Transcripts For WETA Frontline 20131024 : vimarsana.com

Ruthless decisions. These are not ruthless decisions. These are Portfolio Management decisions. 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 tfrontline journalism fund, with a grant from scott nathan and laura debonis. Major funding for this program is provided by the kendeda fund. Narrator 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. siren blaring 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, whiteblond 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. Narrator awardwinning journalist David Hoffman first heard about Addie Rerecich while investigating for frontliwhat 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, im David Hoffman. Narrator . 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, shes 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 didnt sleep much that night, woke me up a couple of times asking if she could take a hot bath or have another ibuprofen. Narrator 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 childrens care. I remember thinking, she looks bad. This is bad. Somethings 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. Hoffman 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. Narrator 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 its also been found outside, in the community. In addies 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. Narrator but the staph was just the start of addies 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. Hoffman 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, youre in real trouble. Narrator 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 . Youre not really talking about ecmo. Narrator this was total life support. Its got huge tubes that are put into an artery and a vein and the patients blood comes out of their body, runs through the machine and the machine does what your lung does. Narrator the tubes presented a whole new set of dangers. Those tubes can harbor bacteria. Ready . Narrator and one of the dilemmas of modern medicine. Good job narrator 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. Thats just the nature of the beast. Hoffman is that what happened here . Correct. Hoffman and she got a particularly nasty one. What was it called . Stenotrophomonas. Narrator stenotrophomonas is an entirely different kind of bacteria from staph. Does it hurt . Narrator found in hospitals, it can live inside breathing tubes, and its extremely difficult to treat. The problem with stenotrophomonas is, even at the outset, its already a very resistant bacteria. There are only four or maybe five antibiotics normally that are able to treat that particular bacteria. Narrator addie was confronting the frightening new face of antibiotic resistance a group of bacteria called gram negatives. Hoffman so can you explain to me why these gramnegatives are so stubbornly nasty . Gramnegative bacteria, its a medical term and it really references the armor that surrounds the gramnegative bacteria. 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. Narrator the ability of gramnegatives to aggressively fight off antibiotics was now playing out in addie. Hold the phone. She was first put on one antibiotic thats good for stenotrophomonas, and it worked for a while. And then guess what, the antibiotic doesnt work anymore. Lets 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 youre doing great you are. Finally one day they said something i never thought i would hear. The stenotrophomonas is panresistant, pan meaning resistant to everything. Like a panorama. Narrator addie and her mother had entered the postantibiotic era. I had to go to her and say, i dont have. I dont have options based on medical science. I have run out of options. I dont 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. Narrator but there was one hope left of saving addies life to remove the infection with surgery. I remember asking the doctors then about lung transplant. And they said no. That it couldnt 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 lifesaving thing youve got. But because of that resistant stenotrophomonas, the expected survival of transplanting her was not good. In fact, you might say close to zero. Youre not going to blow bubbles . Narrator doctors faced a question of medical ethics whether to risk such a valuable resource as a young set of lungs when addies chances of survival were so low. Hoffman what tipped the balance . I think it was addies mom, tonya, who was such a strong advocate and didnt 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 highfive. Thats awesome narrator 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 19yearold 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. Narrator 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. Narrator 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. Narrator 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. Narrator 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 machetetypelooking sawknife, 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. Narrator within 24 hours, ricci was moved to another hospital and his condition deteriorated quickly. Hey, everybody, i talked to the doctors. They said i dont have that much longer, but ill put in a good word for you once i get there. Narrator ricci was barely hanging on. Miss you all. Narrator 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 didnt understand why. He almost had a surgery every day. And they, they said, you know, weve got to clean up the infection. And, and so, you know, i just thought its just an infection, you know. I really didnt realize what they meant by infection. Narrator what ricci and his family didnt know was that they were on the front lines of a superbug crisis that was just beginning to unfold. The study which found the ndm1 superbug in delhis water samples is making the Indian Health establishment see red. Narrator researchers had discovered a new danger. Bacteria carrying the gene that produces this ndm1 enzyme are resistant to very powerful antibiotics. It absolutely was a bombshell. It was unexpected. The lanceinfectious diseases journal found that ndm1 enzyme in 11 different types of bacteria. Narrator ndm1 isnt bacteria; its actually a resistance gene that can turn bacteria into superbugs. Ndm1 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. Ndm1 wasnt just in hospitals. To everyones surprise, it was found out in the environment, too. First, from a scientific standpoint, we didnt 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. Hoffman so youre saying that the bacteria were swapping this information just out there on the street without being in a person. Thats correct. So they could transfer resistance genes even when they were in the same puddle of water. Narrator with the spread of ndm1, a much Wider Population is put at risk. And what has Health Officials around the world especially worried is that ndm1 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 davids 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 drugresistant pathogens. I brought up his medical record and saw a huge amount of Drug Resistance, Drug Resistance we dont typically see. All these rs 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. Narrator lab results confirmed lynchs worst fears. Ricci had brought ndm1 into the United States. It was one of the first cases to ever be identified here, and lynch had little to go on. Theres not a lot of Clinical Experience for treating these bacteria, anywhere. In the literature, theres no books, theres 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 theres these doctors and they tell me, we need to isolate you. We need to put you on your own and quarantine you. Narrator ricci was in the throes of the ndm1 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 antibiotics. And when they said that, thats what worried me because im like, how is he going to get rid of them . Narrator lynch tried several powerful antibiotics. But they didnt work. Have you done any of the colistinrifampin combinations . Narrator 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 dont have a lot of new options and were going back to some of our older antibiotics. 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. Narrator the treatment was too toxic. We had to stop the only drug we had left to treat the gramnegative rods that were in his wound. Hoffman so youre 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 couldnt believe that there wasnt an antibiotic that would fix it, to tell you the truth. Narrator they would have to cut out more of the infection by cutting off more of riccis leg. But it would be months before they knew whether all of the ndm1 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 gramnegative bacteria. This superbug didnt come from overseas; this one was homegrown. It lives in the digestive system and, like ndm1, its a gene that can spread its resistance to other bacteria. Its 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 arent required to report outbreaks to the government and most wont talk publicly about them. But as part of frontlines investigation, one of the nations 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. siren wailing 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. Narrator 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. We immediately went on high alert, the equivalent of hospital epidemiology defcon 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 thats a mouthful. But we really didnt 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. Narrator the room was at the end of the hall, separate from other patients. Let me just check your blood sugar, okay . Narrator but this was the intensive care unit, where patients are very sick and highly vulnerable, and that presented heightened risks. Its 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. Narrator 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. Narrator the new york patient ultimately recovered and was discharged after four weeks in the hospital. We really felt like we had dodged a bullet. Narrator 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 rt closet . A kpc bacteria turned up in a respiratory culture. Narrator 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 didnt have the same caregivers, they didnt 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. Narrator 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. Narrator they had an outbreak. The kpc was spreading. The patients were getting sicker. And antibiotics werent 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. Hoffman an experimental one, a test one. An experimental antibiotic, and that also did not work. Narrator 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 didnt know what was going on. Narrator 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. Narrator 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. Narrator each patient had a number. So this shows you, based on the dna sequences, how we think the bacteria spread throughout the hospital. Narrator by matching the dna, they discovered something none of them knew. Three, four and eight were all silent carriers, and whats 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. Hoffman and the hospital didnt know that . They didnt know because this bacteria has the capacity to live in the stomach of patients without causing infections. For me, the data were stunning. Hoffman why was it stunning . Because it became very clear that we had missed the transmission sequence. Narrator the hightech 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. Thats a very scary moment. Suddenly, its in the general patient population. Narrator the staff was in a panic. As they looked on helplessly, patients began to die. monitor beeping we felt responsible for it. We are responsible for the patients. You go into a room and maybe theres a hole in your glove. Its 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 . Narrator 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. Hoffman but it was a possibility . Absolutely. Narrator instead, they expanded testing hospitalwide 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. Hoffman 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, thats not really part of how we typically that means that we have come to the end of how we Practice Medicine with drugs. Narrator 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. Its hard to recall a time without them, when an infected cut could kill a healthy young person in a matter of days. But its now clear that we are heading back in that direction, that the miracle of these drugs is slipping away. Antibiotics are unique drugs. Theyre 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 will work just as well as they do today. Thats 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. Narrator 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. Narrator 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 penicillinresistant infections. Bacterial resistance is largely inevitable. But it is also something that we have certainly helped along the way. Weve fueled this fire of bacterial resistance. These drugs are miracle drugs, these antibiotics that we have, but we havent taken good care of them. Narrator 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 were running out of antibiotics. Narrator but the growing scarcity of effective antibiotics isnt just a problem of overuse. Its also been driven by whats happening inside the drug industry itself. The place where it started to turn really challenging, id 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 antibiotics. And the brand new things just werent 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 didnt have very much or anything at all. And we had nothing coming to treat them. Narrator thats because most Major Drug Companies were pulling out of the antibiotic Research Field just as the gramnegative threat was worsening. One of the last companies to stay was pfizer, which had made its name on antibiotics. By the mid2000s, it had set its sights squarely on the gramnegative problem. We thought there was medical need. Thats what really matters. And we thought that given our history and being able to develop penicillin, the antifungals, 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. Narrator despite the risk, pfizer built a worldclass Research Team in groton, connecticut, and brought in a veteran in gramnegative 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, biotechs 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 need. Most companies had abandoned the field and we were still in the game. We were proud to still be in the game. Narrator quinn and his team believed they were on to Something Big several different compounds to treat gramnegatives. The potential breakthroughs got the attention of the companys science advisors, including brad spellberg. I felt that their pipeline was probably the most comprehensive and important antibacterial pipeline in the world, focusing on the types of bacteria that were really having severe problems with right now. Hoffman which are the. . The highly resistant gramnegative bacteria. These would have solved problems and saved lives had they been successfully developed. Narrator but bringing these drugs to market faced the economic paradox of antibiotics. If you need an antibiotic, you need it only briefly. Indeed, thats the correct way to use an antibiotic. You use it only briefly. And from an economic standpoint of a developer that means youre not getting the return on the investment youve made, because youve spent between 600 million and 1 billion to bring that new antibiotic to market. Hoffman wait, you mean it costs up to a billion dollars to bring a new drug to market. It can easily cost up to a billion dollars to bring a new drug to the market. And the initial reaction to it is, thats great and lets not use it. Lets 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 isnt going to make me any money, when i can put it over here . So heres the deal. Thats going to make a lot of money for the company. I answer to the shareholders. Narrator that was the problem facing pfizer in 2011. Dont kid yourself. Narrator 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 cant 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. Narrator the Company Ended 70 years of leadership in antibiotic development, leaving its search for a gramnegative cure unfinished. The external people who i spoke to, many of whom are personal friends, said to me, well, pfizers just doing what other companies have done. Theres nothing particularly wrong with that. Its not immoral. We are a capitalist society. Narrator frontline asked pfizer to explain the decision. Hoffman i get the sense that you have to make some very ruthless decisions about where to put the companys capital, about where to invest, where to put your emphasis. When you pulled out of gramnegative 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 decisions. 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. Hoffman the antibiotic pipeline is drying up, some people say. I think its worse than drying up. Hoffman really . I think it is terribly close to a drought. This is one of the great catastrophes of our age. Narrator 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. Hoffman dr. Srinivasan, im just thinking back a little bit about history that when we do have big challenges in Public Health, oftentimes weve tackled them in a big way. Im 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. Hoffman its 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. Were going to have to do a lot more in the area of Antimicrobial Resistance. You know, i think for a long time, we werent investing a lot in Antimicrobial Resistance because we always had new antibiotics to combat the problem. Hoffman 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. Narrator but with the spread of gramnegatives fast accelerating, with new outbreaks of kpc and the rise of ndm1, 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. Theres a warning from the cdc. New and extremely dangerous. Superbug, its a deadly nightmare bacteria. That even the cdc has called it a nightmare. A nightmare . At first i thought that was someone elses hyperbolic headline. Until i saw it was the cdc. The cdc is usually very straightlaced and doesnt use words like that. Hoffman if this is a really big Public Health problem, whos in charge of this problem for the United States government . Can you tell me whos in charge . Whos in charge of resistance . Hoffman of Antimicrobial Resistance and fighting it, and its a threat to Public Health, right . It is a threat. Hoffman so whos in charge with dealing with that . With coordinating it . Well, i think that the issue of whos in charge of combating Antimicrobial Resistance speaks to the fact that this is a very, very complex problem. So theres not one single group that can take full ownership of solving the problem of resistance. Hoffman when i look at the department of health and human services, for example, i look at the assistant secretaries, theres 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 hasnt actually registered in the high levels of the government. Its a crisis, you said. It is a crisis. Its 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. Its not that the Government Agencies are not aware of the problem and are not doing anything. Its that we have not had a comprehensive plan for how to deal with antibiotic resistance. We dont have reporting mechanisms like they do in europe to know where resistance is occurring. Who is using the antibiotics. Are we overusing them . Hoffman wait, youre telling me we dont know the answers to the extent of the problem . We dont have the data . That is correct. I do not know how many resistant infections are occurring right now. I dont know what the frequency of resistance in different bacteria are. We do not have those data. Narrator 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 resistant bacteria. And at least 23,000 die from these infections thats more than die from aids every year. It is a stark yet incomplete picture. So this is a hidden epidemic. Its a hidden epidemic because theres nowhere on your death certificate that would say that such and such person died of an infection that could not be treated. And if its not a cause of death, then its not something that people recognize as something that actually killed them. If people were dying because of drugresistant infections and they had a big x on their foreheads which said that they had drugresistant infections, trust me, there would be policy action. Narrator its 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 its 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. Narrator kpc has been found in hospitals in at least 44 states. But thats just from the hospitals that are reporting it. As for david ricci, its 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 ndm1 from his leg. Theres no muscle left on it and ive only got about six inches left and the bone stops there. Narrator so far, ricci has remained healthy, though not entirely free from the fear of ndm1. 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. Hoffman might not ever go away . Yeah. They said, we dont have enough experience to know whats going to happen. Narrator ndm1 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. Hoffman so david was actually sort of a harbinger of something to come. David was an example of something thats 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 thats 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. Narrator its also been two years for Addie Rerecich. Yeah, but its like not fun. Let there be no light whatsoever. Narrator 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 couldnt do anything for herself. She couldnt even turn over in the bed. She couldnt turn side to side. Thats how weak and contracted and debilitated she was. Hoffman so how are you doing now . Basically, im 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. Hoffman did you understand what was happening to you or. Uhuh. No. Hoffman did anybody talk about infection and what that. What infection meant . No. Basically, what i was told is id say i want to go home and shed say. Shed say i couldnt make the the drive home, ever, like i was too sick to go home. Everythings hard for addie now. Everythings 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. Shes 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 were going to come up against a bacteria that they dont have anything to treat it with . children singing 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. Lets bow our heads in prayer. Hoffman people might say, the story of addie is horrible but that wont 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 nextdoor neighbor. It could happen to your child. It could happen to anybody. Now im not here to practice doomsday thinking, but those bacteria are out there and theyre out there in Healthy People in the community. If you dont 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, its not that simple anymore. Good morning, caleb. How you doing, sweetheart . Im good. Thank you. Addie didnt get better, did she . No, she never did get better, really. She didnt. She had to have surgery and take the infection out, but. Hoffman it may have saved her life . Mmhmm. For now. Bought her time. Thats what happened. We bought her some time, and i am grateful for every minute of it. children singing hi, im addie. I dont think weve ever met. I remember you. I know ive seen you somewhere before. Yeah, me too. laughs were you my nurse . Yeah. Next sprfrontline continues the investigation. Overuse in hospitals is a problem. Theres no place where were using more antibiotics than in food animal production in the United States. Without antibiotics, youre probably going to see a lot more animal disease. But is keeping the food supply safe making us sick . We cant 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 whos 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 tfrontline community. Sign up for our newsletter, and follow us on facebook and twitter, or pbs. Org frontline. 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 tfrontline journalism fund, with a grant from scott nathan and laura debonis. Major funding for this program is provided by the kendeda fund. 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. Frontlinehunting the nightmare bacteria is available on dvd. To order, visit shoppbs. Org, or call 1800playpbs. Frontline is also available for download on itunes. What if news wasnt just a commodity. But a commitment . News anchor the fiscal cliff is a fiscal Suicide Mission why shouldnt we explore every side of the story . News anchor the syrian army had pulled back. 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