Antibiotic resistance - Netflix, HAL 9000 and the $100 billion question

With Yuval Noah Harari’s ‘I told you so’ still ringing in our ears and the battlefield still ablaze, one cannot help but wonder what the next microorganism assault on humankind is going to involve.1 While we are still fully engaged on our main front, another old enemy is gathering strength on our flanks. Bacterial resistance has been described as the single most important threat to public health in the  21st century.2 The United Nations interagency group on bacterial resistance estimates that drug-resistant disease could rise from a current figure of around 700 000 deaths per annum to around 10 million a year by 2050, if we don’t act.3 The six most common bacterial pathogens in orthopaedics are currently all on the CDC (Centers for Disease Control and Prevention) ‘Urgent’ or ‘Serious’ threat list.4 A meta-analysis estimated that 39% to 51% of surgical site infection in the USA was caused by bacteria that are resistant to  the standard prophylactic antibiotics.5 Our primary tool against resistance is antibiotic stewardship programmes. But wil it solve the problem?