping that we will
find new classes of antibiotics.
It’s just a case of searching. We’ve got over 10,000
fungal isolates that we
have to search through. We’ve gone through about 500.
Haven’t found anything new yet,
but it’s early days. What we’re looking for is to see
whether the fungus that we are
incubating the bacteria with whether it can kill any or some or
all of the different species of
bacteria. Every time a bacteria
replicates itself, it has this opportunity to
become a mutant and to change. Well, for some bacteria,
they do that every 20 minutes. So we’re— It is very hard
to keep ahead of them. The costs from discovering a new
antibiotic to getting it to market
and being available for use is estimated to be around a billion
dollars for each antibiotic. It does take about seven to 10 years
from discovery to bringing a drug to
market. But that’s not happened at all
in the last few years in terms
of bringing them to market. It’s more than three years
since Ellie’s medical trauma. She’s progressed but bears
physical and emotional scars
likely to last her lifetime. ROLF: Ellie is now in a hip spica
because of all the operations in
her left hip. Can you help me with my shoes? There was such incredible damage
done to the joint from the
infection. So instead of a nice round ball that
fits into the joint, it is now flat,
and it’s pitted. And all her cartilage has been
completely— It’s almost like,
they said, if you took a shotgun and you blasted the inside of that
with a shotgun; that’s all the holes
that were affected by the bacteria. (ETHEREAL MUSIC) See you, darling.
Have a great day at school, eh? You know how much I love you, hey? It’s Friday today. Yes!
Yay! Yes, the weekend.
(LAUGHS) Yeah. All right, sweetie, see you later,
eh? Bye-bye, darling.
OK. See you. ‘I do physio at school, and, I
don’t take any medication, though.’ Is the classroom unlocked? Yeah, I get tired. That’s why I have an amazing teacher
that always helps me if I say, ‘Oh,
I’m sorry, but I’m really tired,’ or, ‘I’m sore, can I please just do
this?’ And she’ll always let me off. So I can’t really sit in a normal
chair because of my hip, because it’s fused in
this position, really. Well, I do get pain in my hip,
and it’s horrible. But sometimes I can manage it;
I just shake it off — have to
do a little walk. But if I can’t, I will—
Mum will probably pick me up. I’m not gonna do my
three rounds, eh?
No, we’re not gonna do three rounds. No. (LAUGHS) I really want to do PE so badly. But I can’t play netball. I can’t
do karate. I can’t ride a bike. And I used to be able to dance,
but now I can’t really. Sometimes I get a bit emotional
if I see, like, the class running. Some days I’ll just be like,
‘(SIGHS) Why me?’ Like, ‘Why, why?’ Catch!
Connor! Yes!
(CHILDREN CHEER) ROLF: So, the belief is that Ellie
is likely to have MRSA until she’s
60. So, the MRSA will exist
in her bone marrow. It will at this stage remain
dormant, but any trauma— significant
trauma can cause it to reactivate. (CHILDREN CHEER)
Hard luck, Ellie. (SIGHS) KAREN: I think any parent that has
come very close to losing a child — it makes you realise they
mean everything to you. ROLF: Every day that we see our
daughter smile and look happy is
a gift. And it doesn’t take us long
to remember how things were. I’m happy that I’m alive.
It’s just a rollercoaster. (LAUGHS) And you can be sad at one point, and
then you can be so happy at another. But, yeah, you’re still
the normal Ellie. (LAUGHS) (WARM ELECTRONIC MUSIC) (BRIGHT FOLK GUITAR) Captions by John Gibbs.
Edited by Antony Vlug. www.able.co.nz Captions were made with the
support of NZ On Air. Copyright Able 2018 Attitude was made with funding
from New Zealand On Air. Nominations are now open
for the 2018 Attitude Awards. Held at Auckland’s Skycity, this
premiere event shines a spotlight on the achievements of people
who live with disability. Go to attitudeawards.org for
information about the categories and how to nominate someone you
think deserves recognition.

16 Replies to “Outbreak: Resistance and Antibiotics”

  1. i have a long term infection and have had multiple attacks of staph and mrsa. i require long term antibiotics to treat it. this stuff is super scary to me. PLEASE finish your antibiotic courses completely. you can potentially make ME resistant to antibiotics youre taking if you do not finish them, which could potentially Kill Me. Antibiotics are not something to be played around with like normal medications.

  2. no one should go against such suffering, especially a child, when? we will understand that are others the pre-eminent in our world.

    we should spend all our economic and cultural and intellectual resources to improve the lives of all human beings and take care of our planet, but unfortunately we do the opposite

  3. I have chronic eczema so frequently get Staph infections. I carry MRSA and Staph on my skin. I have contracted MRSA in the past. It is scary to think how one day antibiotics might not help. I always complete the entire antibiotic course but usually have to have a few courses to help.

  4. Although human misuse is a big driver of resistance, it's not the biggest; the biggest is the abuse of antibiotics to treat infections in overcrowded livestock pens. That just flat-out needs to be outlawed. We can afford to pay a few bucks extra for a steak if it means not accelerating the creation of untreatable infections.

  5. Superbugs are more scary and potentially a greater danger to civilization that even climate change

    This could potentially kill a great amount of people in a very short time

  6. Had a systemic infection we were never able to identify back in 2015 that took a year and multiple courses of antibiotics to cure. Now I'm wondering if we actually did or if someday it's going to show up again even harder, if not impossible, to treat. Very scary.

    A lot of the physicians I know are helping educate people on the risk of antibiotic overuse and promote preventative measures, which is something, and I hope we can find more solutions soon.

    For me, a healthy (limited sugar) diet, exercise, and regular chiropractic adjustments do wonders for helping my body take care of itself when something attacks. I save going for antibiotics as a last resort only after I've used home remedies and let my immune system try and not seen improvement. Fortunately most of the time I get better on my own in time, and I've gotten very intuitive about whether something is going to need outside help or not. I've also been sick a lot less since I've started doing that.

  7. oh gosh just watched that programme and I am so disappointed that NZ is so very far behind the 8 ball compared to those countries that are looking at all this information from the opposite perspective of looking at reintroducing the bacteria that used to protect us from these issues. The superbugs came about from using the antibiotics so poorly. 10 lots of antibiotics to northland kids before their 5th birthday? Horrible just horrible.

  8. My Mother in law had Diabetes, she caught MRSA and and STAPH they trued fighting it and thought she was ok, for 3 months she seemed fine.. She woke up one morning and her leg hurt, Within 3 weeks her leg was amputated just above the knee….. She passed away 2 years ago.

  9. My brother died of MRSA. What upset me more than anything was that the doctor told him that day that he was going to die. He starting crying to me that he didn't want to die. We were the only ones left in the family. The next day when I went to the hospital, he had slipped into a coma and that he had no brain activity. After talking to him just the day before I had a hard time believing it. I was really trying to believe he would be OK. I wasn't home from the hospital more than an hour when they called me to tell me he had gone.

  10. My dad has been on rifampin, Azithromycin and ethambutol for 2 1/2 years now. I worry his Mycobacterium avium epidural space infection will become resistant to the antibiotics and he will pass due to another stroke caused by extreme pain. (He has artery issues which can cause him to have a stroke due to sudden increase in blood pressure)

  11. i had chronic lyme and was treated with a myriad of different antibiotics for 2 years. am i at risk for antibiotic resistance?

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