Drug-Resistant Superbugs Sweeping Across Europe

Pierre Bezukhov writes "Klebsiella pneumoniae is a common cause of pneumonia, urinary tract, and bloodstream infections in hospital patients. The superbug form is resistant even to a class of medicines called carbapenems, the most powerful known antibiotics, which are usually reserved by doctors as a last line of defense. The ECDC said several EU member states were now reporting that between 15 and up to 50 percent of K. pneumoniae from bloodstream infections were resistant to carbapenems. To a large extent, antibiotic resistance is driven by the misuse and overuse of antibiotics, which encourages bacteria to develop new ways of overcoming them. Experts say primary care doctors are partly to blame for prescribing antibiotics for patients who demand them unnecessarily, and hospitals are also guilty of overuse."

Comments

I wonder

[HerrWolfe]

I wonder if such a common thing as antibiotic soap can increase resistance over a period of time.

Re:I wonder

[Tsingi]

Giving antibiotics to farm animals also doesn't help and genetically mutilated crops is an other example of the same problem of making bacteria drug resistant

Yes, cattle are fed corn, because it is heavily subsidized, and this makes them ill. So cattle are raised on a diet of corn and antibiotics. Then we eat the meat, laced with antibiotics, and the viruses in our bloodstream mutate to brush off this rather mild onslaught.

Not buying beef that was raised on corn is a possible solution, but that just means you won't be raising superbugs, everyone else will still be doing it.

Re:I wonder

[Attila Dimedici]

I have never seen "antibiotic soap". There are many anti-bacterial soaps, however, none of them contain antibiotics (at least not in the US and I was unable to find anything that indicates that it is any different in the EU). I am not a fan of anti-bacterial soaps because they kill not only pathogens but also beneficial bacteria. With the rare exceptions of certain places where the incidence of pathogens is likely to be significantly higher than normal (and just because your co-worker is sick does not make your work one of those places) , antibacterial soap is no more effective at preventing the transmission of disease than ordinary soap.

Re:I wonder

[PCM2]

Yes, cattle are fed corn, because it is heavily subsidized, and this makes them ill. So cattle are raised on a diet of corn and antibiotics. Then we eat the meat, laced with antibiotics, and the viruses in our bloodstream mutate to brush off this rather mild onslaught.

No, that's not it. When you eat meat from animals that have been treated with antibiotics, the amount of effective antibiotics you're exposed to is going to be so minimal as to be at homeopathic levels. Then you cook the meat, which is likely to further break down any compounds in it.

Rather, the problem with giving livestock antibiotics is simply that it creates these resistant strains of bacteria, and then the bacteria escape the farmyard and move into the wild. The kind of bacteria that are in and around farm animals aren't so different from the ones that are found in and around human homes, and some of them can cause disease in humans (E. coli, for example).

Another problem is that many of the genes that confer antibiotic resistance exist on plasmids, which are little capsules of bacterial DNA that exist independently of bacterial cells. Plasmids can potentially move from one strain of bacteria to another. So, you might have one strain of harmless bacteria that gets exposed to a lot of antibiotics and develops resistance. If that bacterium later comes into contact with a harmful kind of bacteria, the plasmid could be transferred to the new bacterium, causing it to gain the same resistance.

So, again, the problem is not that the meat you buy contains antibiotics which causes your body to create bacteria with resistance; the problem is that the animals have already done this process for you, and you might be bringing home meat with that resistant bacteria on it.

Not buying beef that was raised on corn is a possible solution, but that just means you won't be raising superbugs, everyone else will still be doing it.

Here you're correct. Not buying beef raised on corn is pretty much just "voting with your dollar." It doesn't change the fact that the superbugs are still being created elsewhere. It doesn't really change your risk of exposure to harmful bacteria in any meaningful way, either (the same bacteria are probably on the meat that wasn't raised on corn and antibiotics; they just might be less likely to be the resistant kind).

Re:...and patients who don't complete the course

[tsa]

They're not medieval idiots, they're ignorant fools who think they know better than the doctor, even when the doctor tells them that antibiotics will not work against viruses.

Re:VS

[Chrisq]

USians pay for their medicine so they most likely are not prescribed as many by their doctors.

I don't think that is the case. Doctors might find it harder to say "just go home and take asprin" if someone is paying for the consultation. I can't find figures but my feeling is that its just as bad - the European report was issued because most emphasis up to now has been in the USA. I know that multi-resistant TB occurred in the USA and then spread to Europe, not that one example shows much. In all likelihood it actually occurred first in a third-world country with endemic TB and antibiotics available over the counter but tests found it first in te USA.

Re:...and patients who don't complete the course

[einhverfr]

Also consider that up until recently there were classes of illnesses where antibiotics were defensively prescribed, such as in the case of ear aches, not because they were likely to do good in any particular case, but because the doctor feared malpractice suits if it was bacterial and happened to be the rare case that lead to hearing loss.

Often, not always

[Max Romantschuk]

I've had a doctor tell me that I / my kid has a bacterial infection but it's not that serious, so the best option is to rest and let the body's own immune system take care of it.

Yet, something tells me that those doctors would have prescribed antibiotics if I had cluelessly demanded that I get 'proper medicine'...

Re:Often, not always

[spectrokid]

This is were state-run health systems like in scandinavia have the upper hand. Doctors can just tell their patients to fuck off.

Re:Often, not always

[Rich0]

Completely true - well, most of the time.

NPR had a good series on problems in the healthcare system (unlike most treatments they seemed to take a holistic approach and not just find one issue and make it out to be the single thing that is driving up cost). They had a story about a doctor who didn't prescribe a CT scan for a girl who had a suspected spinal fracture. They ended up getting into a fight with the girl's dad who felt like the doctor was just cutting costs at the risk of the girl's health.

However, the doctor pointed out that he had every reason to do exactly what the father wanted. He would be paid more if he ordered the test. Nobody would dispute the test since doing so would expose them to liability. He was taking on risk of liability in the event he was wrong and she had a fracture. However, the fact was that the CT scan for a girl of her age carried a significant increase in risk of cancer much later in life, and based on his physical exam that risk was much greater than the risk that she might have an undetectable fracture. Of course, if she did get cancer later in life it could never be linked to the one test, and by then the doctor would probably be retired/dead/etc. So, the doctor was sticking his neck out, and taking on lots of personal risk, and declining the opportunity to make money, and wasting his time explaining all of this stuff to a father who would have just said yes no discussion needed to a CT scan, all because he wanted the girl to be healthy. How many doctors would do otherwise?

Antibiotics are a similar situation - the doctor can argue with their patient, and maybe lose them. Or, they can just take 30 seconds to fill out a prescription that they'll never get sued over and everybody is smiling since now when the patent gets better it will be because of what the doctor did. Happy patients lead to more patients, and more repeat business as well. Even if the doctor is employed by something like the NHS they probably have metrics and sending a patient on their way without hassle means more visits per hour. Or, even if they're completely unaccountable who wants to sit and argue with somebody all day?

I'm generally in favor of eliminating the need to get a prescription to get access to drugs, but antibiotics are one area where I'd make an exception. I don't see the role of government as protecting people from themselves. However, antibiotic abuse harms everybody and it is completely legitimate to regulate their use - probably more strictly.

I'd probably require doctors to submit a written justification for every prescription of an antibiotic that is less than 20 years old, and with stricter requirements on anything less than 10 years old (either documented testing that shows resistance to the alternatives, or an assessment which will be reviewed by a board that the patient would suffer irreversible harm if they waited for the results of that testing).

Of course, if you do this the market for new antibiotics is almost worthless (compared to being low-value which it is now). Who will spend a billion dollars working on new antibiotics only to release one and have 30 people take it in 10 years? The solution here is bounties - governments will have to decide how many new antibiotics they want and offer substantial bounties for their discovery (probably hundreds of millions of dollars), and use that money to buy the patent rights (the company has already been paid for their work). The bounties can be adjusted based on the number of candidates that are being submitted vs the number desired.

You could actually apply a similar model to other drugs, but it would get expensive (probably cheaper than what we're doing now, but this is completely socializing medicine which is of course much more expensive than having most of the costs be privately borne by patients and their employers). If it were successful enough you'd see the drug patent problem go away without even having to ban them, since patented drugs would be much more expensive than the generics bought with bounties, and companies would still have incentive to do R&D (but not marketing, etc).

Re:I think our etiology of antibiotic resistance i

[erroneus]

Fascinating until some gets into a casual scrape or cut in your skin...

Another cost of our overly-medicating society is that we forget how important it is to keep our immune systems healthy. We scrub and clean and sanitize everything at every turn thinking we can limit or even eliminate those dastardly bacteria which are always bad. (Not all bacteria are bad... how is the over-use of antibiotics harming the good bacteria we depend on?)

Good practices and good hygiene, of course, are important things to maintain... foods should be cooked and handled properly. Hands and bodies kept clean as well. But "sanitized" is just going too far in most cases. And so when people get sick, they have untrained immune systems which don't react as well as it should which necessitates the use of antibiotics.

George Carlin saw this problem long, long ago when he did his "swimming in raw sewage" routine. His point was to keep the immune system operating and working well. My point is that we can't seek to eliminate all "bad things" without serious consequence which includes upsetting nature's balances. Instead we should seek to coexist with bacteria in our world and seek ways to maintain a healthy balance. Instead, people seek to dominate and eliminate "their enemies" without considering the long term consequences of such reactions.

Tragedy of the Commons

[DavidShor]

I think people are oversimplifying by talking about "stupid" parents. The truth is that since antibiotics and antivirals have few side-effects and are cheap to produce, it's individually rational for people to use them. But when everyone uses them, we get lots of resistance.

In America, this is because of legal system

[WindBourne]

I have argued here and elsewhere that there is a high costs to our legal system. Sadly, just about every liberal screams that it only costs 3%. But the issue is that due to quick ability to sue, docs have adopted protective medicine. Not protection for the patient, but protection against lawsuits. As such, they give a number of antibiotics that we would not do.

However, a big issue is that ag makes propholatic use of antibiotics. That is more true in Asia esp. china, than it is anywhere else.
That is what is about cause a massive lowering of the world population.

Re:Patients asking for drugs

[KiloByte]

I'd be far more concerned about doctors listening to drug companies. They send hordes of representatives who shower doctors with incentives if they prescribe a given drug.

Re:VS

[einhverfr]

Compared to the US, they pay relatively little.

The US government spends as much *per American* on health care as the UK government does per UK citizen, and government spending in the US accounts for a bit under half of our medical expenses. So we pay about double.

The reason of course is monopoly powers. The UK government isn't as beholden to Pfeizer as the US government is, and so we charter monopolies to control the market and in an effort to correct those problems require people to buy into those monopolies. Idiocy on top of stupidity. If we wanted to tackle the problem of health care costs, we'd focus on increasing supply. John Medaille has made some proposals I would get entirely behind:

1) Compulsatory licensing for medical-related patents, in order to break up patent-based manufacturing monopolies for medication, medical devices, and the like.

2) Chartering medical guilds which would replace the AMA. The guilds would be bound into malpractice insurance pools, would be in charge of licensing their members, setting licensing requirements, etc. This would create downward pressure on costs of medical training, while creating upward pressures on professionalism.

But no, we think that disempowering consumers will rein in costs. I think Aristotle would have a few things to say about it, which might not account for much except that the last 2500 years of human experience has largely proven him right on this matter.

Re:VS

[MrNaz]

That >2% comes from the funds that they don't spend invading other countries, feeling you up at the airport and paying spooks to pore over your Facebook profile.

Re:VS

[yog]

Drug-resistant tuberculosis (extensively drug-resistant tuberculosis - XDR-TB) and drug-resistant staph (Methicillin-resistant Staphylococcus aureus - MRSA) have been reported in the U.S.

Very worrisome trend. Over-prescribing of antibiotics combined with misuse (taking a little, then stopping, instead of taking a full regimen to completely eliminate the pathogen) can result in the survival of resistant strains of microbes. It was bound to happen anyway, but now the trend has accelerated.

We'll have to resort to novel approaches very soon to attack these critters--nanotechnology holds a lot of promise, some forms of radiation, and new drugs.

We should be treating this as a public health emergency and providing appropriate funds to develop cures.