Superbugs Deadlier Than Cancer Put Chemotherapy Into Question
In India, patients and their families face a heart-wrenching choice: forgo lifesaving treatment or run the risk of a killer infection.
Doctors in India are sounding the alarm over a threat to cancer patients that’s proving deadlier than tumors: untreatable infections from superbugs impervious to existing medications.
Patients undergoing chemotherapy in the country are at the front line of the worldwide spread of bacteria that the most potent antibiotics can’t fight. Bloodstream infections caused by these superbugs have become the leading cause of illness and death in leukemia patients, doctors from India’s top-ranked medical college reported last year.
That frightening reality has forced patients to weigh fighting their deadly malignancies with treatments against the probability of dying sooner from an incurable infection. In India, some 1.7 million receive a cancer diagnosis every year, often leading to chemotherapy that makes them especially vulnerable. Worldwide, at least 700,000 people die annually from drug-resistant infections. That number will balloon to 10 million a year by 2050 and will cost more than $100 trillion in lost economic output without corrective actions, according to a U.K. government study, which estimates that by midcentury more people will die from superbug infections than from cancer and diabetes combined.
“We are facing a difficult scenario to give chemotherapy and cure the cancer, and get a drug-resistant infection and the patient dying of infections,” says Abdul Ghafur, an infectious disease physician, who conducted that study with his colleagues. “We don’t know what to do. The world doesn’t know what to do in this scenario.”
Germs acquired through ingesting contaminated food and water become part of the normal gut microbiome, but they can turn deadly if they escape the bowel and infect the urinary tract, blood, and other tissues. Chemotherapy is often the culprit, allowing that to happen by weakening the lining of the digestive tract.
Bloodstream infections caused by multidrug-resistant bacteria are two to three times more likely to be fatal than infections caused by germs treatable with routine antibiotics, a study from 10 Indian hospitals published in November found.
Almost two-thirds of cancer patients with a carbapenem-resistant infection are dead within four weeks, vs. a 28-day mortality rate of 38% in patients whose infections are curable, Ghafur and colleagues reported in 2014. Ghafur typically tries a last-resort antibiotic called colistin with the most stubborn antibiotic-resistant strains. Increasingly, that’s failing too, resulting in pan-drug-resistant infections. In the past, says Ghafur, “maybe once in six months, once a year I got this kind of bacteria—resistant to everything.” Now it’s occurring every other week.
Ghafur, one of India’s fiercest anti-superbug campaigners, says the cancer patients he sees dying from drug-resistant bacterial infections represent a so-called post-antibiotic era in which something as simple as a scratched knee can kill. “If you’re talking about the post-antibiotic era, you first see that in cancer patients,” he says. “They are expecting us to cure their cancer with chemotherapy—and there are wonderful chemotherapy drugs—and then we explain it to the family: Yes, your cancer will be controlled, but then you may die of infection.”
The problem is especially acute in India, where the misuse and abuse of antibiotics in humans and animals is amplified by inadequate hygiene and sanitation. It’s a return to an earlier, more perilous era. Before the 1940s, festering sores risked ending in fatal, septic shock. The advent of antibiotics changed all that, adding decades to average life expectancy in just one generation and laying the foundation for modern medicine. Surgery, organ transplants, chemotherapy, and Cesarean section births could all be performed with a high degree of safety thanks to the bacteria-stopping ability of antibiotics.
The U.K.’s 2016 review, conducted by former Goldman Sachs economist Jim O’Neill, recommended spending $42 billion over 10 years to boost the supply of new medicines, vaccines, and diagnostic tools and introduce mechanisms to reduce the demand for antibiotics. Yet few governments have been willing to make the investment needed to mitigate the global antimicrobial resistance crisis. “I don’t think they understand the urgency of it, or it’s clearly not a major priority for many countries,” O’Neill says. “Governments don’t like to spend money on prevention, and they end up spending more rather wastefully on the response to an outbreak. It’s really quite stupid.”
Meantime, the lack of response is rendering useless many of what were until very recently among the world’s modern medical miracles. “As a doctor, as an infection specialist living in the 21st century with all the inventions and discoveries in modern medicine, I feel my hands are tied,” Ghafur says. “If I can’t cure my patient’s infection, however wonderful the developments in the field of oncology, they are not going to be useful, because we know cancer patients die of infections.”
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