Like many slow moving disasters, it doesn't feel like one while you live through it.
An example: gonorrhea has no golden standard cure anymore. 40 years ago a single large dose of oral antibiotics was an effective cure. It made controlling it relatively easy. In the 90s, resistance to most of the common oral antibiotics became prevalent. Through the 2010s, a single dose of an intramuscular cephalosporin was effective. Now resistance to that is also common. Gonorrhea remains curable in almost all cases, but cultures and strain-specific targeting and second-line antibiotics in combination may be needed. Repeat testing to be sure it worked is necessary.
From one pill cure in 99%+ of cases, to something requiring multiple clinic visits and lots of lab work and possibly IV infusion antibiotics. The complications for public health, in terms of patient compliance, containing spread, as well as just the labour hours and case management complexity, are awful.
No matter how many new, different, or even radical antibiotics we develop, unless we get ahead of over-prescribing and under-treating (not taking all of a prescribed treatment course) we will continue to rapidly evolve more successful micro-organisms, to our own detriment.
I think it's utterly hopeless. With billions of humans, there's no way to get everyone to agree to do the right thing, both with doctors and especially patients. You just need a small fraction doing the wrong thing for something bad to evolve: look at Covid, for instance. That simply evolved somewhere at one point in time in one place, and then spread like wildfire.
It has happened. My child got a resistant strain of Shigella causing severe dysentery. After a stool assay it was found only 3 kinds of IV antibiotics were effective, with only 1 being safe for children at effective dose. And it still took a week of 3x per-day IV infusion for it to clear. The doctors said only 5-10 years ago there were still oral antibiotics that worked, but now there aren't any.
But it does. Both my grandfathers died as a result of infections with resistant strains, one of them after surgery, and the other after an extended hospital stay. Cause of death for both of them was persistent diarrhea over a few weeks. It’s quite common for tissue to become infected after major surgery (eg hip) with resistant bacteria, often necessitating another round of surgery and/or Dr-House-esque search for a particular antibiotic that will work. Older patients might not survive for long enough.
Older or sicker folks who end up in a hospital or nursing home / rehab are very vulnerable to stuff like TB or c.diff. Cdiff is huge now as hospitals purge support staff and are filthy. If you’re old or immune compromised, you’re gonna pick up a severe, hard to treat infection if you spend time in the ER or general medical area of a hospital. The “money areas” of the hospital are usually better.
Supposedly MRSA kills like 100k people per year (although maybe a good chunk of those 100k aren't getting any antibiotics at all, so it's not entirely due to resistance)
> And yet the crisis hasn’t happened. Why is that?
I used to think this, too (and this is coming from someone who worked at an antibiotic drug-discovery startup in the early 2000s).
I think it's not that there will be a comprehensive event in which "this bacterial pathogen is now unassailable by any antibiotic in our arsenal."
It's more that, if you are on the front lines of a hospital, you'll come across many (but not all!) patients with bacterial infections for whom antibiotics won't work.
If you are an MD with enough of those types of patients, it will fuck with your decision making process. It will also cause a lot of prolonged health issues as well as death. It just won't be a wall-to-wall comprehensive type of antibiotic resistance.
An example: gonorrhea has no golden standard cure anymore. 40 years ago a single large dose of oral antibiotics was an effective cure. It made controlling it relatively easy. In the 90s, resistance to most of the common oral antibiotics became prevalent. Through the 2010s, a single dose of an intramuscular cephalosporin was effective. Now resistance to that is also common. Gonorrhea remains curable in almost all cases, but cultures and strain-specific targeting and second-line antibiotics in combination may be needed. Repeat testing to be sure it worked is necessary.
From one pill cure in 99%+ of cases, to something requiring multiple clinic visits and lots of lab work and possibly IV infusion antibiotics. The complications for public health, in terms of patient compliance, containing spread, as well as just the labour hours and case management complexity, are awful.