ABSTRACT
When you want to cook a frog, they say, don’t throw it into boiling water—it will only jump out. Instead, place the frog in tepid water and, ever so slowly, increase the heat.
Much like the frog that is unaware that it is being cooked, our reaction to the antibiotic resistance problem has been to wait for a crisis before responding—but the frequency of resistance has been increasing slowly and steadily. When resistance reaches crisis levels, it may be too late. Meanwhile, thousands of people continue to die or suffer from a cause that does not show up on any death certificate. A crisis need not be a sudden, uncontrollable outbreak of a resistant pathogen. Many believe that the emergence and spread of deadly infections like community-acquired MRSA already constitutes a crisis. Perhaps we will see drug-resistant pneumonia and MRSA in large numbers of patients afflicted with avian influenza, or perhaps the prevalence of Clostridium difficile, which by itself is not a drug-resistant pathogen but whose survival and proliferation have been facilitated by widespread antibiotic use, will reach epidemic proportions. Many deaths during the influenza epidemic of 1918 are thought to have been caused by untreatable bacterial infections—bacterial pneumonia, and not just pneumonia caused by streptococci but also staphylococcus-associated pneumonia. The combination of today’s highly virulent MRSA with an outbreak of avian flu could have devastating consequences.
