Superbugs - The Race to Stop an Epidemic
This study of the nature, causes and possible cures of microbial infections is as complex as the human body itself but far leaner than the recent works of Siddhartha Mukherjee (The Emperor of All Maladies, and The Gene) whose jacket quote is effusive: “An amazing informative book that changes our perspective on medicine, microbes, and our future.”
As is so often the case, the story begins at war when the now-legendary Alexander Fleming, “Little Flem” as he was known, was caring for British soldiers in France at a makeshift base that doubled as a wound-research laboratory.
“The young doctor grabbed a damp cloth from his surgical bucket and dabbed the soldier’s leg, cleaning mud, blood clots, and shreds of uniform from the gaping exit wound. He picked up a scalpel and carefully excised a small swatch of fabric from the man’s muddy pant leg.
“This piece of clothing, Fleming hoped, would solve one of the most puzzling questions of World War 1: Why were so many soldiers dying of tetanus?”
After the conflict, during which more than 17 million military personnel died, many of them from tetanus, Fleming returned to his lab bench in London, spending the next decade “trying to devise ways to destroy harmful bacteria and improve the treatment of infections”.
In 1928, a chance observation led Fleming to discover that a fungus called Penicillium rubrum could kill Staphyloccus bacterium, “one of the pesky organisms that was no prevalent in battlefield wounds”, as the author puts it. This accidental finding in a discarded petri dish led to the discovery of what Fleming called a slow-acting antiseptic… “He dubbed it penicillin”.
So the tale progresses, both forwards and, as it happens, backwards, with research showing that significant levels of tetracycline, “a broad-spectrum antibiotic still used today”, was found in the skeletal remains of Sudanese mummies dating back as far as 350 AD. Chinese medicine used an array of them, while bacteria from the red soils of Jordan are still used to treat infections.
“The 1950s would come to be known as the golden era in antibiotic development, a time when advances in molecular biology led to all sorts of new medications that markedly increased life expectancy. In fact half of the drugs in use today were discovered during that decade.”
So far we are only 20 pages into this intriguing book (and I have bypassed a number of characters and events), and nowhere near Dr McCarthy’s work with drug resistant infections in US hospital patients, his inspiring relationship with mentor Dr Tom Walsh and their clinical trial with what turned out to be a superbug-busting drug known as dalba(vancin), one dose of which was found to be highly effective against a range of intractable infections. This journey through the shoals and rapids of MRSA, VRE, VRSA, sulphanilamide, daptomycin, nystatin and the rest is truly fascinating, both for the clinical and lay reader, and provides great hope for victory in the battle against the skin infections that affect twenty million people worldwide each year.
Sometimes, however, we are brought down to earth with a thud. When the author’s father-in-law is battered by a multiplicity of ailments, he finds that no drugs would help, and the only response was surgery.
“I felt the supreme limitations of antibiotics… what Bill needed was for someone to go in and just cut out the damned infection. The advances made by Fleming… and all the others were worthless… when he needed a cure, it was a team of surgeons with knives who saved him.”
So the search goes on, whatever the frustrations.
“Despite nearly a century of experience with antibiotic discovery, we still don’t really know where to look or how best to isolate the molecules beneath our feet. Is Borneo [in 1952 a missionary dispatched a muddy soil sample to a friend at distant Eli Lilly - eventually it was developed as vancomycin, from “vanquish”, which could kill penicillin-resistant bacteria] better than Bora Bora?
“What about the desert? Or the ocean? We hunt for antibiotics in sewage and polluted lakes and the intestines of insects, but the results have been inconsistent. There’s a lot of dirt to sift through. We need a better way, or at least a more focused process, to identify the next big thing.”
This book discusses many big things, along with microscopic ones, and the two combine to provide a valuable insight to a challenge facing us all, whether doctor or patient.