Q&A with Jason “The Germ Guy” Tetro
In your lifetime, you’ve probably had an infection that required antibiotics. The specific type of bacteria (say, Streptococcus) and the antibiotic used (maybe clindamycin?) were probably unimportant to you at the time – you just wanted to feel better.
But did you know that with each use of an antibiotic, bacteria learn to adapt and evolve, rendering these medications no longer effective? It’s called antimicrobial resistance, and it’s a growing issue that the world is currently not equipped to tackle.
We chatted with Jason “The Germ Guy” Tetro to learn more about the issue, including his own run-in with AMR, and what actions we can all take to combat the problem today. Jason has written two books about the complicated relationship between humans and microbes (The Germ Code and The Germ Files) and is dedicated to increasing public awareness of microbes and health. He writes a weekly column for The Huffington Post Canada and is a visiting scientist at the University of Guelph.
Nano: Jason, you’re known for your ability to explain complex scientific subjects simply. Antimicrobial resistance (or AMR) is a complicated one, but it affects all of us. For those of us who don’t have backgrounds in science or medicine – what is it?
Jason: Quite simply, it’s the ability of a bacterium to live in the presence of antibiotics meant to kill them. In the environment, bacteria are always under attack from chemicals, including natural antibiotics made by fungi. Many bacterial species have developed ingenious ways to protect themselves from these threats. We’ve known about this ability since antibiotics were first used in the public but many in the medical community never expected the bacteria to be able to resist modern versions of these drugs. As we’ve learned, bacteria are quite capable of keeping themselves alive and their success ends up being medicine’s failure.
Nano: Should the average person be worried about AMR? What worries you the most about AMR?
Jason: Thirty years ago, when I started research, I might have said no as resistance was rare and recovery was pretty much guaranteed. But now, having a bacterial infection may end up being a very long and frustrating process as a result of resistance. The troubles seem to be worsening as we are seeing more people suffering from what we call multi-drug resistant infections. As the name implies, the bacteria can survive multiple types of antibiotics. We even hear of pandrug resistant infections in which no antibiotic options exist. These types of infections are still relatively rare, but I fear we will see more in the near future. I don’t want to spark fear, but people should be aware that these situations are becoming more common.
Nano: Tell us a story about AMR in the real world – have you seen it in action?
Nano: Yes. I’ve lived it. I had pneumonia back in 1996 and was prescribed a standard antibiotic at the time. It didn’t work. I had to go through three different types of antibiotics – including one that led to allergies – before I was able to clear the infection. It was scary not knowing if anything would work. Thankfully, I recovered but I do worry about what might have happened if I caught the infection today.
Nano: What happens when you contract an illness that is resistant to antibiotics? Are there any treatment options?
Jason: Unless you have a pandrug resistant infection, there are going to be options. Combinations of different antibiotics are now the norm in these cases. The length of time to recover can be incredibly long but eventually, at least for the moment, most infections can be cured. The problem of course, is whether our bodies can deal with the infection long enough for use to be treated. In some cases, such as sepsis and pneumonia, the answer is no. That’s why we need to look at new approaches to deal with these types of rapid and potentially lethal infections.
Nano: What types of ideas do you feel are needed?
Jason: We need to think outside of the antibiotic box and return to nature to find more useful and sustainable options. We know the use of viruses of bacteria, known as bacteriophages, is making progress and we may soon have what is known as phage therapy to combat infections. Also there are chemicals produced by a variety of species ranging from humans to bacteria known as antimicrobial peptides. They are effective and bacterial resistance against them is rare. We are seeing more research into these molecules and soon we may have viable options for medical treatment.
Nano: Could any bacterial disease become resistant to antibiotics? Are there certain diseases that are more likely to develop a resistance to antibiotics?
Jason: Because bacteria evolve to resist, there are no favorites when it comes to disease. Any bacterial pathogen has the ability to become resistant. Even some of the species we believed would never gain this ability have somehow managed it. We no longer live in a world where we can say, “Oh, it’s just E. coli.” Every infection poses a possible concern for resistance.
Nano: That being said, what are some of the biggest culprits of AMR? Are certain types more common or posing greater risks?
Jason: Each body part has its own worst enemy. For the skin, Staphylococcus aureus is the most troubling species as resistance can lead to a wound that won’t heal. In the gut, public enemy #1 is Clostridium difficile, which can end up being fatal. The urinary tract has two major enemies, Klebsiella pneumoniae and Neisseria gonorrhoeae leading to long periods of pain and discomfort. But the most troubling place for resistance is the respiratory tract. One of the worst culprits is known as Acinetobacter baumannii, which is close to pandrug resistant. Others such as Steptococcus pneumoniae and Pseudomonas aeruginosa are not far behind. But the worst of all the respiratory diseases continues to be tuberculosis. What’s ironic is that half a century ago we thought we could eradicate this disease with antibiotics. Now we are back in a crisis as this resistant bacterium continues to spread worldwide.
When it comes to risks, we need to examine not the bacteria but rather the environment. Although contaminated food and unsafe water pose some concern, the greatest threats come from other humans. We all shed millions of bacteria every hour – it’s called our microbial cloud. When people are infected, they can spread the pathogens to others. In this situation, the skin and lungs are far more at risk than the urinary tract or the gastrointestinal system. We’ve seen several cases in which people acquire a resistant infection either through close contact with people or sometimes with the objects they touch. It’s a troubling reality we need to accept and hope we can stem the tide before we end up in what is known as the post-antibiotic era.
Nano: Clearly AMR is a significant issue on the rise. Until more effective treatments are developed, is there anything we can do to help the problem today?
Jason: There’s only one option: reduce use. We’ve known this for years but only a few countries have heeded the call and reduced the amount of antibiotics used both in medicine and agriculture. This needs to change in order for us to have any chance.
For you and me, there are two actions we can do to help. The easiest is to choose meats from animals raised without the use of antibiotics. These options are growing in number and as we’ve seen through some public statements from various food suppliers, we expect even more choice in the future. The other way we can help may be a little more difficult. We need to stop asking for antibiotics. When we go to the doctor, we tend to want to have a prescription to help us heal. If there’s an infection, it’s natural to ask for an antibiotic. However, in light of our situation, it’s best to hold back on that and ask for a test instead. We are at a point where we can rapidly diagnose infections and know which treatments will work. Usually, the answers come in less than a day. Although infections are no fun, giving the healthcare system a few hours to learn what can be done will help to prevent unneeded prescriptions and also ensure that the drugs we take will actually do the job and not fail to resistance.