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Antibiotic Resistant Staph Infections
oliphaunt writes "This! morning! at! Yahoo! there! is! a! story! about! drug-resistant! bacteria! This is interesting because, as of July 5 of this year, "It was the first case of vancomycin-resistant Staphylococcus aureus in the United States." Nobody can PROVE it of course, but this is probably a result of overprescription of antibiotics, and people not following doctor's directions, combined with stuff like antibiotic hand soap available over the counter. So what do we do when the bugs are resistant to everything we have? The answer is we die."
The answer is we evolve to resist them as we have for hundreds of thousands of years. Don't get me wrong, artifical defenses are great, but it's only been the last century or so that's had us relying on them so much.
Now we know what killed the dinosaurs, antibiotic soap!
The patient, a 40-year-old Michigan man with diabetes, seems to have caught the bug off an infected catheter inserted while he was in the hospital for the amputation of a gangrenous toe
Suddenly I realize that I am not having such a bad day after all.
there is zero evidence to link resistance to
vancomycin (an extremely rare antibiotic, used only
in cases of desperation) to the use of hand soap.
in my opinion the body of this article is
sensationalistic hogwash.
vancomycin resistance can come from serendipity,
from vancomycin exposure, or from a mechanism which
creates a much broader resistance to a class of
antibiotics which includes vancomycin, subsequent
to exposure to other antibiotics in that class.
hand soap is not in any structurally related class.
-I like my women like I like my tea: green-
Anyway, there are other things we can do. Phage is always there in our armoury, and unlike antibiotics, bacteria have little chance of out evolving it...
(For those not in the know, Phage is the name given to viruses that have coevolved with bacteria. The idea is that you hunt around for a virus that kills the bacteria and spray the viruses around and the bacteria is killed. It seems to work... the Russians use it sometimes, it's cheaper than antibiotics.Viruses mutate faster than bacteria can.)
-WolfWithoutAClause
"Gravity is only a theory, not a fact!"Triclosan is the active ingredient in the antibacterial hand soaps.
From the Soap and Detergent Association:
http://www.sdahq.org/health/faq.html
One statement they make is "Washing with plain soap and water removes many germs from the hands. Antibacterial soaps contain an active ingredient that keeps the number of germs at a reduced level for an extended period of time, providing improved germ control."
So don't let the advertising con you into thinking that plain soap has suddenly stopped working. Triclosan just makes your hands temporarily unsurvivable for germs. Everything is an issue of degrees, and this seems like using a scorched earth policy on your hands.
Take it for what it's worth.
Anyone else think the poster has had a little too much caffeine?
I had a staph infection two years ago, and it really was a bummer. Happily it was just at the skin level or I would probably not be here now. We have known for quite a while that staph would eventually beat vancomycin, it was just a matter of time. That's why it was only used in the most dire cases, in the hope of extending the time before it became resistant. It didn't occur because of not following doctor's orders, since it would probably only be used under intensive care like conditions, with either IV or daily distributions of pills.
Incidentally, new research has focused on interrupting the communication that Staph does to announce its population is large enough to attack. It doesn't attack right away but waits for numbers to be large enough to overwhelm the immune system. If it can either be triggered to attack before numbers are large enough, or never recieve the attack signal, staph infections would likely be dealt with by the immune system.
Degaussing scares the bad magnetism out of the monitor and fills it with good karma.
In one article I read on this topic, antibiotic resistance was described as an armor for the bacteria. The analogy was further extended to show that there is a metabolic cost for that resistance. In other words, all else being equal, antibiotic-resistant bacteria are less competitive than those without the resistance. It's just that when antibiotics are around, that resistance makes all of the difference.
Antibiotics come in families, and a given family will work against bacteria in largely the same way. Imagine if we could take an entire antibiotic family out of use around the world for some period of years.
As mentioned earlier antibiotic resistance comes with a cost. If an antibiotic family is intentionally unused, under evolutionary pressure bacteria would now tend to drop their resistance. I have no idea how long it would take, but I'm sure it could be estimated by someone 'skilled in the art.'
This would suggest a worldwide policy of antibiotic rotation. Of course doing anything on a worldwide basis is tough, as is telling someone to quit making money on penicillin-family antibiotics for a decade.
The living have better things to do than to continue hating the dead.
I don't know how the industry uses these words, but they way I understand them, Antibacterial is usefull against bacteria type microorganisms. Whereas antibiotics specifically target specific microorganisms (bacteria, but also viruses, fungi...etc)
IE, clorax is Antibacteria, but not Antibiotic.
While i suppose when you throw all the permutations of evolution as a denominator of the probability it becomes 'possible' it's still, unlikely, that a super antibacterial resistent bacteria is going to be evolved by using antibacterial soap instead of other soap.
Abuse antibiotics though, and we could be up the creek.
-Malakai
A Dragon Lives in my Garage
See my previous post, since I don't want to repeat myself too much.
... I guess I just repeated myself a bunch. Oh well.
The short version is antibiotic hand soap breeds bacteria that are immune to that type of antibiotic. Since there are only three or four different types of antibiotics out there, breeding a resistant strain from hand soap means the strain is also immune to an entire type of antibiotic, so if you have a staph infection and use the soap you could get a strain of staph resistant to whatever particular antibiotic is in the soap. If someone else living in the same household gets infected with this new resistant strain of staph, they can't be helped by an entire type of antibiotic, focing the use of second- or third-line antibiotics. And the only way to breed a resistant strain is to use an antibiotic on it.
Hmmm
Mr. Spey
Cover your butt. Bernard is watching.
vancomycin (an extremely rare antibiotic, used only in cases of desperation)
this is what vanco is supposed to be, but in fact it is used quite frequently, and is actually gaining popularity given that virtually every major medical centre in the US is now seeing the prevalence of MRSA going through the roof (as MRSA is resistant to pretty much everything except for vanco, linezolid (Zyvox) and dalfopristin/quinupristin (Synercid)). vanco is now the drug of choice in many institituitions until lab sensitivities come back, at which time a patient with a staph infection may be switched to something else or remain on vanco. with infectious disease health care providers simply cannot afford to prescribe nafcillin and wait a day for labs to come back and tell them whether or not the organism is resistant, so they prescribe vanco first and modify later (and you would too if you were on the east coast and 1 in 3 staph infections were nafcillin resistant)...
furthermore:
vancomycin resistance can come from serendipity, from vancomycin exposure, or from a mechanism which creates a much broader resistance to a class of antibiotics which includes vancomycin, subsequent to exposure to other antibiotics in that class
there are currently no antibiotics on the market in use with the same mechanism of action (MOA) of vanco (which is a glycopeptide cell wall inhibitor). the Penicillins/cephalosporins are cell wall inhibitors of a different nature, and do not promote resistance to vancomycin directly, although ceftazidime (Fortaz) independently causes an increased incidence of VRE (Vancomycin-Resistant Enterococcus (not the same as staph a)) for reasons unbeknownst to the medical/research community. Likewise aminoglycosides, flouroquinolones, macrolides, et al. also do not increase the incidence of vancomycin resistance in and of themselves. however all of these compounds increase the selective pressure on organisms, thus favoring strains that more easily acquire resistance than their counterparts... But contrary to your point most of the time when you hear about cross-resistance they're talking about resistances to drugs in the same class or with the same mechanism of action such as all beta-lactams (pens & cephs), all aminiglycocydes (gent, tobra, amikacin), all flouroquinolones (levofloxacin, ciprofloxacin, gatifloxacin, etc) and the like, but this isn't something that normally happens with outliers such as vanco, zyvox, synercid, rifampin, etc.
just as an aside (but of interest), the CDC labels VISA/GISA as staph a with a minimum inhibitory concentration (MIC) of vanco to be greater than 8mcg/mL, and VRSA to be greater than 32mcg/mL. When one does pharmacokinetic dosing for vanco, by the book one looks for a peak serum vanco concentration of 20-40mcg/mL, and a trough of 5-15mcg/mL (usually broken down to 5-10 for normal infections and 10-15 for serious concentrations.) But in real life people don't even look at the peaks (it doesn't improve outcomes and costs too much to do if it doesn't help), just the troughs, and as you probably know vancomycin is a time-dependent killer (like the beta-lactams (with the exception of the carbapenems of course) and macrolides) so a range of 8-32mcg/mL for an intermediate strain won't necessarily tell you if it will work in a clinic, especially since many infections are in areas with poor circulation (necrosed tissue etc) in which the drug levels won't be anything near what they are in the plasma (due to poor tissue perfusion). And thus the distinction between VRSA and VISA/GISA are more of scientific/epidemiological significance than of actual clinical significance (especially if you've only got a vanco peak of 20mcg/mL and your MIC is 25 for the strain). And if you're just looking for hard-to-treat cases of Staph a, then this news is nothing new...
-tid242
With a few exceptions, secrecy is deeply incompatible with democracy and with science. --Carl Sagan
There are lots of things that are 'antibacterial' without being an 'antibiotic'. Chlorox is certainly antibacterial, but it's not an antibiotic in the sense that a doctor prescribes.
The compound used in most soaps, triclosan, isn't related to penecillin, erythromycin, etc. I certainly wouldn't recommend you eat Dial.
So washing your hands with antibacterial Dial isn't going to doom you to death by vancomycin resistant staph.
There are good reasons to avoid antibacterial soap, like killing of beneficial organisms, but don't confuse that with antibiotic resistant organisms caused by misuse of prescribed antibiotics.
My wife seems to be a staph carrier. It isn't strong. When she gets tested, she usually has 3 different strains in her system. If they give her drugs for it, then the next time they test her she has 3 different strains.
The last big flare up occured in 1998 when I was sent to Calgary during my first wedding anniversary (I felt real bad after this.) She had a major flare up of staph A and was recordered for Galveston county. I look at the MMWR at the CDC and think of her when I see the staph #s. Anyway, the doctors had said they had not seen so many different staph infections in one person since college and then only in a text book.
She's fine now and it's just as I said, they are all weak strains. I've never caught any from her, but she always has them.
"Only one thing, is impossible for god: to find any sense in any copyright law on the planet." Mark Twain
The problem is that resistance is not limited to one strain. Bacteria have the ability to swap genetic "cartridges" that confer antibiotic resistance to completely different types of bacteria. One strain we can deal with, widespread resistance to known antibiotics is another matter. There's a very real probability that the human race could be severely deciminated, if not completely wiped out. I'm not saying that such a doomsday scenario is unavoidable, but efforts should be made to reduce its likelihood.
only three or four different types of antibiotics
Bollocks. There are only three or four different classes of antibiotics, but many more types. The classification of antibiotics groups them according to the way in which they interfere with the bacteria, but resistance to one member of a class doesn't result in resistance to other members of the class under most circumstances.
The strongest things survive
No, the fittest things survive. In evolutionary biology, fitness is defined as the ability to pass on your genes. This may be related to strength. It may not.
nature is developing a new device
Nature is developing nothing. There is no consciousness guiding the development of these organisms.
The number of bacteria on the planet is unimaginably huge. Bacteria are capable of passing genes between each other horizontally. As a result, you can effectively treat the entire bacterial population of the planet as a single gene pool. Given enough time, any beneficial mutation will pass from one end of the population to the other.
.
Now, this is obviously a problem in terms of antibiotics. Many antibiotics are still generated from natural sources, and some fairly harmless bacterial species has probably developed immunity to that (by virtue of happening to live in the soil around the ferns that secrete it, for example). The genes providing that immunity can pass to pretty much ever other bacterial species on the planet. This isn't a rapid process, but it will be sped up by imposing additional selection pressure - for instance, treating bacteria with that antibiotic.
Overuse or inappropriate use of antibiotics isn't really the trigger here. Imposing any degree of selection pressure will result in the same thing happening - it's only a matter of timing. More careful use of antibiotics may give us a few hundred years more if we're lucky, ten years more if we're not. The point to remember is that no matter how clever your antibiotic, there will be a gene in some bacterium somewhere that provides immunity to it. And, if you wait long enough, that will end up in the bacteria you're trying to kill.
It's not an intractable problem. There's likely to (somewhere) be an enzyme that will digest your antibiotic, but if you develop something that degrades that enzyme you're back in business. The chances of a random bacterium having both the resistance and an unrelated gene that protects the resistance mechanism is the square root of the probability of it having the resistance alone (probably less - having the resistance is likely to have proven useful in nature, and so will be more popular. The probability of having both genes will therefore be corespondingly less), which gives us a fighting chance. New techniques in drug development are likely to mean that we can design new drgs that can defeat any resistance mechanism that turns up.
Remember though, antibiotics have only been around for a hundred years or so. Humanity survived before then. Antibiotics increase average life expectency, but they're not required for continued human survival.
My final year dissertation was on this topic. You can find a copy at www-jcsu.jesus.cam.ac.uk/~mjg59/resistance.pdf
Righto. According to information on the FDA web, the first bacteria resistant to Penicillin was found only 4 years after the drug went into mass production.
That was in the dark ages of molecular biology. We have a much learer understanding now of how drug resistance is shared between bacteria, but that doesn't mean that we can stop it. In fact, it's pretty clear that as soon as one wild population of bacteria develop a resistance, it's just a matter of time before they all have it.
And the trick is, it's an arms race, and patients are not passive objects to be disinfected. You can wipe a counter down with 100% ethanol, and then set the wet spot on fire, and that's good sterile procedure. You can't do that to someone's bloodstream. If I'm in the hospital with a systemic staph infection, and my doctor wants to start me on penicillin "Just in case your Staph isn't resistant," you can bet your ass that I'll have a new doctor pretty fast. I'm in the hospital, the guy next to me is dying, and I have to wear a dress with no back. I want the best bug-killer he's got, and I want it now!
and anyone who knows better is going to think just like me! How can you, a healthcare provider, reduce the frequency of behavior that encourages resistance, when your patients' most rational demand is for you to break out the big guns right away?
Humpty Dumpty was pushed.
point taken. But like I just responded to someone else, it's an arms race. Penicillin was overprescribed in the 40's and 50's, people didn't understand that they had to take all the pills, for the whole 12 days, and now 30% of strep pneumoniae bugs are penicillin resistant, and that's in all patients, not just those who have been cross-contaminated in hospital environments. I challenge you to find public numbers for hospital environments- I bet Kaiser Permanente is going out of their way to keep those stats off the Net.
handsoap is the same thing, on a wholly different scale. What happens when Triclosan stops working, because every bacterium on the planet has been exposed to some base level, and have developed resistance? People still want to buy antibacterial soap, right? So we'd better start putting a stronger chemical in the soap. Lather, rinse, repeat.
Maybe it's over the top to suggest that you'll be able to buy vanco soap over the counter in 50 years- but maybe it won't do you much good by then.
Humpty Dumpty was pushed.
Doesn't make much sense, but it's part of their name.
May we never see th
I think we are breeding a strain of super resistant-bacteria resistant human...
"Stupid f*^$ing white man..." - Dead Man
-grin-
I've stopped buying antibacteria/antibiotic hand-soap. What doesn't kill me makes me stronger, right?
Some of the stuff I've been reading lately, dumbed down sufficently that I might understand it of course, involves recent research on the sugars our bodies use as building blocks. Knowing more about these sugars, and how organisms interact with them on a fine level may well allow us to build whole other classes of antibiotics (and a wide range of other therapies besides). With the insight we seem to be gaining in to how to more inventively interfer with the machinery at that level, it would seem that bacteria might be the ones with cause for alarm. They might be winning one battle, but it's starting to look like we'll be winning the war. To say nothing of the searches far and wide for natural ready made solution. Some poor researchers even humped out to indonesia to gather samples from komodo dragons to see what exactly might be the source of their appearent immunity to what are certainly lethal bacteria.
Some of the studies that have come out make me wonder if our particular pursuit of wellness is such a good idea. Kids who grow up with pets have fewer allergies, kids who play in the dirt are less likely to have asthma. Maybe being dirty and occansionally ill is like immunological exerciese. You always want to stretch first, and should never over do it; but, in general, it's a good thing.
--Jimmy has fancy plans; and pants to match.