Antibiotic Stewardship:

Managing antibiotic
resistance

Step 1.11

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[Narrator] But what we do with antibiotics-- because we give the wrong

doses of antibiotics to people. Or we give the right doses, but people end
up dosing themselves incorrectly because they don't take a full prescription.
Or because we give antibiotics to healthy farm animals. What we do in all
those situations is we set up a sort of Darwinian battleground within the
body of the human or the animal who's getting the antibiotics, in which the
weak, susceptible bacteria are knocked out by the drug. But the strong
survive.

[Dr. John H Rex] And it unfortunately occurs more rapidly than you might
think. Because they go so quickly as a community of organisms. If there's a
way to become resistant, they can find it.

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[Dr. Brad Spellberg] About 3/4 of the way through my fellowship, we began
to see just an explosion of highly resistant infections. And that was
concordant with it happening all over the country and the world. There was
nothing unique about our setting. And I remember the first patient that I
took care of who had an untreatable infection; could not be treated. And it
was a woman in her 20s who had two small kids who had leukemia--

[CLEARS THROAT] Sorry--[CLEARS THROAT] [CLEARS THROAT]

And she developed an infection in her blood by Acinetobacter. So we

started treating it with the drug that we had left at the time, which was a
drug called Imipenem. That was the big gun. That was the last ditch.

And she looked like she was getting better at first. But then the infection
came back and it was resistant to the Imipenem. It developed resistance in
the middle of a course of therapy.

And when it came back, I have this just vivid recollection of looking at the
computer screen and you see a print out on the computer screen of all the
antibiotics that the bacteria is resistant to. Resistant, resistant, resistant,
resistant, resistant. There was nothing. It was resistant to everything.

And I couldn't fathom how, in the 21st century, an infectious disease

specialist would run out of stuff. You know, since penicillin we have
expected that we're going to have relatively inexpensive, safe, tremendously
effective drugs to treat infections. And this woman had returned to 1935.
She had returned to the pre-antibiotic era. And she died, and there was
nothing to do.