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 viewers like you. Thank you. 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 support is provided by the park foundation. Dedicated to heightening Public Awareness of critical issues. The john and Helen Glessner family trust. Supporting trustworthy journalism that informs and inspires. The ford foundation. Working with visionaries on the front lines of social change worldwide. At fordfoundation. Org. The wyncote foundation. And by tfrontline journalism fund, with major support from jon and jo ann hagler. And Additional Support 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 pati