Study Guide-Video- The Nightmare Bacteria

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Teacher Notes

This 54:46 minute PBS documentary details three cases of people who became infected with antibiotic resistant bacteria. The patients are diverse: an 11 ½ year old healthy, active girl, a 19 year-old boy on a mission trip to India, and a woman transferred in the National Institutes of Health (NIH) Clinical Center hospital in Maryland.

Please be aware that this video is at some points difficult to watch. It profiles people who have contracted a severe infection with bacteria that are antibiotic resistant—the bacteria will not respond to antibiotics. The patients become steadily sicker and the many strategies used to treat the infection and the patients’ resulting conditions are largely unsuccessful.

Why would you want to show this video to your students?  Antibiotic resistance is not always an easy concept for some students. The patients, family members, health professionals, and researchers interviewed for this documentary describe antibiotic resistance in easier-to understand terms and the topic unfolds more dramatically as three stories that portray how antibiotic resistance forms, the increasing severity of the problem, and the consequences to resistance.

Each real-life story presents another perspective to the whole picture of antibiotic resistance. The segments can be viewed individually; each contains a lot of science content on antibiotic resistance.  But, together, the program presents a more comprehensive picture of the many facets to the problem.

The accompanying study guide presents questions that will help guide your students through the video. Questions about the three cases highlight main points about antibiotic resistance and the threat it poses to their health. These are real-life cases. The people shown in the video were devastatingly affected by antibiotic resistant bacterial infections. Underlying the stories is the ever-present fact that this could happen to anyone.

It is recommended that you watch the video before showing it to your classes.  In class, you can always fast-forward through some parts if you know where they fall in the video.  Record the times as you preview the video so you know when you want to pause and fast-forward.

You may also want to pause periodically for questions from students, to discuss a point more fully, or to allow your students to answer the study guide questions in more detail. You may also have questions of your own to add to the study guide. The study guide emphasizes the science behind antibiotic resistance and the epidemiological investigations of the infections, but also includes questions concerning other aspects of our society such as the economic considerations of pharmaceutical companies and the political aspects that influence medical research. You may choose to just use the questions in class to spark discussions and access the comprehension of your students for video content without the students answering the questions during viewing.

After the video, take a few minutes to discuss careers with your students.  What types of careers do they see portrayed in the video? How many different types of professionals are studying the problem of antibiotic resistance?

Hunting the Nightmare Bacteria Study Guide

Case #1: Addie Rerecich

  1. Addie Rerecich was a healthy, active 11 ½ year old when she suddenly got sick. She complained to her mother about pain in her hip after a soccer game and by the next day, she was admitted to the hospital. Soon, she was on oxygen and doctors reported she had pneumonia. By the time Dr. Sean Elliott saw Addie, she had boils all over her body.

What was Addie’s infection?  Explain specifically what this infection was and how Addie got it.

Addie had community associated MRSA (Methicillin Resistant Staphylococcus aureus). MRSA was usually picked up in hospital settings, but then was more routinely discovered to be out in the environments of the community.

Addie probably had the typical scrapes and cuts of the average 11 ½ year old and most likely picked at the scabs.  MRSA  bacteria were introduced into her body at that time.

  1. Addie had to be put on an ECMO machine. What did this machine do for Addie?

When a patient is connected to an ECMO (extracorporeal membrane oxygenation) machine, blood passes out of the body through large tubes and passes through the machine that does what the lungs should do; it oxygenates the blood.

  1. What are the bacterial risks to an ECMO? What happened to Addie because of the ECMO?

The tubes can harbor bacteria.  Any patient put on ECMO is at increased risk of getting other infections.

Addie was infected with Stenotrophomonas bacteria. It is a naturally resistant bacterium.

  1. Addie was infected with gram-negative bacteria. What makes gram-negative bacteria so resistant to antibiotics?

Gram-negative bacteria has an “armor” which makes it difficult for the antibiotics to get inside the bacteria and kill it. This type of bacteria is difficult to treat. (The “armor” is the unique structure of the gram negative bacterial cell wall.)

  1. When the doctors found out that the Stenotrophomonas bacteria was “pan resistant” (resistant to all antibiotics), what was the last hope for treatment for Addie?

a double lung transplant

  1. Because of the Stenotrophomonas infection, Addie’s chances of surviving the lung transplant were close to zero, according to her doctor. The doctor faced a medical dilemma. Does he use a valuable resource like a lung for “an almost no chance of survival”? What two considerations made him decide to chance the lung transplant for Addie?

The doctor said that the factors that decided the matter for him were 1) Addie’s mother was an advocate for the transplant and 2) Addie was not an unresponsive body; she communicated with them and let them know she still was a responsive person.


Case #2: “An Emergency in India”

  1. David Ricci was a 19 year old American that traveled to India with a mission group to work in an orphanage. What happened to David as the group went to work the day he was injured?

The group took a short cut and walked over train tracks. David said the train clipped the sleeve of his shirt and dragged him under the train. He lost a lot of blood at the train tracks and they rushed him to a hospital.

  1. What happened to David at the hospital?

David said that the doctor came in, took out a large machete-type knife, told nurses to hold him down, and started cutting off his leg.

  1. Within 24 hours, David was transferred to another hospital and his condition had deteriorated rapidly. He had developed a severe infection. What type of infection did David have?

India was having a “Super-bug Crisis”. Delhi water was contaminated with antibiotic resistant bacteria with the NDM 1 gene that makes bacteria resistant to almost all antibiotics. The gene can “jump” from one bacteria to another and pass along the resistance.

  1. David was flown home to Seattle. What did doctors at the Seattle hospital discover about the infections in David’s leg?

The original bacteria had passed along the gene for resistance to other infections in his leg. He had multiple infections and all were resistant.

  1. What did the doctors eventually try for treating David’s leg?

They tried a 1940’s antibiotic, colistin. The colistin had side effects and was toxic to other parts of David’s body. The doctors had to amputate more of David’s leg.


Case #3—Outbreak

  1. In 2011, a woman carrying KPC, Klebsiella pneumoniae carbapenemase bacteria, was admitted to the NIH Clinical Center in Maryland. This bacterium is known to be highly resistant. What did the hospital do to handle the infection and prevent the spread of the bacteria? Did it work?

They went on high alert to prevent the spread. They had an “enhanced contact isolation” procedure, they put the patient room at the end of the hall, and they had strict procedures for medical personnel to wear protective clothing and for hand-washing.

It worked initially because the woman was discharged and for 5 weeks there were no other cases.

  1. What happened after the 5-week period?

Another case of KPC turned up in a respiratory culture. As they investigated the infection, other cases occurred. They had an outbreak.

  1. What did the hospital do to combat the spread? Were they successful?

They tried combinations of different antibiotics, they used experimental antibiotics, they created a separate KPC patient area, and they got robots to clean the areas. No matter what they did, the bacterial infections still spread.

  1. Genetic researchers compared the DNA from the bacterial samples from different patients. What did they find?

Some patients were silent carriers. Silent carriers can transmit bacteria while not sick with any symptoms.  High tech genomic tests revealed that the outbreak would be much more difficult to contain.

  1. As the scientists searched for clues, “their worst nightmare came true”. The infection spread outside the ICU and into the general hospital population. People died from the infection and hospital administrators considered closing the hospital to new admissions. Instead, they expanded testing in order to identify the cause. What eventually happened?

The outbreak subsided.


“Life Without Antibiotics”

  1. A researcher at Houston Methodist Medical Center says “antibiotics are the only class of drugs that we have that can become ineffective.” Explain.

Other classes of drug will work the same in the future as they do now. The doctor uses cholesterol-lowering drugs, heart drugs, and drugs for high blood pressure as examples. These classes of drugs will work in the same in fifty years as they do now.  Generally, antibiotics are the only class of drugs that can become less effective over time.

  1. Dr. Brad Spellberg says “If you use antibiotics, they can become less effective for me.” Explain.

Because bacteria can develop resistance to an antibiotic if exposed over time and especially if used improperly, people may subsequently get infected with bacteria that have developed this resistance. The more you expose bacteria to an antibiotic, the more likely it is that antibiotic resistance will develop.

  1. Pharmaceutical companies started pulling out of antibiotic resistance research. Why?

If you need an antibiotic, you only need it for a short time. Drug companies didn’t think they could make as big a profit on antibiotics as they could other drugs; it costs a lot of money to get a drug on the market and drug companies want to make more of a profit on what they produce even though antibiotics that are effective against the gram negative bacteria could save lives.

  1. How has politics influenced antibiotic resistance research?

The Obama administration called for a national action plan for antibiotic research. The Trump administration has proposed funding cuts for antibiotic resistance research.



  1. What was the final update on Addie Rerecich?

Addie finally returned home after her double lung transplant. She says she is doing well, but she is weak and takes a lot of medicine to keep her functioning. She has pneumonia often, and it is always a worry that other antibiotic resistant bacteria will infect her.

The survival rate for people like Addie with double lung transplants is 80% for the first year and 50% for five years. Addie’s Mom says they have just bought her some time.

Addie was healthy, but she got infected with an antibiotic resistant bacteria.  This could happen to anyone.

  1. What was the final update on David Ricci?

It took additional surgeries and more toxic antibiotics to remove most of the bacteria from his leg. Doctors have told him that there is possibility that it is not all removed and that it may come back.

He has only 6 inches of tissue left and no muscle tissue where his leg used to be, but he walks with a prosthetic leg.

  1. What finally happened at the NIH Clinical Center?

They worked to clear the infection out of the hospital and no more patients came down with resistant infections for over a year. Then, another patient who had been admitted died from a KPC infection.