Hunting the Superbugs

The trigger for this crisis was hiding in a urine sample. An invisible organism, one thousandth of the size of a grain of rice. A mutant bacterium capable of surviving antibiotics: what science calls a superbug. The real worry was that it did not have just one mutation, but two. This made it almost impossible to detect. It was May 2020, the middle of the coronavirus lockdown. The scientists were overwhelmed, taking turns to go into the lab each day, a bubble of three people to do the work of twenty. Although the mutant bacterium seemed unusual, they didn’t have enough time to study it in depth. They took it as an isolated case. Four months later, it appeared in another sample. The following month, in 35 more. Almost a year later, they had 1,200 in the laboratory. The samples were from patients who had caught “common” illnesses — UTIs, skin or ear infections, pneumonia — but no treatment was working. Many of them died within days.

In the “Antimocrobial Service”, the laboratory where the samples were collated, a team of scientists from the Instituto Malbrán — a public body in Argentina researching how infectious diseases behave and seeking solutions— had found a sinister pattern: a pandemic within the pandemic. In April 2021, almost a year after they had detected the mutant bacteria, they issued a warning to all hospitals in the country, scientific societies and global health agencies. A twelve-page document entitled “Epidemiological alert” in red capital letters. The first of a series of warnings that, in the following months, would be issued by Uruguay, Ecuador, Paraguay, Belize, Chile and Guatemala. “The discovery must be considered high risk,” one paragraph insisted. “All members of the health teams must do their utmost to ensure the rapid detection and containment of the mechanism.” The words “rapid detection” and “containment” appeared in capital letters, underlined. This technical language concealed an apocalyptic message: we’re on course to die from infections we haven’t seen since the Middle Ages.

* * *

The Instituto Malbrán occupies a block of the Barracas neighbourhood, a manufacturing district in the south of Buenos Aires. The main building has two levels with high ceilings and geometric floor tiles. Walking in, you’re greeted by the kind of marble staircase that wouldn’t look out of place in Gatsby’s mansion, which branches into two to reach the upper floor. All the walls are decorated with framed photographs of Nobel prize winners. The Malbrán, as it is known around the world, was established on 10 July 1916. It was the consequence of the worst yellow fever epidemic ever to hit Buenos Aires, at the end of the 19th Century, in which 13 million people died. Behind the main building, a small city opens up. Laboratories pop up amid passageways lined with plants, an insect house, a daycare centre and a 35-metre-high tower that served as a water tank for half a century. 13 years ago, the tower was renovated and now houses three postgraduate teaching rooms and a conference room. The top floor has a view of the park, below which they buried the bodies of thousands of yellow fever victims. 

“If I had my time again, I’d still choose this place,” Alejandra Corso, the director of the Antimicrobial Service tells us one May morning. “Here, we’re working to stop a health problem that almost no-one in the world knows about, but is just as serious as climate change.”

The Service is based at the end of one of many corridors in the main building, behind a frosted glass door. It is a small place split over two floors. On the ground floor there are six rooms with doors covered in stickers with slogans like “Never stop learning” and “Team work allows common people to attain uncommon results” Inside the rooms are black granite benchtops holding pipettes, test tubes, scales, microscopes, and dozens of Petri dishes: flat, circular containers where bacteria are grown. On the walls there are electric ovens to accelerate their reproduction and freezers calibrated to -70 degrees containing 20,000 strains of frozen bacteria. 

“The world has got used to taking antibiotics indiscriminately. And the consequence of that is that they stop working,” Alejandra explains. “This means that many infections caused by bacteria cannot be cured. It was like using a bomb to kill an ant.” 

54-year-old Alejandra Corso has been running the Antimicrobial Service for the last 16 years. She is petite, with big bright eyes framed by bold red glasses. Her bottle blonde hair is tied back, with two loose strands framing her face. She wears a white coat, jeans and sneakers. The way to her office is up a creaky wooden staircase, through two rooms and a kitchen. It is tucked away in a corner of the laboratory where there is only a table, a computer and a black and white photo of an empty park.

“If I wanted to, I’d have the media at the door here every day, but that’s what I avoid. We don’t want to drop any bombs without offering solutions,” she says, as she flops into a leather chair with tattered upholstery and exposed foam padding. “The people who work in this place live with constant fear, stomach aches, anxiety.”

There are 20 people working in the Antimicrobial Service: biochemists, biotechnologists, systems engineers, lab technicians and students from the University of Buenos Aires doing their residency. Every day, they receive hundreds of samples with bacteria from over 500 hospitals in Argentina. These are resistant bacteria that appear in urine, sputum or blood analysis. They identify them, investigate how they reproduce, design protocols so that any laboratory can recognise them, and seek out combinations of drugs to combat them. Alejandra has military-style terms for these tasks: “conduct surveillance”, “attack target”, “issue alerts”, and behind these is a growing phenomenon whose scientific name also holds connotations of war: “Antibiotic Resistance”. One of the greatest threats to global health, according to the World Health Organization (WHO), which predicted that it would kill 11,000 people per year by 2050. More than the total number of annual deaths from cancer.

“Deep down, this is a cultural problem. People think they’re being taken care of when they’re prescribed antibiotics,” she says. “They even self-medicate. That’s the hardest thing to change, and if we don’t change it, there isn’t going to be any light at the end of the tunnel.”

The Antimicrobial Service was designated the Nacional Reference Laboratory for Antimicrobial Resistance by Argentina’s Ministry of Health and, since 1986, has coordinated the country’s National Antimicrobial Resistance Monitoring System. Since 2000, it has also coordinated the Latin American Antimicrobial Resistance Monitoring System (ReLAVRA) of the Pan American Health Organization (PAHO) and has trained over 800 laboratories in Mexico, Chile, Uruguay and another 21 countries in Latin America and the Caribbean to identify superbugs. As of 2020, it is the first and only laboratory in Latin America to be designated a “Collaborating Centre for Resistance Monitoring” by the WHO. The PAHO defines it as a “state-of-the-art” laboratory, “key to tackling antimicrobial resistance”, “with the highest quality standards in the world”.

The Service identified the most dangerous superbugs known to man. In 2006, they discovered Klebsiella Pneumoniae Carbapenemasa, (KPC), which has an enzyme — a protein that alters cell function — capable of rejecting all antibiotics. Seven years later, they discovered that New Delhi Metallo-β-lactamase (NDM) had reached Latin America, with another enzyme that lurks in superbugs and makes them almost invincible. These two superbugs appeared in Argentina through people who had travelled abroad. During the coronavirus pandemic, they merged. The Service, called them “dual producers” and issued a worldwide alert: a bomb is about to go off. 

“During the pandemic, much more resistant bacteria appeared, that we had never seen before, because they used a hell of a lot of unnecessary antibiotics. The amount of superbugs in hospitals increased by 50%. What the WHO warned us against, we can now expect by 2037. There’s no leeway. It’s a race against time.”

* * *

This story is almost 3.5 billion years old. It began when there was no oxygen on Earth, the oceans were green and the skies were orange. As water flowed through cracks in the Earth’s crust at 400 degrees, the first life form appeared: single cell organisms that duplicated every 24 minutes. This barren landscape became home to an invisible community on a massive scale. One billion years later, they lived in the deserts, oceans and poles, and inside plants, reptiles and dinosaurs. They had survived ice ages, the break-up of continents, mass extinctions. In the Mesozoic era, when an asteroid with the power of 10 billion atomic bombs hit the Earth, wiping out the dinosaurs and almost all forms of life, the single cell organisms were still there, duplicating every 24 minutes. 

Science first described them in 1676: Dutch scientist Anton van Leeuwenhoek, the inventor of the microscope, observed them for the first time and called them “animalcules”, a term that defined animals that can only be seen through a magnifying glass. Due to their length, in 1828, the German botanist Christian Ehrenberg gave them a name meaning “small staffs” in Greek, by which they would come to be known all over the world. He called them bacteria.

The number of bacteria living in our bodies in unspeakable, it would have thirty zeros, and is only comparable to the number of stars in the Milky Way. The majority live in the digestive system and the skin. They absorb what we eat, strengthen the defences of our immune system, and modulate emotions. But there are organs in the body, such as the brain, lungs and liver, where bacteria become poisonous. When they invade these organs ―through a wound, air or food― they feed on them. The first person to realise this was the German doctor Robert Koch, who proved, in 1988, that bacteria caused the oldest illness known to humanity: tuberculosis, which is still the second highest cause of death worldwide. Six years later, a Swiss-French doctor called Alexander Yersin discovered that the bacterium Yersinia pestis was responsible for the “worst biological disaster in history”, an epidemic that occurred in the Middle Ages, leaving over 200 million people dead in Asia, Africa and Europe: the Black Death. 

Bacteria that infected and killed human beings were impossible to combat. That was until the beginning of the 20th Century, when a Scottish scientist called Alexander Fleming took a holiday that would change the course of human history.

* * *

Alejandra Corso decided that she was going to be a biochemist when she was seven. One night, when she felt a severe pain in the right side of her abdomen. She had appendicitis and underwent emergency surgery. The worst part, for her, came before she even went into the operating theatre: a nurse wanted to take her blood. She looked at the needle and wept with fear. But she didn’t feel the prick. “When I grow up, I want to be like her”, she thought. At the end of primary school, she asked her parents — a businessman and a homemaker — to send her to a technical school with a focus on chemistry. They said no. The entrance exam was very hard and they couldn’t afford a private tutor. Besides, these were “boys’ schools”. 12-year-old Alejandra insisted: “I want to be doing chemistry now, I don’t want to wait a thousand years.” She decided to prepare for the exams herself: practising maths on Saturdays, asking a cousin who studied philosophy to teach her semantics. She passed the exam. She became the only female student on a course with 30 boys. When she finished secondary school, she worked as a technician in a clinical analysis laboratory and enrolled in the Faculty of Pharmacy and Biochemistry at the University of Buenos Aires. She completed her studies in 1987 and got an internship at what she considered the mecca for her profession: the Instituto Malbrán.

“When I started, I was working for free”, she recalls in her office. “Everyone here started out the same. Because we love what we do, it’s fun. Now, I still work partly for free, but voluntarily. On Saturdays, Sundays, anytime we take work home. This weekend, for example, I have to do a presentation for the WHO. Fortunately, my husband understands, otherwise there would be trouble.”

When she did her internship, the place was called the Antibiogram Service. The name referred to the basic laboratory test performed on bacteria to detect whether they are resistant. In the 90s, it was renamed the Antimicrobial Service (synonymous with antibiotic) because it had become the laboratory that monitored the appearance of superbugs in Argentina’s hospitals and sought combinations of antibiotics to fight them. In those years, antibiotic resistance was emerging as a nascent global problem and most countries set up laboratories within the public health system to detect resistant bacteria. The most important on a global scale developed in the USA, UK, Spain and Sweden. 

Alejandra received a grant to train at the Microbiology laboratory at Rockefeller University in New York, a world-class medical research centre. When she returned from this stay, the PAHO called on the Service to replicate its work monitoring superbugs across the region. From 2000, Alejandra travelled around Latin America to train other laboratories: one week, she would be in El Salvador, another in Peru, the next in Bolivia. An adventure that saw the Service hit its peak, while her private life was crumbling.

“It was one of the worst experiences of my life. It coincided with the birth of Catalina, my first child. She was four months old. It was chaos. Whenever I was travelling, she would get an ear infection, and then my husband would go down with it. But I had to do it, it was a time when there was nobody with more training than me on this issue and it was a quantum leap for the laboratory. It positioned us as the region’s laboratory of reference.”

A smiling woman with black curls and a serious voice, comes into the office to drop off some papers. Her name is Paula Gagetti. She studied Biochemistry with Alejandra and joined the Service as an intern in 1999. For the first six years, until a paid post came up, she had to work evenings in a hospital to support herself. She specialises in the study of two bacteria — pneumococcus and meningococcus – which cause outbreaks of pneumonia, otitis and meningitis in hospitals throughout Argentina. She also oversees the methods used by laboratories in Latin America for detecting superbugs.

“Here, nobody stopped doing anything for family or financial reasons”, Paula says. “Vocation comes first. When Ale was travelling around Latin America, I was taking care of Catalina and taking her to daycare. She still calls me Auntie. Everyone who works here is a godparent to the others’ children. We’ll take any excuse to get together for a meal, even when someone moves house. We’ve become almost like family.”

* * *

On 28 September 1928, Alexander Fleming went on holiday and accidentally left a dish on his desk, containing a bacterium called Staphylococcus aureus. A month later, when he returned to his laboratory in the basement of St. Mary’s Hospital in London, he discovered that mould had grown around the bacteria, enveloping it like a thick storm cloud. During the First World War, Fleming had served in the Royal Army Medical Corps on the Western Front in France. In the trenches, he had discovered that the majority of soldiers were not killed by bullets, bombs or missiles. They died because they were infected with Staphylococcus aureus. The same bacteria that, in his laboratory, was colonised by a mould that grew on stale bread: Penicillium notatum. As it grew, it secreted a substance capable of killing the bacteria. In June 1929, Fleming published the findings in the British Journal of Experimental Pathology. He had discovered penicillin: a chemical that eliminated infections caused by bacteria. The world’s first antibiotic. 

Towards the end of 1945, penicillin was promoted as “the medicine that won the Second World War”. It saved over 6 million soldiers in the Allied army. In the same year, Fleming won the Nobel Prize for Medicine. On 10 December 1945, at the prize-giving ceremony in Stockholm, the scientist, dressed in a smart suit and bow tie, gave a worrying speech: “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” What doesn’t kill them, makes them stronger.

75 years after this lecture, as 2020 wore on, the samples with the mutant superbugs accumulating at the Antimicrobial Service of the Instituto Malbrán carried a horrifying message: Fleming’s prophecy had come true.

 * * *

The world produces over one hundred tons of antibiotics every year: the equivalent of two Titanics full of medication. But two thirds of that production is intended for “animal improvement”. Millions and millions of pigs, cows, turkeys and chickens are injected to accelerate their growth so that they reach butchers’ shops more quickly. Only one third of antibiotics are used in the human healthcare system. And half of that share are used to treat colds and flus: illnesses that are not caused by bacteria. According to the PAHO, this happens because “self-medication with antibiotics is a deep-rooted custom, and it’s still growing, sometimes replacing a medical consultation.” According to the organisation, “even though the sale of antibiotics without a prescription is prohibited, in up to 80% of cases, it is possible to procure antibiotics from pharmacies, without a script, or even worse, they are prescribed there or recommended by friends, relatives or colleagues.” The world is overrun with antibiotics that are not attacking bacteria but making them more resistant. Back in 2019, a study published in the scientific journal The Lancet estimated that over 1.2 million people died each year from illnesses caused by superbugs. “When bacteria are exposed to an antibiotic, within five years, maximum, they mutate and adapt”, explains scientist and commentator Alejandro Vila, in his calm, nasal voice. “Meanwhile, it takes human beings 15 years to develop a new antibiotic. There’s no way we can win the race against bacteria.” Alejandro Vila is speaking on the phone from Ezeiza International Airport in Buenos Aires, Argentina. He is about to board a plane to L’Aquila, a medieval walled city, two hours away from Rome, Italy. He will be giving a talk entitled “Evolution of NDM variants: A journey from test tube to bacterial periplasm” at the International Congress on Beta-lactamase, a gathering of scientists from around the world to present advances in the field of antimicrobial resistance. Vila is a researcher at the Institute of Molecular and Cell Biology of Rosario (IBR), part of Argentina’s National Scientific and Technical Research Council (CONICET), the country’s largest scientific organisation. His research aims to design a drug to neutralise lactamases: proteins found in certain bacteria that destroy antibiotics. 

“The majority of resistant bacteria are in hospitals. From the point where a patient enters the hospital with an infection until a test shows which specific bacteria they have, there are about 24 to 48 hours”, the scientist says. “In those hours the doctors give them what are called broad-spectrum antibiotics. That’s the main problem.”

Broad-spectrum antibiotics can cure most infections caused by bacteria. According to Vila, whenever doctors deduce which specific bacteria caused the infection, they should stop using these excessive antibiotics and focus the treatment on that one type of bacteria. During the first wave of covid-19, because nothing was known about the disease, 70% of patients infected around the world received broad-spectrum antibiotics, when most didn’t need them. The effect was devastating. In Argentina alone, the percentage of patients hospitalised and infected with superbugs went from 20% in 2019 to almost double that in 2021. Superbugs appeared with new mutations, like the “dual producers” first detected by the Antimicrobial Service that, once the global alert was raised, were found in Uruguay, Ecuador, Paraguay, Belize, Chile and Guatemala. In the months that followed, these countries then sent out their own alerts. All the advice was collated by the PAHO, which issued a report in October 2021 which warned that unless measures were taken, “the risk of these resistance mechanisms spreading is very high”. 

“We are entering the pre-antibiotic era and the prognosis is worrying. The public need to help combat superbugs by washing their hands. It seems really obvious but it’s very important, and we need to take care with how we’re administering antibiotics”, Vila warns. “They must not be sold without a medical prescription, and if we do start taking antibiotics, the course must be completed. But more than this scientific education for the public, we need an awareness campaign at country level. A global plan.” 

In May 2015, the WHO launched a global action plan against antimicrobial resistance called “One Health”. As well as “raising awareness among the public” and “healthcare staff” about antibiotic use, it set targets for the next 10 years, to “strengthen monitoring and research”, “prevent infections through hygiene measures” in hospitals and, as a highlight, “increase investment in new medicines”. A plan that has been implemented in South America under the coordination of the Antimicrobial Service.

“For the big pharmaceutical companies, it is no longer profitable to produce antibiotics that, almost automatically generate resistance and stop working. This is why, so far in the 21st Century, there has only been one new type of antibiotic. There is more profit to be made from medicines for chronic illnesses, neurodegenerative conditions, cancer, or erectile disfunction. Governments need to launch health and science policies to produce new antibiotics”, Vila warns. “And to strengthen the role of reference laboratories, like the Antimicrobial Service at the Malbrán, who detect which superbugs are affecting patients and which mechanisms made them resistant, so that we can give the right treatment. In the case of the Malbrán, they take it so seriously that they have become the reference at regional level. They have an impact beyond the country. I think they’re brilliant.”

* * *

A grey cloud the size of a little finger nail is growing the middle of what looks like the surface of a green planet with bright veins. What we’re actually seeing, in a Petri dish, is Pseudomonas aeruginosa, a bacterium resistant to all antibiotics. It causes fatal infections in the blood, lungs, urinary tract and surgical wounds. The latest list of “bacteria that pose a critical threat to human health” published by the WHO in 2017, lists it among the most harmful. 

“Look how pretty it is”, says Alejandra Corso as she shows me her phone, where she keeps images of the most “attractive” bacteria she works with.

It’s a June morning and the sun is streaming through the window of the Clinic I laboratory, on the ground floor of the Antimicrobial Service. In the background a version of the song Killing Me Softly by Ed Sheeran and Miley Cyrus is playing from a computer. In the next room, there is a constant beep from a machine that can identify bacteria in seconds. Celeste Lucero, one of the biochemists in the Antimicrobial Service, places a dozen Petri dishes — the containers for growing bacteria — on the benchtop. 

“We’re basically sadists here”, says Lucero, dressed in jeans, a white coat and macrame necklace. “It's like the weird thing, the thing sucks for the patient, is entertaining for us, it’s the thing that gives us adrenaline. It's mind-blowing.” 

Celeste Lucero is 50 and has worked in the Service since 1998. She is responsible for performing antibiograms: the laboratory tests that show whether bacteria are resistant to antibiotics. Every day, Celeste grows colonies of bacteria in Petri dishes that contain “agar”, a gelatine with nutrients that helps them grow. She handles them with a “bacteriological handle”: a long metal tool that looks like a bubble blower. Onto the dish with the bacteria, she adds small paper circles soaked in 15 different antibiotics. The dish goes into the “stove” — a machine maintained at 37 degrees, which does look like an electric stove — for 24 hours. The following day, she analyses the “halos”: the grey clouds that form around the antibiotic circles. The bigger the halo, the more resistant the bacteria. 

“This is the Bible! ― Celeste says, pointing to a ring bound photocopy resting on the benchtop. 

On the cover, white text on a black background reads: 33rd Edition of the Clinical and Laboratory Standards Institute (CLSI). It contains the international standards for determining whether bacteria are resistant to antibiotics. Since the number of superbugs is always growing, the guide is updated every year. 

“The truth is that everyone who works here is crossing their fingers that they don’t end up in hospital. Us or our families. Then you’re on tenterhooks, because you know that at some point, in the hospital… It happened to my mum.”

Two years ago, Celeste’s mother was admitted following a heart attack. In the hospital, she caught pneumonia. She was taken into intensive care. After a few days, she caught a urinary tract infection. Celeste tried to keep her mother calm, but inside she was struggling with thoughts that she might have contracted a superbug. According to the WHO, most contagion happens among patients in intensive care who undergo invasive procedures: putting in respirators, catheters or IV lines. 

“I begged the hospital lab to give me her urine test so I could bring it here to diagnose her quickly. I knew that if she had a bug, it was resistant. They gave me the final sample on a Saturday.” 

Celeste locked herself in the Clinic I laboratory for the night to do the antibiogram. She left the dish in the stove and the following day when she went back to the service to measure the halos, she was holding the worst possible news in her hands. Her mother had a superbug called Proteus. The WHO list classes it as “especially dangerous”, stating under its name “causes fatal infections”. 

“When you know a bit more… how are you supposed talk to the doctor? Subtly, I told him which antibiotic to give her. Luckily for my mum, they gave her what I suggested. And my mum survived.”

* * *

“If I see a good paper, I save it so I can read it in peace at home. It’s like scientific TLC. I read it on my tablet, before I go to bed. That way, I can enjoy it in silence. Here it’s just chaos with people around all the time.” 

Fernando Pasterán is a biochemist and deputy director of the Antimicrobial Service. A man with a placid face and black beard covering part of his cheeks. He is sitting in one of the laboratories beside two residents, assessing the efficiency of an antibiotic called cefiderocol, which has just been launched on the market to tackle Pseudomonas aeruginosa. 

“We want to know as soon as possible whether cefiderocol is going to work”, Fernando says. “Recently, in Chile, for example, they launched an antibiotic on the market for a superbug that had already become resistant. As soon as it came out, the antibiotic was already obsolete.”

Every day at the Antimicrobial Service, Fernando oversees antibiotics, tests combinations to combat superbug infections, looks for new ways to detect them, and puts together protocols so that these methods can be applied in hospitals. In the documents he prepares to send to health organisations around the world, he includes drawings of zombies, graves and crows. He even studied graphic design to make them look better. In 2006, when the service discovered KPC — one of the two enzymes that make up the “dual producer” superbugs discovered during the pandemic — Fernando’s protocol included the drawing of an obelisk — the iconic Buenos Aires monument, standing almost 70m tall — split in two. Below, in red lettering, was the word “apocaliKPCsis”.

“It was a turning point for the Service”, he says, stroking his beard. The method that allowed them to discover KPC came from one of Fernando’s strange ideas. The Service received a sample from a woman who had undergone a kidney transplant. She had been in hospital for several months because her surgical wound wasn’t healing. Many years ago, Fernando had read a scientific article about the possible antibiotic properties of boronic acid, a pesticide. In the Petri dish incubating the sample, the anxiously-awaited grey halo formed around the acid. 

“The acid allowed us to detect KPC”, Fernando recalls. “It was unusual, unexpected, it changed laboratory practices around the world.” Six months later, Fernando wrote up the discovery in a paper published in the journal of the Centers for Disease Control (CDC), the most important body dedicated to disease prevention in the US. The pharmaceutical company Melinta, based in New Jersey, developed a powerful antibiotic based on boronic acid. In homage to the Antibicrobial Service, the study that assessed the efficiency of this drug was called “Tango”. 

“The people at the Malbrán have a tradition of modifying the tests for detecting superbugs that makes them unique. The best example is the use of boronic acid disks to identify KPC”, says Pilar Ramón-Pardo on a videocall from Washington. She is an Antibicrobial Resistance specialist at the PAHO. “The Service knows the problems hospitals face every day and looks for solutions using methods that are viable all over the world. This means that countries without resources can tackle superbugs. The outlook for resistance is bleak. Unless we do something collectively to stop it, it won’t be reversed. What happens in one country affects another, what is detected in one place appears in another. Superbugs need to be monitored in laboratories in every country to contain possible outbreaks. The Malbrán carried out training in Latin America, so that every country can have laboratories capable of handling the problem.”

* * *

When he found out that his mother had contracted the bacterium Klebsiella Pneumoniae, Jorge Trgovcic was reminded of the film “Slumdog Millionaire”. This story of an orphan living in the slums of Mumbai who wins the quiz show “Who Wants To Be A Millionaire?” became a global phenomenon and won the Oscar for Best Picture in 2009. 

“The protagonist knew all the answers because of his own experiences, and it was the same in my own life”, says Jorge. He is 53, with grey hair styled up with gel, and we meet on a Sunday morning in a café in San Telmo, a district full of old bars and cobbled streets in the south of Buenos Aires. “I was always aware of that name, Klebsiella. I heard it in the corridors at work. What a strange name, I would say, but I never thought it was going to ruin my life.” 

Jorge Trgovcic has worked for 31 years as a technician in Parasitology at the Instituto Malbrán, a laboratory that is one corridor away from the Antimicrobial Service. In 2017, his mother, Rosa, caught a cold. When she was seen by a doctor, she discovered that her cold was in fact advanced pneumonia. She was admitted to hospital and put on a respirator. They found an outbreak of candida, a vaginal infection caused by bacteria. No antibiotic was improving her symptoms. Jorge knocked on the door of the Antimicrobial Service and told his story to Alejandra Corso. She got in touch with the doctors treating his mother, and asked them for a sample for the Service to analyse. The antibiogram test found the very superbug that had always caught Jorge’s attention: Klebsiella Pneumoniae. 

“That’s one fucked up superbug. You think that if they treat something with an antibiotic, it’s cured, but no way. They were treating my mum with four antibiotics and nothing was working. The Service suggested a different combination, but it was too late. My mum died.” 

At the Service, Jorge’s story is a dangerous exception: they never know who is behind the samples they analyse. 15 years before Jorge brought them the Klebsiella, the Service was visited by an unknown man who had had maxillary osteomyelitis, a mouth infection caused by the superbug Staphylococcus aureus. He had been saved by a combination of antibiotics suggested by the Service and he wanted to thank them. As he told his story, the staff listened in silence, with a tear in their eyes. 

“We don’t put a face to the samples. For us they’re just bacteria”, says Alejandra Corso. “You try not to get emotionally involved, because otherwise you wouldn’t be able to work. Every case that comes here is a serious case. We can’t be grieving every time we turn the page.”

 * * *

The Chief Resident of the Antimicrobial Service, a skinny guy wearing a blue suit and earrings walks past the laboratory doors calling out: “Let’s eeeeeeeeat!” 

Every Friday, the members of the Antimicrobial Service gather in the kitchen to eat lunch and drink Fernet, a herbal liqueur mixed with Coca Cola. They’ve been doing this since the start of the coronavirus pandemic, when they took turns to come to work in bubbles of three. In those dark and gruelling days, they were drinking to cope with the work. 

“At first we really didn’t want to link coronavirus to superbugs”, Celeste Lucero recalls in the kitchen. “We were deniers. But we knew it was going to impact us in the worst way. Because obviously, with all that backlog of patients, emergency rooms overflowing… hospital-acquired infections were bound to increase. Super-resistant bacteria were bound to appear.”

On the long, white, wooden table are plates filled with bread and slices of rolled pork. There are sachets of mayonnaise, cutlery and plastic glasses, and cups that say “Cubicin. Daptomycin for infusion”: a medicine used to treat infections caused by Staphylococcus aureus. 

“Hey, is the Coke in the cold room?” the Chief Resident asks. He goes down to the ground floor, opens a fridge full of Petri dishes with bacteria, grabs a pack of soft drinks from the corner, and brings them back to the kitchen. Colourful pennants hang on the walls, and two printed sheets are taped to a window. One says: “Protocol for the safe use of the dining room” and has recommendations like “wash your hands before ingesting food”, accompanied by the relevant pictures. The other is entitled “The four Toltec agreements” and says: “1) be impeccable with your word, 2) always do your best, 3) don't make assumptions, 4) don't take anything personally.”

“We were discussing them over lunch last Friday and we said we should stick them on every wall”, says Paula Gagetti. “The first is the best one. The second one we all try to do here. The third one is hard. The fourth is impossible, because here we all turn around and say: ‘Are you talking to me?!’ We should put that one into practice more.”

Over lunch, they talk about the dress code for people who work in the Service, exchange stickers on their phones, discuss popular series and films. 

“Has anyone got the note?” Paula asks. “I still haven’t managed to get one.” Last May, Argentina put a new 2,000 peso note into circulation. It’s the highest value note in the country. One side, in dark grey and pink, shows a drawing of the Instituto Malbrán. Argentina’s Central Bank decided to use it “in homage to Argentinian science and public health”. 

“Here, I’ll let you look at it, but that’s all! They gave it to me at the kiosk the other day and I kept it”, the Chief Resident says.

After lunch, they take a group selfie and go back to work. In a corner of the kitchen sits Fernando Pasterán, answering emails on a laptop. 

“They think that the discovery of antibiotics added 22 years to human life expectancy. Now we’re going to die from an eye or ear or throat infection, anything could end up killing us”, he says, his face illuminated by the glow from the screen. “Have you seen the film Cast Away? There’s a scene where Tom Hanks extracts an infected tooth using the blade from an ice skate because he didn’t have antibiotics to treat the localised infection. Well, that’s where we’re all heading. Toothless, with no antibiotics to cure a simple mouth infection. Removing infected parts of our bodies with a blade.”