As the military medical community fights the growing threat of antibiotic-resistant germs, a military medical historian painted a stark picture of the worst-case scenario — the stench and agony of field hospital wards in the pre-antibiotic days of World War I.
The failure of antibiotic therapy as an option is "probably the most serious and frightening thing that I’m conscious of,” said Emily Mayhew, a military medical historian who is historian in residence in the department of bioengineering at the Imperial College of London.
“I’m hoping that scientists are going to fix this, because it’s really urgent,” she told an audience at the Military Health System Research Symposium in Kissimmee, Florida. “When I think about the smell and the horror of the field hospitals in the first World War, I know what’s coming if they don’t manage to fix this."
Mayhew said that according to her scientist colleagues, the way things are going, by 2030 it could be as hard to fight these infections as it was in those World War I wards.
Antibiotics are life-saving medicines designed to kill germs, but over the years many germs have developed the ability to defeat the drugs designed to kill them. The growth of this resistance is also accelerated by the overuse and misuse of antibiotics — in many cases incorrectly prescribed.
According to the Centers for Disease Control and Prevention, antibiotic resistance is one of the biggest public health challenges of our time. Infections caused by these antibiotic-resistant germs are difficult, and sometimes impossible, to treat, according to the CDC.
Service members who deploy to areas of the world where there’s widespread antibiotic-resistant bacteria are at risk for bacterial infections. And those who are already ill, wounded or injured may be more susceptible to these infections. In addition, troops may carry these infections home with them.
Researchers, including some in the Defense Department, are working on a variety of different solutions, including some that would take us to a “post-antibiotic era,” said one DoD researcher. One possibility is a mechanism that would identify viruses and bacteria in the blood, and essentially filter them from the bloodstream before returning the cleansed blood to the body.
In World War I, in the days before antibiotics, the field hospitals had long wards with perhaps 60 to 80 patient suffering serious trauma wounds, mostly blast injuries, she said. After they survived the initial shock of their wounding, they went to a ward, and underwent operations “The infections came, the like of which was never seen before. The solution was often more surgery, or a very slow and agonizing death," said Mayhew, during a later media roundtable.
Using extracorporeal — outside the body — mechanisms, could mean removing the sepsis or infection without having to use antibiotics, said Air Force Col. Todd Rasmussen, professor of surgery and associate dean for clinical research at Uniformed Services University of the Health Sciences. And this process is not that far away, he said. “I think we’re seeing exciting research being performed.”
He noted similar technology is already being used every day in other ways, for example, with artificial kidney machines, and artificial heart machines during bypass surgery.
It also could mean earlier identification of these pathogens in the bloodstream — rather than waiting until someone has a fever before an infection is identified. This process could potentially rid the pathogen from the bloodstream before it infects the organs.
“The post-antibiotic era, identifying pathogens in our bloodstream earlier, and using non-antibiotic mechanisms to rid the pathogens from our bloodstream… [is] one area where DoD has led research, and exciting breakthroughs are being made,” Rasmussen said.
“I have a historian’s sense of what it looks like for antibiotic therapy to no longer be an option in large, open, complex wounds," said Mayhew, during a media roundtable. "So whatever I can do to add to the debate about how we deal with that in our own time is something I’m very happy to do.”