Maria Jarchow almost died after running the gamut of antibiotics to treat a golden staph infection. Photo: Pat Scala
It's difficult to know precisely when Maria Jarchow should have died but didn't. It might have been in 2000 after she was diagnosed with cancer in her spine and spent months lying in a hospital bed so sick from the chemotherapy that her oncologist told her there was nothing more to be done.
Then a neurologist who had heard about Jarchow's case came to see her on the ward and proposed a surgical solution: a metal frame inserted inside her body to support her spine, which hopefully would then allow her to regain her strength to be able to cope with the rigours of stem-cell treatment.
''I got lucky, and then I got very, very unlucky,'' Jarchow explains. At 72, she is a 13-year veteran of Australia's health system and the many false dawns patients such as herself live through as doctors experiment with various drug cocktails in the hope they may save a life they had privately given up on.
Infectious diseases specialist Karin Thursky says it's extraordinary that Jarchow survived. Photo: Simon Schluter
The stem-cell therapy - a relatively new treatment a decade ago - didn't work, but an experimental chemotherapy drug did, putting Jarchow's cancer into remission.
''The operation saved my life because I was able to have all these treatments,'' she says, ''but it also nearly killed me in the end.''
She became one of the 180,000 Australians who pick up an infection in hospital - in her case, the potentially fatal superbug Staphylococcus aureus, or golden staph. The metal screws that held her spinal brace together became home to the bacteria and for years refused to die as one antibiotic after another was tried but failed to kill the infection.
''The screws began to protrude through my skin, then they turned black and I had a colostomy bag attached to my back to drain the infection. Black pus just poured out of me and I kept having to go back to hospital because I would get septicaemia and my body would shut down.''
The superbug definitely should have killed her, says Jarchow's infectious diseases specialist from the Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Associate Professor Karin Thursky. She is full of admiration for Jarchow and says her case could be written up in a medical journal because of its medical significance.
''We went through all of the available options over the years, but her bug became very resistant and we were faced with having to commit Maria to a lifetime of intravenous antibiotics,'' Thursky says.
''In the end - and this is what is so amazing about Maria - we had nothing left to try except an old-fashioned oral antibiotic, which is normally used for multi-drug-resistant urine infections, a last-line treatment that we had no real reason to believe would work.''
That was in January 2012. Last week, Jarchow was told she was cured. The golden staph had gone. She is now walking around on a broken hip - ''it's swinging in the breeze'', says Thursky - because Jarchow isn't game to have any more surgery for fear of infection. ''The cancer has been nothing compared to this bug - nothing,'' she says.
Jarchow's story illustrates what the World Health Organisation refers to as one of the greatest threats to human health. Antibiotic resistance.
When the WHO warns of an impending global disaster, we should pay attention. But as some scientists and doctors are asking, is it too late? Are we already living in the post- antibiotic age? The fact that Jarchow survived the bacterial onslaught is what makes her case fascinating.
While she was winning her fight against the superbug, a Wellington teacher, Brian Poole, was losing his by becoming, it is believed, the first New Zealander to have contracted a super-superbug that rejects every antibiotic.
The 68-year-old died in July from complications caused by a stroke, but doctors insist his immune system was already weak from fighting a strain of bacterium known as KPC-Oxa 48 - an organism Poole picked up either during hernia surgery in India two years ago or brain surgery in Vietnam early this year after his stroke.
Wellington Hospital clinical microbiologist Mark Jones told Fairfax Media: ''Nothing would touch it. Absolutely nothing. It's the first one we've ever seen that's resistant to every single antibiotic known.
''This man was in the post-antibiotic era, and this is why so many agencies over the world are raising alarm bells.''
Britain's chief medical officer, Sally Davies, has described resistance to antibiotics as a ''catastrophic global threat'' that should be ranked alongside terrorism.
Australia's chief scientist, Ian Chubb, has warned: ''Once we truly get into the post-antibiotic age, people will die from common infections, such as strep throat.''
His office released a report saying the unrestrained use of antibiotics in medicine and agriculture was driving the growth of drug-resistant organisms. The problem was further exacerbated by a lack of research to discover new antibiotics.
The report's authors, Simon Prasad and Phillippa Smith, said urgent action was required to revive research into new antibiotics.
''Only one antibiotic that works in a novel way has been discovered and developed for use in humans in the past 50 years,'' their report said, adding that more prudent use of current antibiotics and greater surveillance of infections were also crucial to reducing the spread of drug-resistant microbes.
''There is now a genuine threat of humanity returning to an era where mortality due to common infections is rife.''
Not long after this report was released, a Senate inquiry into antimicrobial resistance tabled its report in July, but it was buried amid the Labor government's post-Gillard leadership dogfight.
It made many recommendations, including the establishment of an independent body, such as a centre for disease control, to co-ordinate Australia's response to antimicrobial resistance; improved government surveillance for resistant bacteria; and more thorough monitoring of antibiotic use.
It also recommended screening food imports for drug-resistant organisms, as well as investment in research for new antibiotics.
''The chief scientist has rung the alarm again and we simply cannot afford another decade of inaction on this issue,'' says Greens senator Richard Di Natale, who was the chief instigator of the inquiry. ''A similar inquiry 10 years earlier made the same set of recommendations, but then the post-antibiotic age seemed a generation away and people just didn't take it seriously - to our peril.''
Australians love their antibiotics. Data shows the nation to be one of the highest users in the developed world, with about 22 million prescriptions written every year in primary care alone, and that's a conservative figure.
The public is driving some of this pill popping. According to a survey by NPS MedicineWise, the national prescribing service, four in five Australians expect their GP to write them a prescription when they have an ear, nose, throat or chest infection. This despite the fact antibiotics are useless against most acute respiratory infections, which are usually caused by viruses.
Antibiotics are lauded as the 20th century's greatest medical achievement, and not just because they have saved millions of people from dying from simple illnesses such as a throat infection or pneumonia. Much of the advancement in modern medicine - organ transplantation, all surgical procedures - has only been possible through access to antibiotics.
Last month The Age reported that a weepy eye in a newborn baby was the first clue in what turned out to be a critical piece of health detective work regarding antibiotic-resistant bacteria.
A vigilant nurse working in Monash Medical Centre's special-care nursery, where the most vulnerable babies spend the first days of their lives, noticed the baby's gluey eye and alerted doctors.
To everyone's surprise, the baby, who was otherwise thriving, tested positive to a potentially fatal superbug.
It was the first time the antibiotic-resistant bacterium vancomycin-resistant Enterococcus, or VRE, had infiltrated the hospital's nursery.
''We then began screening all our new babies, including those that have been born since that first infection, and to our surprise, 38 babies across our three hospitals have tested positive for VRE,'' said the medical director of infection control at Monash Health, Dr Rhonda Stuart. The babies are not sick and most have gone home, albeit with this superbug dormant in their tiny guts.
In explaining the antibiotic catastrophe, Professor David Paterson, an infectious diseases expert from the University of Queensland, mainly steers clear of the apocalyptic scenario to let the facts speak for themselves. But they are frightening.
''I looked after a patient a year ago and she gave me a letter,'' he recalls. ''She was in her 70s and, according to her letter, back in 1943 she was seriously ill in hospital in Queensland.
''Her father went to a nearby US army base and made a plea for this new drug called penicillin. He got it for his daughter and I have no doubt that gift of penicillin saved her life.
''Fast forward to last week when one of my colleagues told me about a patient who was in hospital after returning from overseas and who had an untreatable infection that had to be treated with surgery not antibiotics.''
Last year on a trip to India, Paterson visited a large private hospital, where he said they had stopped giving chemotherapy to treat cancer. If you were in a public hospital, you could still receive chemotherapy but the risk of becoming infected with a superbug in an Indian hospital generally is so high, it invites death.
''You could not safely receive chemotherapy treatment for cancer in one of the largest cities in India. These citizens are living in the post-antibiotic age,'' he says.
For Australians, one of the greatest risks of catching a superbug is travel, Paterson contends. More especially, through inter-hospital transfers.
''We are seeing it with soldiers coming back from Afghanistan and Iraq and travellers returning from Greece, certain parts of the US, most of Asia, where we estimate you stand a 25 per cent chance of picking up a multi-resistant bug.
''Medical tourism or crashing your motorbike in Bali represents the same thing - a high-risk stay in a hospital in Asia. Avoid both,'' Paterson says.
One of the most insidious means by which Australia's antibiotic defences are being breached is through our love of seafood.
It is estimated that $1billion worth of seafood was imported into Australia last year. But as Australian National University infectious diseases expert Professor Peter Collignon says, with every plateful of prawns we eat, we also get an overdose of antibiotics.
''I wouldn't be eating imported seafood,'' he says.
Some foods are tested for chemicals, antibiotics and microbes. But the levels of resistance in bacteria are not tested.
''We do reasonable testing for drugs in the form of antibiotics, but we don't do superbug testing, and we need to do both for domestic products and imported products.''
The federal government is trying to set up a national surveillance system that will tell us how much antibiotics are being used in the community and how much in hospitals.
Professor Lindsay Grayson, from Melbourne's Austin Hospital, is one of Australia's foremost experts in infectious diseases and has been agitating for years to try to get some answers to some fundamental questions.
''We need to know, but don't at present, two pretty basic things: how common are superbugs in the human and animal populations in Australia; and how prevalent is the use of antibiotics in both of these groups? Until we know the scale of the problem, it's pretty hard to treat it.''
Grayson is seeing some alarming signs in the patients he treats.
''Three years ago we were seeing the superbugs only in immuno-suppressed people - those with cancer or transplant patients. Now healthy people in the community are getting very sick with superbugs, especially in their bowel and their urinary tract. The only thing these people had done was perhaps travel overseas. Some had not even done that.
''We had three recent patients from country Victoria who hadn't been in hospital, hadn't travelled either, and they had superbug infections. Now how did that happen?''