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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."
Great. A big thank-you to all the knee-jerk antibiotics prescribers and disinfectant abusers.
No, it's obvious that we need even less government regulation so that the free market can allow doctors and sick patients to reach stable equilibrium with the bacterial hordes! There's a basic game theory model that proves my position!!!
May the Maths Be with you!
Assuming they delay the process by a decade, 200,000-300,000 in the U.S., but that is assuming that all of those people are otherwise healthy.
That's more than AIDs but less than car accidents (and a hilarious footnote compared to heart disease and cancer).
Nerd rage is the funniest rage.
It wasn't the Mayo Clinic and they have this to say: "Oil of oregano has received a great deal of attention, with proponents claiming it can treat a variety of illnesses, including sinus disorders. Like many spices, oregano does have some antibacterial and antifungal properties — making it at least plausible that it might help or prevent some sinus problems caused by bacteria and fungi. Unfortunately, there have been no published trials that have looked at oil of oregano specifically for this use. For this reason, it isn't known what role, if any, oil of oregano plays in treating or preventing sinusitis." Or at least that's James T. Li, M.D., Mayo clinic asthma and allergy specialist has to say on the Clinic's webpage. Current as of Aug 29, 2009.
As for the crack about big pharma, bullshit. Traditional treatments have attracted a lot of investigation for the last couple of decades. If (if!) you find out that the traditional treatment works, then you can isolated the active compound(s) and patent and sell that.
I am a med student studying on renal physiology (test on friday...)
Let me know if you pass, then I'll mod you up.
There are some who call me
While TFS is indeed inflammatory, your post is factually incorrect. Specifically, gram negative bacteria are very much more virulent than gram positive bacteria (or, for that matter, organisms that don't gram stain at all). The gram negatives are the only class of bacteria that express lipopolysaccharide endotoxin. The human immune system has specific receptors (like CD14) for this toxin, resulting in an extreme inflammatory response which is the pre-death phenomenon called 'sepsis'.
We saw these pathogens emerge in our ICU three years ago and have been using colistin. The side effects are real but not nearly as common with modern supportive care as they were 40 years ago. Which is good, because when the colistin quits working, well, your patient is dead. Currently these pathogens only emerge after many weeks of critical illness and multiple runs of strong intravenous antibiotics.
We go through fairly draconian measures to limit any spread of these organisms, which so far seem to work. Negative pressure rooms, isolation gowns and masks for simply entering the room, disposable stethoscopes, etc. all help. Rooms and gear are disinfected by two different individuals so that personal tendencies don't allow transmission. And we wash our hands. A lot.
Theoretically yes. It would just take rerouting the incoming kidney blood supply into a loop to bypass it into dialysis. However, you would likely have to filter the drugs out, pass it back to the kidney, reroute it out again and restore the drug. Wouldn't help if your kidneys died from lack of blood supply. Last case scenario stuff probably though.
While the idea sounds like a good idea on paper, I have to tell you, as a practicing surgeon, it really sucks.
First let me clear up, the antibiotics themselves are either directly nephrotoxic (damage the kidneys) or their breakdown products are. Its not a matter of taking the kidneys “off-line”. And in addition not all drugs are removed with dialysis.
To access both renal arteries and veins (assuming normal anatomy many people have duplicated renal vascular systems) is not an benign undertaking. The vessels are in the retroperitoneum (behind all the structures in the "classic" abdominal cavity. So it is not a "trivial" procedure. Next to totally bypass the kidneys is not a great idea...extended bypass systems tend to cause a lot of damage to the blood, they can speed up the drestructiong of red cells (oxygen carrying) and platelets (clotting cells). The circuit also tends to active the clotting system and you get a paradoxical, hyper/hypo-coagulable state. This is similar to DIC (Disseminated intravascular coagulation) [http://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation]
Also the bypass circuit itself is made of synthetic material with acts to harbor bacteria. Given large scale infections, we as surgeon, routinely remove all sorts of prosthetics (AV graft material used for dialysis, artificially heart valves, pacemakers, rods and screws from orthopedic procedures)
The information in the article itself is not new. When I did a rotation in a burn unit in 2004, we had a standing problem with the unit harboring several species of Acinetobacter, and these organisms were resistant to all the antibiotics that the lab routinely tested. We routinely had to use Imipenem(tm) [http://en.wikipedia.org/wiki/Imipenem]. And it was not unusual to have bugs start to build resistance to that drug. We usually had to resort to poly-pharmacy as opposed to mono-therapy as we usually prefer.
Again as I posted a few weeks ago: As physicians we need to be vigilant in our use of antibiotics, but patients need to be respectful of them as well and to stop asking for an antibiotic (that is useless for viral infections) for every little sniffle when you have the common cold or flu (both caused by viruses).
Forgive me for quoting wikipedia, but I felt some footnotes were warrented. I usually yell at my students and residents when they quote it to me, but for the level of discussion here, it is adequate.
Actually, a few weeks/months is enough.
Give it a year without prescribing antibiotics for anything but the most severe cases, and all the nice little antibiotics are effective again.
Google for 'norway antibiotics' .. ( http://www.fftimes.com/node/229972 )
"Rune Kristian Viken" - http://www.nwo.no - arca
I'm horrified that you achieved +4 insightful instead of the +5 funny that you were going for.
This is mother-in-law we're talking about here.