I always find myself telling people (who are just so interested in me, duh) that often cystic fibrosis is not what’s making me sick. Typically, the fevers, gross cough, fatigue and just about all of my problems stem from the bacteria living in my lungs. That’s not to say that CF creates a number of issues in itself, but ugly bacteria, as I have said time and again, are problematic.

Over time, bacteria become resistant to antibiotics because the strains evolve very quickly, leaving people who suffer from infections with fewer treatment options. For people who have CF and are constantly dealing with bacterial infections, antibiotic resistance is a significant topic. In the CF world we have a very succinct set of guidelines to help prevent bacterial infection.

A point of emphasis for people with CF is that our interactions between patients must be limited. We call it “the 5-foot rule.” At all times, two CF patients must avoid direct contact with each other, or stay at least 5 feet away from each other, which does sometimes make things a little awkward when people with CF happen to meet in person. The reason being (and in very basic terms), two people with CF can transmit (I think that’s the right word, I’m no scientist) bacterial strains between each other like two healthy people could give each other a cold. There is just a little bit of a difference between the two noted examples. While the common cold may last for a few days, bacteria can colonize inside a CF patient’s lungs leading to catastrophic consequences that last a lifetime. In-person patient interactions, as a result, can be extremely dangerous. As with anything, though, for someone like me in my line of work, at times the 5-foot rule can be impossible to adhere to, but I do always take necessary precautions if I get into a sticky situation.

I have to believe this “rule” exists for two reasons. The first is that patient safety is a paramount concern. It’s irresponsible to expose oneself to unwanted bacteria. The second and perhaps more important reason this “rule” exists is to prevent the spread of antibiotic resistant bacteria within the CF community, which makes sense because it becomes a public safety issue – the public, of course, being cystic fibrosis patients since we can’t infect healthy people. If you want to learn more about the science behind that, attend a biology class at your local high school, and attempt not to be creepy.

So where am I going with this?

Over the weekend a BBC article caught my eye on my Facebook newsfeed. To answer your first question, no, I do not find myself reading BBC news all the time.

The article talks about the very real possibility of a “post-antibiotic era.” While it does not mention cystic fibrosis specifically, it does implicate CF patients.

From the BBC:

The world is on the cusp of a “post-antibiotic era”, scientists have warned after finding bacteria resistant to drugs used when all other treatments have failed.

They identified bacteria able to shrug off the drug of last resort – colistin – in patients and livestock in China.

They said that resistance would spread around the world and raised the spectre of untreatable infections.

The drug mentioned in the article, colistin, has historically been a popular drug used to treat infections within cystic fibrosis since it is both strong and can be administered via nebulizer. In fact, as I sit here writing this blog post, I am sucking down some colistin right now. It has a little bit of a thick taste to it, and it probably leans towards being more bitter than it does sweet. I have also used the IV form of the drug in the past, and let me tell you, that was quite the experience – maybe I’ll write about it sometime.

The BBC comments on the study posted in the Lancet Infectious Diseases:

Common infections would kill once again, while surgery and cancer therapies, which are reliant on antibiotics, would be under threat.

Chinese scientists identified a new mutation, dubbed the MCR-1 gene, that prevented colistin from killing bacteria…the resistance had spread between a range of bacterial strains and species, including E. coli, Klebsiella pneumoniae and Pseudomonas aeruginosa.

There is also evidence that it has spread to Laos and Malaysia.

Prof Timothy Walsh, who collaborated on the study, from the University of Cardiff, told the BBC News website: “All the key players are now in place to make the post-antibiotic world a reality.

“If MCR-1 becomes global, which is a case of when not if, and the gene aligns itself with other antibiotic resistance genes, which is inevitable, then we will have very likely reached the start of the post-antibiotic era.

“At that point if a patient is seriously ill, say with E. coli, then there is virtually nothing you can do.”

The article does note that MCR-1 has been identified in 16 patients suffering from E. Coli. With that being said, don’t quit on me now – the article also mentions that there are new antibiotics on the way, but they are still in very early stages of discovery. New antibiotics, by the way, are something the world has not seen in about 30 years.

The BBC article finishes up:

A commentary in the Lancet concluded the “implications [of this study] are enormous” and unless something significant changes, doctors would “face increasing numbers of patients for whom we will need to say, ‘Sorry, there is nothing I can do to cure your infection.'”

This is a problem – a very real one. I’ve read several articles over the past year talking about the post-antibiotic era, but the BBC one is terrifying. Many of these articles attribute this to the misuse of antibiotics. Bacteria are evolving faster than we can develop new antibiotics – see above where I said it’s been 30 damn years since we (humans) have developed anything new in that department.

People with CF depend on antibiotics for survival, and organ transplants cannot be accomplished without them. The natural remedy you found on your post-graduate backpacking trip through Vietnam and Cambodia, unfortunately does not work in the real world, or in any world for that matter. Antibiotics are designed to eliminate bacteria. I very much attribute my survival thus far due in part to the antibiotics I have been fortunate enough to receive, either through IV, pill or nebulizer. The moment we lose the power to use antibiotics, is the moment we are all in trouble. Something must be done.

Last week I did an interview for the Adversity 2 Advocacy Alliance with its founder Jeff Bell. The interview aired on KCBS radio in San Fransisco, but you can listen here.