Slashdot Mirror
New Wave of Antibiotic-Resistant Bacteria
reporter writes "New strains of 'Gram-negative' bacteria have become resistant to all safe antibiotics. Though methicillin-resistant Staphylococcus aureus (MRSA) is the best-known antibiotic-resistant germ, the new class of resistant bacteria could be more dangerous still. 'The bacteria, classified as Gram-negative because of their reaction to the so-called Gram stain test, can cause severe pneumonia and infections of the urinary tract, bloodstream, and other parts of the body. Their cell structure makes them more difficult to attack with antibiotics than Gram-positive organisms like MRSA.' The only antibiotics — colistin and polymyxin B — that still have efficacy against Gram-negative bacteria produce dangerous side effects: kidney damage and nerve damage. Patients who are infected with Gram-negative bacteria must make the unsavory choice between life with kidney damage or death with intact kidneys. Recently, some new strains of Gram-negative bacteria have shown resistance against even colistin and polymyxin B. Infection with these new strains typically means death for the patient."
Stop wasting all those antibiotics on beefing up our cattle and giving a bunch of supergerms a tolerance for the stuff?
Great. A big thank-you to all the knee-jerk antibiotics prescribers and disinfectant abusers.
And the soccer moms as well who scream for antibiotics for everything from the common cold to a skinned knee.
These prescriptions are thrown around like candy whether they are warranted or not.
I'd really be pissed if that happened to me.
And this, children, is why you always, always complete the full course of antibiotic treatment, even if you think the problem's cleared up half-way through. If you stop early you leave the small subset of bugs, not enough to cause a visible problem, that are the most resistant to the antibiotics. Lather rinse repeat a few times and you end up with bugs that laugh at antibiotics and proceed to run rampant.
Anyone remember Phage Therapy?
There's plenty of blame to go around, but of course the trick is what we do moving forward. Some of the simple techniques, such as ensuring hospital staff wash their hands, are very useful in terms of preventing the contraction of bacterial infections and should be something where we encourage, expect, and ultimately demand a 100% success rate (i.e. always wash your hands), without blaming people for not having done it in the past. Nurses at the hospitals with poor discipline stopped washing their hands once disposable gloves started being commonly used in medicine. At this point, for many of them, they have been told or taught to always wash hands or put on new gloves before touching a patient after touching nonsterile surfaces, but they're not part of a hospital culture where that is the unbreakable rule, so they get sloppy.
It's not everyone, nor every hospital, but it's common enough that it's not even frowned on at some hospitals. Simply attacking someone about doing it wrong isn't enough, nor helpful, and our goal isn't to blame, it's to move forward and say, "all right. No more! Let's get this right! Let's cut down on staph infections by twenty percent in the next year." There should be intense competition for objectively defineable metrics of success, where the higher the number the better the patient care (so no race conditions), with conservative results and massive penalties for failing to report properly (so it's in everyone's interest to do well but nobody's interest to cheat), and each year the hospital should be able to report, "we saved X lives this year, and Y of those are lives we saved because of these particular programs and improvements we've achieved since last year."
The goal isn't to blame, it's to achieve. It's to save lives. And ultimately, of course, to save the world. *Flash Gordon Theme plays*
-- IANAL, this isn't legal advice, and definitely isn't legal advice for you. Also, Squee!
The language of the slashdot post seems to suggest that the presence of gram negative bacteria is recent. It also suggests that the gram negative characteristic of the bacteria is the definitive characteristic of its virulence. Also, the Gram test isn't a 'so called' test, which somehow suggests or implies doubt.
The test has been done for decades; our knowledge of the two major types of bacteria (gram positive and gram negative) has been around for decades as well. And while gram negativity is characteristic of bacteria that must be approached with different antibiotic means than gram positive, due to their extracellular topology/materials, it does not mean that being gram negative makes the microbes virulent or specifically dangerous.
And to debunk the loose implication that gram negativity might have evolved from human antibiotic applications I will say this: it didn't.
General Bacteriology ftmfw.
Welcome back to the world before antibiotics were discovered.
However, a few decades of not using antibiotics at all and the bacteria around the world will again mostly be susceptible to the more common, low-risk ones. The mutations that make for antibiotic resistance have negative effects on bacteria's ability to reproduce... except in an environment with significant antibiotic use.
Terrorist, bomb, al Qaeda, nuclear, yellowcake, kill, assassinate. Carnivore is dead... long live Echelon.
Would it be possible to at least take one (or both) Kidneys offline? Basically, run your body through a dialysis machine during the antibiotic procedure. Of course, this would have to be an extreme life or death situation to consider the possibility.
Life is not for the lazy.
In general, pharma companies benefit from heavy use of antibiotics: immediately because they can sell more, but also in the long run because it makes their old products (for which they no longer hold a government-issued monopoly) obsolete faster, improving the market for newly developed drugs that fix old problems.
On the other hand, when it comes to these gram-negative bacteria the above idea does not hold true. They can't benefit from it if they don't have a product to sell that fixes the problem.
Most medical antibiotics are based on naturally-occuring antibiotics found in soil organisms. Of course, as these organisms evolved the antibiotics the bacteria around them co-evolved defenses. This means that for most antibiotics there are bacteria around that have genes that make them resistant. Since bacteria trade their genes around it's only a matter of time until the resistance genes find their way into disease organisms. Hospitals contain concentrations of people being treated with antibiotics and so that is where the resistant disease organisms tend to appear.
We need antibiotics based on novel modes of action not found in nature, but these are hard to develop. The ability to sequence the genes of bacteria as well as the ability to synthesize proteins with predictable characteristics will help.
Warning: this article may contain humor, sarcasm, parody, and perhaps even irony. Read at your own risk.
In fact, more than 60% of the Gram negative isolates in our hospital (in-patients) appear to be producing an enzyme called extended spectrum beta lactamases (ESBL). These ESBL-strains are often resistant to other classes of antibiotics as well, narrowing therapeutic options. In a subset of cases, these bugs turn up as resistant to almost all the antibiotics we test.
But, I am yet to come across a case where the isolate was resistant to colistin and polymyxin B. No clinician would even think of using these drugs if other options are available. But, if, as the article reports, these organisms turn out to be resistant to even these last-resort drug... we can safely assume that we are in deep shit.
My family raises cattle on a farm in Iowa. Speaking from our experience, I'll tell you that putting a pound of meat on a steer takes in the neighborhood of ten pounds of feed -- and much more than that, if you're feeding them exclusively grasses (including hay).
So. Take a hundred head of cattle and turn them loose on a hundred acres of land. These animals are still growing (since, when they're ready for the slaughterhouse, well... they get taken to the slaughterhouse). If we want to put a hundred pounds on each steer, then that means each steer needs half a ton of feed.
Good luck getting 50 tons of grass from a hundred acres of land. It's not going to happen. The farmer has two choices at this point: raise fewer cattle (and thus raise meat prices for the consumer), or convert some of the cornfields into pasture (and thus raise grain prices for the consumer).
Either way you're talking about raising the prices of basic foodstuffs. You won't inconvenience the rich: the rich will still be able to afford filet mignon and Kobe beef. After all, they're rich.
But the elderly, who live on fixed incomes... poor families who depend on food stamps... or just a college student burdened with debt who wants to be able to take his girlfriend to a steakhouse for a special occasion... all of these people are seriously impacted.
The name of the game in modern farming is efficiency. Reducing prices is the overall goal.
When visiting a doctor for a sinus infection, he said that in India they would take a swab from my nose, determine in a few minutes with a microscope what bacteria was bothering me, and give me a specific antibiotic that was known to work well.
In the USA, he said insurance tells them to just proscribe an antibiotic and if it doesn't work, they'll come back. The ten minutes of lab work isn't covered by insurance, so they don't do it. I asked if I could pay cash for the test with the microscope, but he refused and said he'd get in trouble.
Most doctors follow insurance rules, worry about liability, and treat symptoms, in that order.
"The programme revealed that we - ie humankind - had discovered a superior cure (to antibiotics) for bacterial infections around the same time that penicillin was being discovered. The research programme on bacteriophages (phages for short) began in Stalin's Georgia in the 1930s. To this day, our knowledge of each of the many thousands of phage viruses remains concentrated in a now rundown laboratory in Tbilisi, Georgia. The arrival of capitalism in the Caucuses threatens a repository of knowledge, built up over 50 years, that could prevent the superbug pandemic that threatens us all next century. ...
While there are some genuine reasons why phage treatments of bacterial diseases were overlooked in the 1930s and 1940s, the failure to develop a western research program into bacteriophage treatment in the 1980s and 1990s represents an inexcusable failure of western capitalism. By the 1980s, ther e could be no denial that antibiotic resistance was going to be a major problem in (if not before) the twentyfirst century. Yet, we just didn't want to know about what will probably turn out to be the most important medical breakthrough in the twentieth century; a breakthrough made in communist G eorgia, in Stalin's Soviet Union.
It is embarrassing when western science is out-trumped, especially by the "communists". Usually, when out-trumped, we don't tell anyone. That's what happened here. Not only did we not have the nous to start a western programme in bacteriophage research; we looked the other way when the files of phials threatened to be destroyed following the breakup of the Soviet Union, and during the little reported civil war that engulfed Georgia a few years ago. So much for the knowledge economies of the west. How can such valuable knowledge be so cheap?
It's not too late for western medicine to enter the post-antibiotic bacteriophage era. Our grandchildren will hardly thank us if we persevere with our corporate-profit-motivated conservatism.
The Soviets were able, eventually, to admit that they were wrong to follow Lysenko. Will we in the west be equally able to admit that we were wrong to put all our medical eggs into the one antibiotic basket, in the process ignoring the most basic tenets of the theory of evolution?
"""
From:
http://www.scoop.co.nz/stories/HL9910/S00096.htm
(I'm glad to see several people have posted links to phage therapy information.)
A 21st century issue: the irony of technologies of abundance in the hands of those still thinking in terms of scarcity.
To be honest, I'm caught in the middle of this "Big pharma? Good or evil?" debate.... On one hand, sure, I agree with you that many people employed in the pharmaceutical industry want to do good, and aren't part of some agenda to kill people and boost stock prices But let's face the facts. That's almost a universal truth, when you start talking about individuals you've singled out in ANY company. It also holds true for the military. (Talk to a U.S. solider who was deployed to Iraq, sometime. Chances are, he signed up for the service NOT because he had some agenda in his head, but simply because it paid pretty well in a bad economy - and he's trying to take care of a family.)
What you always have to examine is what direction the company is headed, on the whole. That's where I start to see the other side of the debate. It's pretty easy (and common) to hire thousands or even millions of employees who practically ALL believe they're doing "good", while the end result is decidedly "evil". Some of the big pharmaceutical firms come from fairly "tainted" backgrounds, too.
Take, for example, Bayer Corp. Today, you think of them mainly as providers of aspirin ... but in WWII, they were cranking out mustard gas, military grade chlorine and phosgene for Germany. In fact, they were stripped of their right to trademark aspirin after WWII in many nations due to their direct involvement in the war.
Bruce Sterling wrote what is still probably the best article for the layman about the inevitability and dangers of bacteriological antibiotic resistance.
Bitter Resistance
Check it out, peeps.
- jon
Ganymede, a GPL'ed metadirectory for UNIX
The article is incorrect in many points. Firstly it is not just the two antibiotics mentioned that are effective against gram negatives, but quite a large range of Aminoglycosides, Quinolones, and even some Cephalosporines for example. Resistance against these happns too, of course.
Furthermore, damage to the kidneys (or hearing nerve) and other severe adverse effetcs can happen, but are rather the exception than the rule. The patient's choice is thus not "to lose his kidneys or die with intact kidneys" but to accept a reasonably small risk of potentially serious adverse effects in exchange for a treatment that is most likely life saving.
Of course it is sad if we gradually lose more and more powerful antibiotics because some reckless idiots overuse them in clinical practice (the USA is one of the worst offenders in that aspect within the "ciilized" realm, especially when it comes to misuse and overuse of Fluoroquinolones) or, even worse, just in order to make cruel intensive meat farming viable.