Prologue
The Killers Within: The Deadly Rise of Drug-Resistant Bacteria
Book Description
A battle is taking place on the frontiers of medicine between rapidly evolving bacteria that threaten our health and the doctors who are struggling to outwit them. These bacteria are everywhere: in and on our bodies, in homes, schools, hospitals, crowded airplanes, day-care centers. And, as this acclaimed book makes frighteningly clear, so far the bacteria are winning. The Killers Within is popular science writing at its best-a report from the front lines at once accessible and riveting.
Prologue
Dr. Glenn Morris was growing very worried. His patient was not supposed to
die.
The son of Southern Baptist missionaries, Morris had grown up in
Morris's parents had assured the shaken child that by staying away from
street food, drinking boiled water, and, most important, taking fluids and
antibiotics at the slightest cholera-like symptom, he would be safe. But as
Morris now looked down at his suffering patient, he knew that such soothing
assurances had no relevance here.
A year before, Ed Burke* had taken his good health for granted.
Forty years old, lean and fit, he was a recently divorced accountant living
with his mother while he tried to put his life together again. But Burke had
been feeling weak and tired when he went to the
That was the beginning of the end.
Burke's physician initiated chemotherapy almost immediately. Though often
effective against leukemia and other cancers, the drastic treatment-with its
searing chemicals that course through the body like Drano-can have the
undesired effect of suppressing the immune system as well, sometimes leading to
bacterial infections that the weakened immune system cannot contain. Physicians
use antibiotics to help eradicate these potentially life-threatening
infections. Sometimes these bugs prove resistant to the initial antibiotic, in
which case the physician simply switches to another one. For decades, there had
always been plenty in reserve. But for this particular case, the reserve had
been exhausted.
Burke's infection was caused by the bacterium known as Enterococcus
faecium. One expert calls E. faecium the cockroach of microbial
pathogens: proliferating freely in the gastrointestinal tract, it usually
causes no more trouble than roaches colonizing a dark cupboard. But when
breakdowns in the immune system allow the bugs to escape, they begin to cause
serious infections, anywhere from the heart down to the urinary tract. After
proving resistant to the initial antibiotics used, Burke's E. faecium
also showed resistance to vancomycin, an older but still powerful antibiotic
that represented the last-chance treatment for resistant enterococci when all
else failed. This time vancomycin failed as well: vancomycin-resistant E.
faecium, better known as VRE, had appeared in Burke's bloodstream, a
dangerous escalation. That was when Morris had been called in.
With his stocky build and powerful arms and shoulders, the ruddyfaced Morris
looked more like an ex-linebacker than a man of medicine, though his
soft-spoken manner made him, at first glance, seem shy and retiring. But when
he was stationed behind a microphone at a scientific conference and given a
rapt audience for his impassioned calls to action about disturbing bacterial
advances, the Southern preacher inside him very clearly emerged.
Awed by the bacterial devastation he had witnessed in
The full import of this trend was difficult for patients to absorb. Certain
strains of E. faecium were resistant to nearly all of the more than one
hundred antibiotics that modern science had produced. They were, quite simply,
unstoppable.
Even harder to explain to patients was that E. faecium was a hospital
bug. Almost certainly, it had infected Burke after he was in the care of his
oncologists. It had infected him right there in his hospital bed. And
how had it gotten there? Probably by alighting from the unwashed hands of a
busy doctor, nurse, or other healthcare worker who had just had contact with
another patient carrying the bug. Oncology wards and intensive care units of
nearly all hospitals were notoriously rife with resistant bugs, though few
institutions would admit as much. All too often, these drug-resistant bugs took
weeks to develop into infections, so that the doctors and nurses who had
inadvertently passed them to a patient might not ever learn what they had done.
For elderly patients with chronic illnesses and ravaged immune systems, VRE
was proving lethal, the extra infection that nudged an already sick person over
the edge. Younger patients were usually impervious to it -unless, that is,
their own immune systems were compromised by chemotherapy, as Burke's was, or
by drugs given to prevent rejection of a transplanted kidney, or by some
life-threatening, out-of-the-blue calamity: a car accident, perhaps, or a
thirddegree burn. Then they were as susceptible as patients twice their age.
Given that well over one million Americans were diagnosed each year with some
form of invasive cancer-15 million since 1990-the number of potential victims
for VRE was surprisingly large.
When Morris entered Burke's hospital room the first time, the accountant had
looked up at him with desperate hope. Gently, Morris had had to explain that he
had no magic bullet for Burke's VRE-no cure at all. He could only hope that
with the end of chemotherapy, Burke's white blood cell count would bounce back
up quickly enough for his immune system to handle the infection itself.
As if in answer to the Burke family's prayers, that was what happened- at first.
The leukemia disappeared-whether it was in remission or gone for good, the
doctors could not yet tell-and chemotherapy was halted. Burke's immune system
began to recover and started producing the white blood cells responsible for
killing bacteria that invade the bloodstream. As the white blood cells attacked
the infection, the patient's fever broke, and he felt stronger every day.
Within a week, he was sent home.
Just ten months later, Burke was back in the hospital with a relapse of
leukemia. Reluctantly, his doctors gave him more chemotherapy. When they did,
VRE reappeared in his bloodstream. It had been lurking in his intestinal tract,
a killer within. Twice more the man recovered enough for his immune system to
fight the VRE to a standoff. But the superbug was not yet beaten.
A year later, another relapse of leukemia, and more chemotherapy, pushed
Burke's white blood cell count down too far. The bug that had been his constant
companion, as Morris grimly put it, once again infected his bloodstream. Back
came the high fever, the chills, the irregular heartbeat, the shortage of
breath. But this time there was no rebound, even when chemotherapy was halted.
Burke began vomiting, and his blood pressure plunged. As the flow of blood to
his brain slowed to a trickle, his vision dimmed and he became disoriented. At
the same time, his ever weakening heartbeat pumped less and less blood to his
other vital organs. One by one they began shutting down, like lights winking
out during a power blackout. As the kidneys and liver ceased to operate and
cleanse his body of waste materials, Burke essentially poisoned himself.
Finally came full-blown septic shock. Burke went pale and delirious, cold and
clammy to the touch. He suffered a series of small heart attacks, and began to
suffocate as his lungs filled with fluid. Eight days after the VRE infected his
bloodstream a final time, Burke succumbed.
That was in September 1995.
It doesn't get much worse than this, Morris thought at the time: a
forty-year-old man with an infection no antibiotic can stop. But he would be
wrong. Over the next six years, a grim new era of multiresistant bacteria would
unfold in-and out of-hospitals around the globe, making Burke's case seem all
too typical. Relentlessly, these newly hardy, invisible bugs would proliferate
all around us, some festering on bedrails and seat cushions, telephones and
thermometers, others passing through the air from one human host to the next.
Silently, they would colonize even the healthiest of us, coating our skin,
nestling in our noses, spreading in our throats, swimming through our stomachs
and gastrointestinal tracts-until it could not be said that any of us was ever
without at least a smattering of highly drug-resistant bugs, waiting for the
chance to infect those among us who grew suddenly weak and sick.
The bugs were everywhere, exponentially multiplying. And each year now,
fewer drugs seemed able to stop them.
*Some names, including this one, have been changed to protect the privacy
of patients and their families.
