Lifeline, A Musical That Raises The Alarm On Antimicrobial Resistance
The past, present, and future of antibiotics are dramatized in the musical Lifeline , which on September 21, 2024 held a gala performance to precede the 79th United Nations General Assembly's September 26 Antimicrobial Resistance (AMR) meeting. The show playing at the Alice Griffin Jewel Box Theater at The Pershing Square Signature Center through September 28, dramatizes Alexander Fleming's discovery of penicillin and the personalization of the AMR global crisis.
Historically, antibiotics have saved hundred of millions of lives, but they are in danger of being defeated by the evolving microbes that circumvent their protection. "Without antibiotics, we can't have modern medicine," said Dame Sally Davies, formerly Chief Medical Officer of England and Chief Medical Adviser to the UK government, and now the UK Special Envoy on Antimicrobial Resistance.
In The New Statesman , she expressed concern that "One in four patients with cancer gets a nasty infection that can kill without effective antibiotics." In her 2013 book, The Drugs Don't Work: A Global Threat , she wrote, "If we don't take action, treatments for infectious diseases may not work" and "In 20 years, we could be back in the 19th century where infections kill us after routine operations."
The lack of new antibiotics, diagnostics, and therapeutics enhances the increasing danger of antibiotic resistance. And using current diagnostic methods, culturing blood or tissue samples to identify the organisms responsible for infections takes 24 to 72 hours to yield initial results. For every hour delay in initiating targeted antimicrobial therapy for a patient with sepsis, there is a 7·6% decrease in survival . Timely and accurate diagnosis of infection is essential for reducing morbidity and mortality as well as reducing antibiotic misuse or overuse. Diagnostic uncertainty in presumed self-limiting or viral infections can lead to unnecessary antibiotic prescribing. In short, traditional diagnostics and therapeutics are no match for the ever-evolving pathogens of today.
Thankfully, in addition to raising awareness through the show, there is a ray of hope. New rapid diagnostics first identify the organism so that AI infectious disease platforms can then recommend the best antibiotic regimen for an individual patient.
The fight against AMR will not be won by chasing new antibiotics alone—we must stop antibiotic misuse in real-time. Prxcision, Inc., the sponsor of the Lifeline gala, is a company with an Electronic Health Records-integrated AI platform that takes diagnostic data, patient and laboratory information and presents the clinician with a rank-ordered list of regimens right at the bedside. Prxcision leverages 20 years of knowledge from ICPD, Inc. , a company involved in the development of about 90% of FDA-approved antibiotics over the past two decades. The full Prxcision concept can be found at Prxcision | Infectious Disease Artificial Intelligence .
Together with rapid diagnostics, AI-powered decision support tools like pRxcision® disrupt the cycle of antimicrobial resistance. With rapid diagnostics identifying organisms within hours not days, AI then ensures the right drug, dose, and duration as clinical conditions change. This results in the patient being on the most effective regimens from diagnosis to discharge. This breaks the resistance cycle, reduces the economic burden of infectious disease, and ultimately saves lives.
The arts are sometimes an excellent way to portray the agonies and ecstasies of disease and suffering. The creative team of Robin Hiley, Becky Hope-Palmer, Wayne Palmer and Neil Metcalf conceived Lifeline to humanize the threat posed by antimicrobial-resistant organisms or superbugs by describing the journey of a single immunocompromised patient who develops an antibiotic-resistant bacterial infection. Without advances in diagnostics and therapeutics, this could be a story we all share.
Alexander Fleming predicted the message of Lifeline shortly after he discovered penicillin. In his 1945 Nobel Prize lecture, Fleming said, "It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations insufficient to kill them, and the same thing has occasionally happened in the body."
His prescient statement rings true today with the evolution of organisms resistant to a host of antimicrobials due mainly to the misuse and overuse of antibiotics. In 2015, Margaret Chan, then the World Health Organization Director-General, echoed Fleming's warning in her address to the G7 health ministers meeting, saying, "With few replacement products in the pipeline, the world is heading toward a post-antibiotic era in which common infections will once again kill."
We may already be in the early stages of a post-antibiotic era. In 2019, 5 million deaths were associated with bacterial antibiotic resistance, including resistance to very expensive last-resort antibiotics. The COVID-19 pandemic spawned an increase in, often inappropriate, antibiotic usage, which fueled additional antimicrobial resistance.
The message of Lifeline is that of Fleming for the modern era. Whether indicated and appropriate or not, the culture of shotgun antibiotic administration must end. It is folly to continue current protocols that treat first and diagnose second. It may seem sophomoric, but we need real-time diagnostics to identify pathogens, AI infectious disease platforms, the next generation of antimicrobials, and therapeutics to counter the inflammatory devastation of uncontrolled infections if we expect to survive these unseen foes. As predicted by Fleming and dramatized by Lifeline, the microbes are evolving; this is no time for inaction.
