A view From the Bridge

Superbugs: fighting the flood of antimicrobial resistance

Posted on behalf of Andrew Jermy

Enterobacter cloacae, Enterococcus faecalis, Staphylococcus epidermidis and the Superbugs exhibition.

Petri dishes with cultured Enterobacter cloacae, Enterococcus faecalis, Staphylococcus epidermidis and Escherichia coli at the London Science Museum’s Superbugs exhibition.

® The Board of Trustees of the Science Museum

Antimicrobial resistance has spread to London this month. The source of the outbreak? The Science Museum: its new exhibition, Superbugsexplores this monumental issue and our responses to it.

As Superbugs graphically shows, the inflammatory tone of the many headlines predicting an impending antibiotic apocalypse is not baseless. The evolution and spread of resistance among serious (and increasingly commonplace) bacterial infections continues to blunt much of our antibiotic arsenal, and make routine operations significantly more risky. Such infections now claim almost 700,000 lives annually, a figure that could rise to more than 10 million by 2050.

Superbugs isn’t out simply to scare, however. Much like Nature Microbiology, the journal I edit, the Science Museum aims to join the ‘resistance against resistance’ by shining a light on the problem’s scale, and the range of potential solutions.

The monumental 'wall' and towers at the exhibition.

The monumental ‘wall’ and towers at the exhibition.

{credit}® The Board of Trustees of the Science Museum

The physical design of the installation aptly reflects aspects of the crisis. A vast illuminated wall dominates; set into it is a series of displays. This monolith, emblazoned with the show’s title, speaks of antibiotics’ barrier function — how they act as a great dam holding back a flood of infections. Standing in front of this cracked levee are 12 small towers into which have been set Petri dishes. Each contains a different type of (inactive) microbe, including MRSA and Neisseria gonorrhoeae — like outposts of resistance that have breached the barricade and now mingle among the crowds. It’s a powerful scene.

I was drawn irresistibly to the inset display cases. Combining text with striking visuals and interactive content, these take the visitor through medical history, from the discovery and introduction of antibiotics in the first half of the twentieth century, to the rise of resistance in the years following the introduction of each new drug, to ongoing efforts to revitalize our dwindling drug cabinet. Peppered through are personal testimonies. We meet doctors explaining why antibiotics are overprescribed; a nurse reminding of the fundamental importance of their work on infection control; designers who create products that enable no-touch use, or incorporate anti-bacterial materials, to reduce the risk of transmission.

Interviews with nurses, medics and others waging war on antibiotic resistance feature in the exhibition.

A display on the people at the frontline of ‘resistance against resistance’.

® The Board of Trustees of the Science Museum

We hear a recording of bacteriologist and discoverer of penicillin Alexander Fleming, describing how microbes can become ‘educated’ to resist a drug. A culture of Penicillium mold grown from a stock of his original sample is shown nearby. A video describes the harrowing experience of Geoffrey Pattie, a cancer patient who during surgery contracted a strain of Klebsiella pneumoniae resistant to all current antibiotics. He spent five months in an isolation ward, and today lives with the life-altering effects of the infection, such as reduced mobility.

Nearly half of antibiotic use occurs in agriculture, to treat and prevent infection in livestock, but often also to promote growth. The drugs and bacterial resistance genes that they select for become widespread in terrestrial and marine environments, giving a large potential reservoir from which resistance can leap into clinically relevant pathogens. Inevitably, that is a serious problem for human health. The show reveals some of the technological fixes that are being investigated, including automated systems for monitoring livestock welfare to allow targeted interventions rather than treating an entire herd prophylactically. Also presented are possible alternative approaches to tackling infections, such as phages (viruses that kill bacteria) sourcing new antibiotic leads from oceans, soils and host-associated microbiomes in humans, komodo dragons and leafcutter ants.

The promise of such efforts is stirring. But finding a new antibiotic class that will make it to the clinic is “like searching for a needle in a field of haystacks”, cautions one researcher interviewed.

The bacteria leafcutter ants use to defend their nests against fungi and microbes excrete chemicals that are effective antibiotics.

The bacteria leafcutter ants use to defend their nests against fungi and microbes excrete chemicals that are effectively antibiotics.

® The Board of Trustees of the Science Museum

What isn’t covered in much depth is the parlous state of the antibiotic R&D pipeline. Many large pharmaceutical companies have closed their antibiotic development programmes in recent years. That includes Pfizer, the main sponsor of the exhibit — although the company did announce in 2016 that it planned to acquire AstraZeneca’s antibiotics division, and reinforced a strategic focus on tackling infectious diseases. The economics of antibiotic discovery and development is complicated: to bring a drug to market takes a massive investment in time and finances. Yet we will need these new drugs to be used ever more sparingly in future. So, under the current system, there is actually a disincentive for industry to put in the necessary investment – they would never break even, let alone see a return.

Superbugs is doubly timely. This week (13-19 November) is the World Health Organization’s World Antibiotics Awareness Week 2017, an opportunity to take stock of progress. Antibiotic resistance, until recent years a concern only of clinicians and microbiologists, is now globally recognised as a crisis through the work of key individuals, such as Britain’s chief medical officer Sally Davies, and reports from national and international bodies. In 2016 this culminated in the UN High-Level Meeting on Antimicrobial Resistance (see this Nature Microbiology editorial).The rise in academic research and conferences focused on antimicrobial resistance is a positive sign that new approaches can and will be found, despite the issues with the pharma marketplace and the ongoing hunger for antibiotics in agriculture and medicine.

But we remain a long way from winning what the Science Museum describes succinctly as the “fight for our lives”. Hopefully this polished, fact-packed exhibition will call many more to arms — from the lay visitor to the family doctor, local farmer and political representative.

Andrew Jermy is chief editor at Nature Microbiology. He tweets at @jermynation.

Superbugs: The Fight for Our Lives is free, and at the Science Museum until spring 2019.

 

For Nature’s full coverage of science in culture, visit www.nature.com/news/booksandarts.

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