The finding of British and Chinese colleagues of a new plasmid-borne resistance, MCR-1, encoding for resistance to colistin/polymyxin in Escherichia coli, Klebsiella, and Pseudomonas aeruginosa is, as many have pointed out, very bad news (Lancet Infec Dis. 2015 Nov 18. doi: 10.1016/S1473-3099[15]00424-7).
The fact that it may have infiltrated large areas of East and Southeast Asia forebodes an era where no antibiotic will be available to treat some of our patients. It is not the end of mankind, and it will not bring us back to the Middle Ages, after all we managed to rather successfully experience the end of the Second World War without having experienced extinction as a species.
Dr. Gunnar Kahlmeter
BUT, here is the crunch of the matter – we have since then developed what is today ‘modern medicine’ and modern medicine as we know it with successful treatment of malignant blood disorders, cancer, transplantations, intensive care, neonatal care, and foreign body surgery is very much dependent on managing to prevent and treat complications in the form of infections. If panresistance becomes common we may have to reevaluate our strategies when dealing with these disorders and procedures.
What did we do to deserve this? We have behaved the way we behave with most natural resources available to us. We have abused antibiotics since we discovered them, and we continue to squander them for economical gain in areas where antibiotics have no place at all. We look for evidence that using 600 tons of antibiotics to successfully rear pigs is not harmful instead of saying ‘why take the risk?’
In the latest case, that of the new gene MCR-1 encoding resistance to colistin/polymyxin, it is now believed that the frequent use of colistin in animal husbandry in China and other East Asian countries may be behind the catastrophe.
Evolution is a harsh but fair task master. We deserve everything we get. But again we have squandered the resources of our children and grandchildren.
Dr. Gunnar Kahlmeter is communications officer at the European Society of Clinical Microbiology and Infectious Diseases and practices in the department of clinical microbiology at Central Hospital in Växjö, Sweden.