>> Tonight... >> We are seeing now the
emergence globally of some forms
of bacteria that are effectively
untreatable.
>> Each year at least two
million people are infected
with drug-resistant super bugs.
>> They had asked me to sign the
papers to let her go.
And I did.
>> And at least 23,000 die frm them.
>> He had some bugs that they
had never seen before.
>> Frontline investigates how we
got here.
>> We immediately went on high
alert, the equivalent of DEFCON 5.
>> No matter what we did, the
bacteria was still spreading.
>> And why major drug companis
are giving up on developing new
antibiotics.
>> You have to make some very
ruthless decisions.
>> These are not ruthless decisions.
These are portfolio management
Our investors require that of us.
>> And what happens now.
>> There have been covers of
magazines about "The end of antibiotics?"
I would say you could change the
title to, "The End of Antibiotics. "
>> Tonight oFrontline,
"Hunting the Nightmare Bacteria. "
>> Frontline is made possible by contributions to your PBS
station from:
And by the Corporation for Public Broadcasting.
Major support for Frontline is
provided by the John D. and
Catherine T. MacArthur Foundation.
Committed to building a more
just, verdant and peaceful world.
More information is available
at macfound. org.
Additional funding is provided
by the Park Foundation.
Dedicated to heightening public
awareness of critical issues.
The Wyncote Foundation.
And by the Frontline Journalism
Fund, with a grant from
Scott Nathan and Laura DeBonis.
Major funding for this program
is provided by the Kendeda Fund.
This is the story of three seemingly
disconnected events beginning at
the same time.
What they each have in common is
a type of infection that is
becoming impossible to treat...
a type of infection that has
triggered deadly outbreaks, even
at one of our most prestigious hospitals.
It is a crisis that is
spreading alarmingly fast,
threatening everyone, even the healthy.
Our first story starts in Tucson, Arizona, in May 2011.
>> When I think about that time,
I think about spring...
and just, you know, how busy
it was and how beautiful she was.
She was 11 and a half
years old and just physically
perfect, beautiful from head to
toe, slim, you know,
white-blond hair from being out
in the sun.
A little bit of freckles across
her nose, bright blue eyes,
paying attention to what her
clothes looked like and her
hair, never stopped talking,
talked a mile a minute.
That was Addie, at that
just, you know, in the month
before she got sick.
Award-winning
journalist David Hoffman first
heard about Addie Rerecich while
investigating for Frontline what
doctors and government officials
are now calling a "nightmare,"
a kind of dangerous bacteria
that is increasingly resistant
to the strongest antibiotics.
This is what brought us to Tucson... >> Morning.
Hi, Tonya, I'm David Hoffman.
...to find out more about an astonishing set of
events that began one Sunday
when Addie complained to her
mother about a pain in her hip.
I thought, well, you know,
she's just finishing up softball.
She had been to the track meet,
you know, all kind of, well, it
could have been an injury.
I gave her some ibuprofen.
As the night wore on, her pain got worse.
She didn't sleep much that
night, woke me up a couple of
times asking if she could take a
hot bath or have another ibuprofen.
The next morning, Tonya Rerecich, a nurse for 16
years, took Addie to a local
hospital, where they said she had symptoms of a virus.
But over the next few days, the
pain spread and the fever got worse.
I was afraid at that point.
I remember being very afraid,
and so I packed a bag and we
went to another hospital that
had specialized in children's care.
I remember thinking, "She looks bad.
This is bad.
Something's really, really wrong. "
They put her on antibiotics.
They were... her blood pressure
was dropping, they were making
space in the ICU for her.
The next morning she needed oxygen via mask.
They looked at part of her
lungs and diagnosed her with pneumonia.
I remember sitting there, watching the sun come up and
thinking, "How did she get so sick?
How did this happen so fast?"
I met Addie in a hospital bed in the intensive care unit.
She was lying there, breathing quickly.
She was scared.
She had little infected boils all over her body.
What really looked most likely when I saw her was a
staph bacteria causing septic shock.
And Addie fit a pattern
that I recognized with community associated MRSA.
When you say "community," I mean, this is
what you mean.
A kid picks it up in a playground with a scraped
knee, right?
Correct.
The spread of MRSA, a staph bacteria that causes
infections resistant to many
antibiotics, has long been a
big problem inside hospitals.
But over the last two decades
it's also been found outside, in the community.
In Addie's case, she was a a skin picker.
She, as do many kids, picked at her little scabs.
And that was likely what
introduced the staph infection.
But the staph was just the start of Addie's troubles.
She already had evidence of an early pneumonia.
And it looked like she was about to get a lot sicker.
I asked him what were the
odds of her making it, getting well.
What did he say?
He said 30%, but he had to think about it for a minute,
and I knew he was lying to me.
I knew.
By the time your blood has
bacteria in it, you're in real trouble.
The staph infection had so damaged her lungs, the
doctors had no choice.
To save her life, they put her
on a lung bypass machine called ECMO.
I remember saying, "ECMO?"...
with a squeaky voice, like "No, really?
You're not really talking about ECMO."
This was total life support.
It's got huge tubes that are
put into an artery and a vein
and the patient's blood comes
out of their body, runs through
the machine and the machine does what your lung does.
The tubes presented a whole new set of dangers.
Those tubes can harbor bacteria.
Ready?
And one of the dilemmas of modern medicine...
Good job!
The interventions that can save you can also
put you at serious risk.
You did great!
So any patient we put on ECMO
has a much higher risk of having additional infections.
That's just the nature of the beast.
Is that what happened here?
And she got a particularly nasty one.
What was it called?
Stenotrophomonas.
Stenotrophomonas is an entirely different kind of
bacteria from staph.
Does it hurt?
Found in hospitals, it can live inside breathing
tubes, and it's extremely difficult to treat.
The problem with Stenotrophomonas is, even at the
outset, it's already a very resistant bacteria.
There are only four or maybe
five antibiotics normally that
are able to treat that particular bacteria.
Addie was confronting the frightening new
face of antibiotic resistance:
a group of bacteria called gram- negatives.
So can you explain to me why these gram-negatives
are so stubbornly nasty?
Gram-negative bacteria, it's
a medical term and it really references the armor that
surrounds the gram-negative
That armor makes it very
difficult for normal antibiotics
to get into the bacteria and to kill it.
So Miss Addie... >> So Stenotrophomonas is
incredibly difficult to treat
because it has that serious body armor surrounding it.
Are you guys going to come out and go that way?
Okay.
The ability of gram-negatives to aggressively
fight off antibiotics was now playing out in Addie.
Hold the phone.
She was first put on one antibiotic that's good for
Stenotrophomonas, and it worked for a while.
And then guess what, the antibiotic doesn't work
anymore.
Let's give her a different one.
Well, then it would, you know, work.
A couple weeks- three weeks-
and then the Stenotrophomonas
would sort of like bloom back
up, rear its ugly head, so to speak.
And you're doing great!
You are.
Finally one day they said
something I never thought I would hear.
The Stenotrophomonas is pan-resistant, "pan" meaning
resistant to everything.
Like a panorama.
Addie and her mother had entered the
post-antibiotic era.
I had to go to her and say,
"I don't have... I don't have
options based on medical science.
I have run out of options.
I don't see a way out of this. "
I remember a long weekend
went by and they had asked me to
sign the papers to let her go and I did.
But there was one hope left of saving Addie's
life: to remove the infection with surgery.
I remember asking the doctors
then about lung transplant.
And they said "No. "
That it couldn't be done; that
it would be too dangerous.
The problem was that she was
too sick to be transplanted.
And that sounds a bit strange
because you think of a transplant as the final
life-saving thing you've got.
But because of that resistant
Stenotrophomonas, the expected
survival of transplanting her was not good.
In fact, you might say close to zero.
You're not going to blow bubbles?
Doctors faced a question of medical ethics-
whether to risk such a valuable
resource as a young set of lungs
when Addie's chances of survival were so low.
What tipped the balance?
I think it was Addie's mom,
Tonya, who was such a strong
advocate and didn't give up.
¶ Happy birthday to you...
And it was also the fact that
this was not an unresponsive body lying on the table.
This was a young girl who was
communicating with us and had
temper tantrums and sparks of life.
Which we could all see on the ECMO apparatus.
I mean the... how can you say no
to this, you know, living, alive
human being who is communicating with you?
I need a high-five.
That's awesome!
But Addie would still have to wait in the
intensive care unit, hoping to get a new set of lungs.
As Addie was fighting for her life, a 19-year-old American
named David Ricci was about to
face another threat on the streets of India.
So after 30 hours on a train,
we finally ended up in Calcutta.
Here, gram- negatives were spreading in
frightening ways and coming from unexpected places.
I wanted to experience another culture and put myself
in an environment where I was serving, where I was
helping people.
I think, uh... India ended up changing me a lot
more than I could have ever changed India.
Eight little monkeys jumping on the bed.
He had come here with a mission group to work in
orphanages.
The momma called the doctor
and the doctor said, "No more
monkeys jumping on the bed. "
One morning, the group headed off to work at one
of those orphanages, a Mother Teresa home.
It was in the slums of the slums, really, where this
orphanage was, so we had to walk through all of these
narrow streets that I had never walked through before.
And we basically took a
shortcut through the train station.
So you crossed over the tracks and then we were walking
adjacent to the train tracks.
And as we were going under an overpass...
I was in the very back, walking, and all of a sudden,
you know, out of nowhere...
A train went by and I noticed, I just remember
thinking in my head that it went
by, "Wow, that went by rather quickly. "
The momentum and the speed
hooked my sleeve and ran me over
and dragged me underneath the train.
The wheel ran over my leg and
I start losing a ton of blood.
I just started bleeding everywhere.
Ricci was pulled from under the train.
Lucky to be alive, he was rushed to a local hospital.
A doctor came in.
He reached up on the top
shelf and he pulls out this leather bundle.
And then, you know, he takes out
a big knife- you know, a big machete-type-looking
saw-knife, and he just starts
telling all the nurses to hold
me down and to hold me steady
and then he just started cutting my leg off.
Just hacking it off.
We were standing outside and
we could hear him screaming the whole time.
And then I passed out.
Within 24 hours, Ricci was moved to another
hospital and his condition deteriorated quickly.
Hey, everybody, I talked to the doctors.
They said I don't have that much
longer, but I'll put in a good
word for you once I get there.
Ricci was barely hanging on.
Miss you all.
And by the time his family reached India, there were
new complications.
They were just telling us we
need to take him back in for another surgery.
Another surgery.
And we didn't understand why.
He almost had a surgery every day.
And they, they said, you
know, "We've got to clean up the infection. "
And, and so, you know, I just
thought it's just an infection, you know.
I really didn't realize what they meant by infection.
What Ricci and his family didn't know was that they
were on the front lines of a
superbug crisis that was just beginning to unfold.
The study which found the NDM-1 superbug in Delhi's
water samples is making the
Indian health establishment see red.
Researchers had discovered a new danger.
Bacteria carrying the gene that produces this NDM-1
enzyme are resistant to very powerful antibiotics.
It absolutely was a bombshell.
It was unexpected.
>> The Lanceinfectious
diseases journal found that
NDM-1 enzyme in 11 different types of bacteria.
NDM-1 isn't bacteria; it's actually a
resistance gene that can turn bacteria into superbugs.
NDM-1 is resistant to almost all antibiotics.
Even more frightening, it is promiscuous.
The resistance gene can jump from bacteria to bacteria,
making treatable infections suddenly untreatable.
But there was more.
NDM-1 wasn't just in hospitals.
To everyone's surprise, it was
found out in the environment, too.
First, from a scientific standpoint, we didn't realize
that this could be done quite so easily.
It meant that in places where
water and sanitation was poor,
where there was going to be lots
of bacteria sitting next to each
other, that you could have very
rapid spread of resistance information across unrelated
bacteria, just out there in the
environment, which is a hugely
greater risk than if it were
only to happen within the bodies
of patients who had these infections.
So you're saying that the bacteria were swapping
this information just out there
on the street without being in a person.
That's correct.
So they could transfer resistance genes even when they
were in the same puddle of water.
With the spread of NDM-1, a much wider population
is put at risk.
And what has health officials
around the world especially
worried is that NDM-1 is hardy, and it travels.
After two weeks in an Indian hospital, David Ricci was flown
home to Seattle, and taken to
the trauma unit at Harborview Medical Center.
I first heard about David's case in July of 2011.
I was sitting in my office doing
some work and one of my colleagues, an orthopedic
surgeon, Dr. Doug Smith, gave me
a call asking me if I had known
about a patient up on one of our
acute care floors with a number
of drug-resistant pathogens.
I brought up his medical record
and saw a huge amount of drug
resistance, drug resistance we don't typically see.
All these R's mean that the bacteria is resistant
to that antibiotic.
Knowing that David had come from
India, I was immediately concerned, even before seeing
David, about bacteria in the
wound containing this new type of drug resistance.
Lab results confirmed Lynch's worst fears.
Ricci had brought NDM-1 into the United States.
It was one of the first cases to
ever be identified here, and Lynch had little to go on.
There's not a lot of clinical experience for treating
these bacteria, anywhere.
In the literature, there's no
books, there's no things on it.
So we had to figure out what to
do for David right then and there.
I get this knock on my door
and they open up the door and
there's these doctors and they
tell me, "We need to isolate you.
We need to put you on your own and quarantine you. "
Ricci was in the throes of the NDM-1 nightmare.
The gene was spreading
resistance to other infections in his leg.
They showed us the list of them.
There were about five bugs.
And they said all these infections are resistant to
And when they said that, that's what worried me because
I'm like, How is he going to get rid of them?
Lynch tried several
But they didn't work.
Have you done any of the
Colistin-Rifampin combinations?
He had only one option left: a 1940s
antibiotic called Colistin.
We went away from it because
of its toxicity and the ability to use new antibiotics.
The problem now is we don't have
a lot of new options and we're
going back to some of our older
The hardest part was watching
to see what the antibiotics did to him.
It started to eat away at my
organs on the inside, you know.
I could just feel it, just this
poison rushing through my blood.
The treatment was too toxic.
We had to stop the only drug we had left to
treat the gram-negative rods that were in his wound.
So you're telling me that he had these bugs and
you had nothing left to treat him with.
At this point we had nothing left to treat him with.
I just couldn't believe that
there wasn't an antibiotic that
would fix it, to tell you the truth.
They would have to cut out more of the infection by
cutting off more of Ricci's leg.
But it would be months before
they knew whether all of the NDM-1 was gone.
Over the last ten years, hospitals in the New York City
area have become the epicenter
of another highly resistant and
deadly type of gram-negative
This superbug didn't come from
overseas; this one was homegrown.
It lives in the digestive system and, like NDM-1, it's a gene
that can spread its resistance to other bacteria.
It's called KPC.
No one knows exactly how many
patients in the New York City
area have been infected with KPC...
or how many have died from it.
Nationally, most hospitals aren't required to report
outbreaks to the government and most won't talk
publicly about them.
But as part of Frontline's
investigation, one of the
nation's most prestigious
hospitals, the Clinical Center
at the National Institutes of
Health, the NIH, agreed to
recount how it dealt with a
major KPC outbreak.
It began in the summer of 2011,
when a woman carrying KPC was
transferred from a New York City
hospital, here, to the NIH, in
Bethesda, Maryland.
>> Talking about hospital
infections is really difficult
for a hospital because what you
are saying is that we all know
that when you come to the
hospital there are certain risks.
But we have now laid bare what
are those risks.
The NIH had never
treated a case of KPC before.
And as the patient was brought
into the ICU, the staff was
determined to keep the KPC from
spreading to other patients.
alert, the equivalent of
hospital epidemiology Def-con 5.
And we tried to implement as
many things as we could think
of, at the time, to prevent any
further spread of the organism
in the hospital.
>> They called it KPC, and so we
learned later that was
Klebsiella pneumoniae
carbapenemase, and that's a mouthful.
But we really didn't
know what that meant.
>> The patient was placed in
what we call enhanced contact
isolation, which means everybody
who went in the room, including
visitors, had to wear gloves and gowns.
The room was at the
end of the hall, separate from
other patients.
>> Let me just check your
blood sugar, okay?
But this was the
intensive care unit, where
patients are very sick and
highly vulnerable, and that
presented heightened risks.
>> It's the kind of place where
the bacteria can spread with ease.
People are very busy and there
are a lot of things going on.
Patients get very sick very
quickly and require intervention.
The bacteria can be spread
on the hands; they can be spread
on pieces of equipment that
might go from patient to patient.
So you have to be really cautious.
Their efforts to
contain the KPC appeared to work.
When other ICU patients
were tested for KPC...
>> We found nothing.
So at that point we thought that
there had not been spread of the
bacteria.
The New York patient ultimately recovered
and was discharged after
four weeks in the hospital.
>> We really felt like we had
dodged a bullet.
But then, a big surprise.
>> Five weeks later, unexpectedly...
>> Could you do me a favor?
Could you get me just a tube
fixator out of the R-T closet?
>> A KPC bacteria turned up in
a respiratory culture.
And with it, a mystery.
>> How this could have spread
from the first patient to the
second patient.
>> They were not in the ICU at
the same time, they didn't have
the same caregivers, they didn't
have the same equipment, so
initially we thought that it
might be possible that this was
a second introduction of yet
another KPC organism.
>> I was extremely concerned
because the infections with
these bacteria had a high mortality rate.
As they began to
investigate, searching for KPC
on equipment and testing the
patients yet again, they
realized the problem was much bigger.
>> We started finding other
patients in the intensive care
unit to whom the bacteria had spread.
They had an outbreak.
The KPC was spreading.
The patients were getting sicker.
And antibiotics weren't working.
>> And we tried combinations
of five, six antibiotics.
We tried making oral antibiotics
into intravenous antibiotics.
We even got an investigational
antibiotic from a pharmaceutical company.
An experimental one, a test one.
>> An experimental antibiotic,
and that also did not work.
Desperate to contain the outbreak,
the hospital took unprecedented steps.
They created a separate ICU for
KPC patients, brought in robots
to disinfect empty rooms.
>> Had monitors here reminding
us to wash our hands,
built a whole wall up in the other side.
We moved every patient in the
ICU, completely cleaned it,
moved patients back in and no
matter what we did, the bacteria
was still... it was still spreading.
>> We didn't know what was going on.
With the hospital
in crisis, genetic researchers
in building 49 next door
were scrambling to figure out
how the KPC was spreading.
>> We had now gotten to the
point where they were
identifying a patient a week and
it was not clear how these
patients might be related to each other.
Julie Segre and her
colleague Evan Snitkin started
to compare the DNA samples of
the KPC taken from the patients.
>> Are these all the DNAs then?
>> Yeah, these are all the...
Each patient had a number.
>> So this shows you, based on
the DNA sequences, how we think
the bacteria spread throughout
the hospital.
By matching the
DNA, they discovered something
none of them knew.
>> Three, four and eight were
all silent carriers, and what's
scary about that is they can be
transmitting to other patients
without anyone knowing that they
even have the bacteria themselves.
So this bacteria seemed to have
been all over the hospital
before they had come up positive.
And the hospital didn't know that?
>> They didn't know because this
bacteria has the capacity to
live in the stomach of patients
without causing infections.
>> For me, the data were stunning.
Why was it stunning?
>> Because it became very clear
that we had missed the
transmission sequence.
The high-tech
genomics revealed a disturbing
truth: the outbreak would be
much more difficult to contain.
And to stop it, they needed to
figure out exactly how the KPC
was moving through the hospital.
Was it on the hands of workers?
Or visitors?
Or on hospital equipment?
And then, as they urgently
searched for silent carriers
throughout the rest of the
hospital, their worst nightmare
came true.
The outbreak had spread beyond the ICU.
>> That's a very scary moment.
Suddenly, it's in the general
patient population.
The staff was in a panic.
As they looked on helplessly,
patients began to die.
>> We felt responsible for it.
We are responsible for the patients.
You go into a room and maybe
there's a hole in your glove.
It's a very complex environment,
alarms are ringing, did you miss
something?
Did you forget to tell the
doctor something?
Did I forget to wash my hands
between Mr. X and Mrs. Y?
Is that why Mrs. Y got KPC?
There were few options left.
>> Dr. Gallin asked me if we
needed to close the hospital or
if we needed to close the
hospital to admissions.
Ultimately we decided not to
close the hospital, but...
But it was a possibility?
>> Absolutely.
Instead, they
expanded testing hospital-wide
and isolated all those found with KPC.
Finally, six months after
patient one first arrived, the
outbreak subsided, almost as
suddenly as it had begun.
By then, 18 patients had been
infected with KPC and the
ultimate tragedy: six people had
died from it.
Many inside NIH continued to be
concerned.
Do you think KPC is
now gone from your hospital?
>> Oh no, absolutely not.
I think that, that we have to be
extremely vigilant in the coming years.
Because of the increasing rise,
the increasing prevalence of
KPCs in the United States.
>> One of the reasons
that really brought me into this
field is that I asked the
director of clinical
microbiology what do you do, you
know, when you isolate one of
these bacteria and you see that
it is resistant to all known
known antibiotics.
I said, "Well, what do you do
then?" and he said, "I pray. "
Well, that's not really part of
how we typically- that means
that we have come to the end of
how we practice medicine with drugs.
The prospect of
life without antibiotics is
barely imaginable for a world
that has had a cheap and
plentiful supply of them since
the end of World War II.
They are a staple of modern medicine.
It's hard to recall a time
without them, when an infected
cut could kill a healthy young
person in a matter of days.
But it's now clear that we are
heading back in that direction,
that the miracle of these drugs
is slipping away.
>> Antibiotics are unique drugs.
They're not like any other class
of drugs.
50 years from today the
cholesterol drugs we have now
will work just as well as they
work today.
The cancer drugs we have now
do today.
That's true of all the other
drug classes.
Antibiotics are the only class
of drugs that the more we use,
the more rapidly we lose.
When you use it, it becomes less
effective for me and vice versa.
That is the essence
of antibiotic resistance.
>> The more you expose a
bacteria to an antibiotic, the
greater the likelihood that
resistance to that antibiotic is
going to develop.
So the more antibiotics we put
into people, we put into the
environment, the more
opportunities we create for
these bacteria to become resistant.
But people forgot
about the danger of resistance
because the drugs were so effective.
>> And what they had forgotten
was the warning that Alexander
Fleming himself, the man who
discovered penicillin, gave us
in 1945- that resistance was already
being seen and the more we
wasted penicillin, the more
people were going to die of
penicillin-resistant infections.
>> Bacterial resistance is
largely inevitable.
But it is also something that we
have certainly helped along the way.
We've fueled this fire of
bacterial resistance.
These drugs are miracle
drugs, these antibiotics that we
have, but we haven't taken good
care of them.
Public health
officials estimate that up to
half of all antibiotic use in
the U.S. is either unnecessary
or inappropriate.
>> And in overusing these
antibiotics, we have set
ourselves up for the scenario
that we find ourselves in now,
where we're running out of antibiotics.
But the growing scarcity of effective
antibiotics isn't just a problem
of overuse.
It's also been driven by what's
happening inside the drug
industry itself.
>> The place where it started to
turn really challenging, I'd
say, would be in the '80s and
the '90s, when we began to see
occasional bacteria that were
very hard to treat.
And it became less obvious
that you were able to invent new
And the brand new things just
weren't coming at the same pace.
And then in the '90s and the
first part of this century, we
began to see resistant bacteria
for which we really didn't have
very much or anything at all.
And we had nothing coming to treat them.
That's because most
major drug companies were
pulling out of the antibiotic
research field just as the
gram-negative threat was worsening.
One of the last companies to
stay was Pfizer, which had made
its name on antibiotics.
By the mid-2000s, it had set
its sights squarely on the
gram-negative problem.
>> We thought there was medical need.
That's what really matters.
And we thought that given our
history and being able to
develop penicillin, the
anti-fungals, you know,
antibiotics, that in fact, if we
put our minds to it, that we
would succeed.
But this is a highly risky and
unpredictable enterprise.
Despite the risk,
Pfizer built a world-class
research team in Groton,
Connecticut, and brought in
a veteran in gram-negative
research: John Quinn.
>> In 1983, when I finished my
training, almost every
pharmaceutical company had
an antibiotic development team,
and by the time I landed at
Pfizer in 2008, we were really
down to three big guys and
some smaller companies,
bio-techs and so on.
And I think all of us felt
that, you know, we had a moral
obligation to continue to work
in this area.
There was a pressing clinical
Most companies had abandoned the
field and we were still in the game.
We were proud to still be in the
Quinn and his team
believed they were on to
something big- several
different compounds to treat
gram-negatives.
The potential breakthroughs got
the attention of the company's
science advisors, including Brad
Spellberg.
>> I felt that their pipeline
was probably the most
comprehensive and important
anti-bacterial pipeline in the
world, focusing on the types of
bacteria that we're really
having severe problems with right now.
Which are the...?
>> The highly resistant
gram-negative bacteria.
These would have solved problems
and saved lives had they been
successfully developed.
But bringing these
drugs to market faced the
economic paradox of antibiotics.
>> If you need an antibiotic,
you need it only briefly.
Indeed, that's the correct way
to use an antibiotic.
You use it only briefly.
And from an economic standpoint
of a developer that means you're
not getting the return on the
investment you've made, because
you've spent between
$600 million and $1 billion to
bring that new antibiotic to market.
Wait, you mean it costs up to a billion
dollars to bring a new drug to
>> It can easily cost up
to a billion dollars to bring a
new drug to the market.
And the initial reaction to
it is, "That's great and let's
not use it.
Let's use it as little as possible. "
>> So here is a large company
saying, "I can make billions
off cholesterol drugs,
blood pressure drugs, arthritis
drugs, dementia, things that I
know patients are going to have
to take every day for the rest
of their lives.
Why would I put my R&D dollars
into the antibiotic division
that isn't going to make me any
money, when I can put it over here?"
>> So here's the deal.
>> That's going to make a lot of
money for the company.
I answer to the shareholders.
That was the
problem facing Pfizer in 2011.
>> Don't kid yourself.
Its stock had
plummeted on Wall Street, and
its blockbuster cholesterol
drug, Lipitor, was about to lose
its patent.
>> I received an email on my
BlackBerry that there was
a mandatory emergency meeting in
two hours- can't be good.
So I called in for the meeting
and was told that the
announcement had been made that
the Groton facility was going to
be closed.
The company ended
70 years of leadership in
antibiotic development, leaving
its search for a gram-negative
cure unfinished.
>> The external people who I
spoke to, many of whom are
personal friends, said to me,
"Well, Pfizer's just doing what
other companies have done.
There's nothing particularly
wrong with that.
It's not immoral.
We are a capitalist society. "
Frontline asked Pfizer to explain the decision.
I get the sense that you have to make some very
ruthless decisions about where
to put the company's capital,
about where to invest, where to put your emphasis.
When you pulled out of gram-negative research like that
and shifted to vaccines, do you
look back on that and say, you
know, "We learned something about this"?
These are not ruthless decisions.
These are, you know, portfolio
decisions about how we can serve
medical need in the best way.
We want to stay, you know, in
the business of providing new
therapeutics for the future.
Our investors require that of
us; I think society wants a
Pfizer to be doing what we do in 20 years.
We make portfolio management
It takes a long time to learn
to make any class of drug.
When a major company leaves
an area, we really do have a
loss of skills, of history in
terms of understanding how to develop a new antibiotic.
The antibiotic pipeline is drying up, some people say.
I think it's worse than drying up.
Really?
I think it is terribly close to a drought.
This is one of the great catastrophes of our age.
Widespread antibiotic resistance has been a
long time in the making.
And with the pharmaceutical industry pulling back from
developing new antibiotics,
serious questions are now being
raised about whether the U.S.
government is prepared to confront the problem.
Dr. Srinivasan, I'm just thinking back a little
bit about history that when we do have big challenges
in public health, oftentimes
we've tackled them in a big way.
I'm thinking about, for example,
HIV/AIDS and how we tackled that
problem, and it required a lot
of effort and people were in charge.
And I took a look the other day
at the research levels devoted
to the problem of antimicrobial resistance at NIH.
Antimicrobial resistance is way down the list.
Right.
It's actually number 70 on their list.
What does that say about the priority?
Well, I think what that points to is the fact that, you
know, our research in this area has lagged.
We're going to have to do a
lot more in the area of antimicrobial resistance.
You know, I think for a long
time, we weren't investing a lot
in antimicrobial resistance because we always had new
antibiotics to combat the problem.
We got complacent.
In a sense, I think we did.
You know, there were always new
drugs to treat these infections
and so I think the need to do
basic research on antimicrobial
resistance moved down our priority list.
But with the spread of gram-negatives fast
accelerating, with new outbreaks of KPC and the
rise of NDM-1, last March the
Centers for Disease Control and
Prevention decided it was time to sound a loud alarm.
We now turn to health news tonight.
There's a warning from the CDC.
New and extremely dangerous.
Superbug, it's a deadly nightmare bacteria.
That even the CDC has called it a nightmare.
A nightmare?
At first I thought that was
someone else's hyperbolic headline.
Until I saw it was the CDC.
The CDC is usually very
straight-laced and doesn't use words like that.
If this is a really big public health
problem, who's in charge of this
problem for the United States government?
Can you tell me who's in charge?
Who's in charge of resistance?
Of antimicrobial resistance and fighting it,
and it's a threat to public health, right?
It is a threat.
So who's in charge with dealing with that?
With coordinating it?
Well, I think that the issue of who's in charge of
combating antimicrobial resistance speaks to the fact
that this is a very, very complex problem.
So there's not one single group that can take full
ownership of solving the problem of resistance.
When I look at the Department of Health and
Human Services, for example, I
look at the assistant secretaries, there's not an
assistant secretary who deals
with antimicrobial resistance.
There is for other kinds of health problems.
It seems that this is a problem that hasn't actually
registered in the high levels of the government.
It's a crisis, you said.
It is a crisis.
It's indeed a crisis.
There are a variety of
different issues that have to be addressed.
They require a variety of
different actions by all of the
different federal agencies who are involved in this.
It's not that the government
agencies are not aware of the
problem and are not doing anything.
It's that we have not had a
comprehensive plan for how to
deal with antibiotic resistance.
We don't have reporting mechanisms like they do in
Europe to know where resistance is occurring...
who is using the antibiotics.
Are we overusing them?
Wait, you're telling me we don't know the answers to
the extent of the problem?
We don't have the data?
That is correct.
I do not know how many resistant
infections are occurring right now.
I don't know what the frequency
of resistance in different bacteria are.
We do not have those data.
Frontline requested an interview with the secretary
of Health and Human Services, Kathleen Sebelius.
We wanted to ask about the lack
of data and about the priority
the department is giving to the new superbug crisis.
But she declined to be interviewed.
The CDC now estimates that
every year at least two million
people are infected with
And at least 23,000 die from
these infections- that's more
than die from AIDS every year.
It is a stark yet incomplete picture.
So this is a hidden epidemic.
It's a hidden epidemic because
there's nowhere on your death
certificate that would say that
such and such person died of an
infection that could not be treated.
And if it's not a cause of
death, then it's not something that people recognize as
something that actually killed
If people were dying because of
drug-resistant infections and they had a big X on their
foreheads which said that they
had drug-resistant infections,
trust me, there would be policy action.
It's been two years since KPC first came to NIH.
But as it turns out, the hospital never did fully rid
itself of the deadly superbug.
Last year, a young man came to
NIH because of complications
from a bone marrow transplant.
While he was there, he contracted KPC and died, the
seventh victim of the outbreak.
I guess if I had a major
message it would be that it's never going to end.
So, this organism and organisms
like this are going to be with
us till the cows come home and
we have to learn how to deal with them.
We have to change our culture in the hospital.
KPC has been found in hospitals in at least 44
states.
But that's just from the hospitals that are
reporting it.
¶
As for David Ricci, it's been two years since his last
operation.
It had taken three surgeries and
another round of highly toxic
antibiotics before doctors
believed they had removed all the NDM-1 from his leg.
There's no muscle left on it and I've only got about six
inches left and the bone stops
So far, Ricci has remained healthy, though not
entirely free from the fear of NDM-1.
You know, my doctors were
pretty straightforward with me
and they were very honest and
said there is a good chance that
this infection might not go away.
Might not ever go away?
Yeah.
They said, "We don't have enough
experience to know what's going to happen. "
NDM-1 has now spread to at least 48 countries.
Here in the U.S., there were 16
new cases identified by the CDC last year.
This year, that number has already more than doubled.
So David was actually sort of a harbinger of
something to come.
David was an example of something that's already here.
So there are entire continents
that have this major problem.
Public health problem already.
David was simply a sample of
that population in... new to us and that's key because
hospitals in any city in the country are going to have
patients from all over the world.
That globalization, that mobility is going on now.
This is already here.
All right, Addie, let there be light.
This is the day that the Lord has made.
It's also been two years for Addie Rerecich.
Yeah, but it's like not fun.
Let there be no light whatsoever.
Two years since she
came home after receiving a new set of lungs.
Hi.
It was like bringing home a premature baby.
We brought home monitors and she
couldn't do anything for herself.
She couldn't even turn over in the bed.
She couldn't turn side to side.
That's how weak and contracted and debilitated she was.
So how are you doing now?
Basically, I'm fine.
Nothing seems out of whack right now.
I seem... I feel pretty good.
I look pretty much like I did before.
I have all my friends back.
Did you understand what was happening to you or...
Uh-uh.
No.
Did anybody talk about infection and what
that... what infection meant?
No.
Basically, what I was told is
I'd say I want to go home and she'd say...
She'd say I couldn't make the
the drive home, ever, like I was too sick to go home.
Everything's hard for Addie now.
Everything's a battle.
She has to take a handful of pills twice a day.
We have to worry constantly
about picking up a bacteria or a virus.
She's had pneumonia five times in the past two years.
Bacterial pneumonia, that had
to be treated with antibiotics,
and every time I wonder, is this
the time that we're going to
come up against a bacteria that
they don't have anything to treat it with?
I think for lung transplants,
the survival rate, about 80%
make it a year and about 50%
make it five years.
And every year after that, the risks just go up.
Let's bow our heads in prayer.
People might say, "The story of Addie is horrible
but that won't happen to my daughter. "
Is this- could this happen to anybody?
It happened to Addie.
She was healthy.
It could happen to anybody.
It could happen to your next-door neighbor.
It could happen to your child.
Now I'm not here to practice
doomsday thinking, but those bacteria are out there and
they're out there in healthy people in the community.
If you don't mind standing up, you can walk around and
please greet each other.
Can we?
Sure.
The average person thinks, "Oh, I have an infection.
I take an antibiotic.
I get better. "
Yeah, it's not that simple
Good morning, Caleb.
How you doing, sweetheart?
I'm good.
Thank you.
Addie didn't get better, did she?
No, she never did get better, really.
She didn't.
She had to have surgery and take
the infection out, but... It may have saved her life?
Mm-hmm.
For now.
Bought her time.
That's what happened.
We bought her some time, and I
am grateful for every minute of it.
Hi, I'm Addie. I don't think we've ever met.
I remember you.
I know I've seen you somewhere
Yeah, me too.
Were you my nurse?
>> Next springFrontline continues the investigation.
>> Overuse in hospitals is a problem.
There's no place where we're
using more antibiotics than in
food animal production in the
United States.
>> Without antibiotics, you're
probably going to see a lot more
animal disease.
>> But is keeping the food
supply safe making us sick?
>> We can't ignore any aspect of
antibiotic misuse and overuse
and that pertains to humans,
it pertains to animals.
> > The reporting continues
next spring on FRONTLINE.
>> Go to pbs. org/frontline, ad
find out who's working to
fight the nightmare bacteria.
>> We have to be extremely vigilant.
>> And what you can do to
protect yourself.
Learn about the worst super
bugs in our rogues' gallery
of nightmare bacteria.
Track the outbreak at the NIH
as it spread throughout the hospital.
And connect to the Frontline community.
Sign up for our newsletter,
and follow us on Facebook and
Twitter, or pbs. org/frontline.
Captioned by Media Access Group at WGBH, access. wgbh. org
>> For more on this and other Frontline programs, visit our
website at pbs. org/frontline.
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