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

VS

[Anonymous Coward]

Any reason why this would not be the case in the US?

Re:VS

[Dr_Barnowl]

It's actually more likely to build resistance - because USians pay for their medicine, they are much less likely to complete a course of antibiotics.

The article misrepresents the position - antibiotics don't "encourage bacteria to develop new ways of overcoming them", they just leave behind bacteria that have more resistance. It's therefore very important to go Darth Sidious on their ass and "wipe them out. All of them.", or the few that remain will multiply, unobstructed by their cream-puff peers who are all dead now.

Paying for your medicine gives you an incentive to stop taking it as soon as you feel well, rather then comply with the advice of your doctor and finish the course. A lot of people save the remainder of the course for future illnesses.

The doctor has no incentive to refuse you antibiotics, as pointed out by siblings. Because your perception of his care matters to his paycheck, he's far more likely to prescribe them. Even in a socialised healthcare system, doctors will prescribe antibiotics just to get the patient out of their office so they can see the next one.

This doesn't take into account that the other thing that USians do / did with antibiotics (do they still do this?) is feed them to their livestock. If the animal isn't funding the growth of bacteria with it's nutrients, it will grow more itself. Alas, this also promotes resistance.

The pharma companies have no incentive to fix this either, because they can sell newer (often less effective) antibiotics that have less communal resistance. They are ecstatic that the old antibiotics no longer work, because they are out of patent and anyone could make them for a few pennies a dose. Instead they can sell "last line" drugs that cost upwards of $100 a day.

Re:VS

[Luckyo]

The problem with "last line" drugs is that they cannot really be given to many. They tend to cause things like complete kidney and liver failures you see. As a result, their profitability is quite shit due to small volumes - these drugs are literally something you only give when you see that patient will likely die. Also these antibiotics aren't "new", most of them have been known for a long time. They just weren't given because side effects were utterly devastating to human organs responsible for cleaning toxins out of the bloodstream.

Re:VS

[jpapon]

Yup, the community is paying. Which you have a problem with apparently. Fortunately, there are lots of people who don't have the mindset of "Screw you, I'm getting mine. If you want help, help yourself ya moocher". We all need help sometimes.

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

[Anonymous Coward]

Which makes them better (or different) from medieval idiots... how, exactly?

The root cause remains an "ignorant" (your vocabulary) assumption that illness = bacteria. Bacteria are killed by magic drugs whose formulation and mechanism(s) of action most simply lack the education to understand. Because I am ill, the patient believes, I must seek this magic medicine to make the illness go away. Thus, even when a doctor says, "This magic medicine will do nothing," the patient insists that they receive it, presupposing the evil doctor must be withholding life-saving treatment to increase return visits. Despite the absence of education, the patient knows the medicine will work, denying physics, chemistry, and biology in the process.

The critical failure occurs when the patient makes the anecdotal correlation between close friends' or relatives' medical condition(s) manifesting in a similar way - this is a fundamental flaw in human cognition, not an effect that can be solved with the assumption that "modern" fools are not medieval idiots. They are medieval idiots - just with shinier toys.

Re:I wonder

[captainpanic]

The smiley suggests you think you're making a joke... but it's actually true: it will train the bacteria to become alcoholics, and build up a tolerance.
But there are good reasons to expect the bugs to need a lot longer to develop a resistance against alcohol. They will need to reinvent their cell walls for example, which is quite a dramatic change.

Re:I think our etiology of antibiotic resistance i

[einhverfr]

I agree with your points about the immune system and sanitizing everything. I would go further and say I enjoy beef tartare, sashimi, and good old fashioned home-made eggnog, plus a few scandinavian desserts with raw eggs.

I would however like to point out that with simple care, most bacterial infections can be treated without antibiotics. The last few times I have had skin infections, I have used sterilized kitchen knives to lance the infection and hot salt water to draw fluids, etc, out, and I got better at least as fast as I would have with antibiotics. I also travel a LOT and have had E coli and possibly even a mild case of cholera. None of these need to be treated with antibiotics either (with cholera the key concern is hydration, and with any diarrhea I have found the key is to go off all foods for a while to let one's immune system get a grip on what's in the digestive tract.

We use antibiotics a lot when we don't really have to, because we believe in modern medicine and all of that, and because it's easier than teaching people to soak infected fingers in hot salt water.

Re:I think our etiology of antibiotic resistance i

[einhverfr]

Just adding to that last comment. One of the big issues with antibiotics is that they often target harmless bacteria as well as bad ones. This means impoverished microbial biodiversity, which means it is easier to get infected again with something else. And so one intervention leads to another.

Re:I wonder

[hairyfeet]

Don't forget the sewer systems and water supplies. I remember reading in a magazine how many drugs could be found in your average river because the sewer systems end up one way or another into the rivers, be it leaking pipes, floods, etc and you end up with all these drugs from antibiotics to painkillers to hormones in the water supply. Then of course fish absorb the drugs, animals and people absorb the fish, and around it goes.

And finally let us not forget the massive bribes...err I mean "incentives" the drug companies give out to doctors. I could always tell which drug my local doc was getting a nice vacation package from because that is what he is pushing for EVERYTHING, funnily enough the current one fits right into TFA because his handout drug ATM is an antibiotic called Z-Pac.

Re:Often, not always

[Spad]

In the UK a lot of doctors now have pre-printed notes that they can sign and give to patients that basically say: "Your illness is not bacterial and therefore prescribing antibiotics is pointless, if you don't believe me take this to another doctor and ask them"

The problem is that some GPs would still rather hand out the antibiotics than have the argument with the patient.

Re:I wonder

[tibit]

and genetically mutilated crops is an other example of the same problem of making bacteria drug resistant

I agree with most of the post, but this is just silly. Kinda takes away from credibility of the rest of it. WTF has GM food got with drug resistant bacteria, for crying out loud?

TOTAL BS

[PortHaven]

"Experts say primary care doctors are partly to blame for prescribing antibiotics for patients who demand them unnecessarily"

Sorry, I have seen from personal experience over and over again. Patients never "demand them unnecessarily".

Rather, patients go to the doctor. And the first thing the doctor almost always tries is "Here's a prescription for antibiotics." It's almost more akin to a diagnosis test. Take these and we'll determine if it's viral or baterial.

Occasionally the doctor will call for a test such as flu, strep, etc. Just recently we were concerned about my 4 yr old daughter having been bit twice by ticks in a 2 week period. Short time later all her lymph nodes were swollen, she ached, and was generally miserable.

Rather than evaluate for any of the tick born infections. Our doctor was convinced it was the flu. We knew it was NOT the flu. They did a flu test, and guess what. We were right.

The truth of the matter is most American doctors are arrogant. 1/2 the time they are wrong. And very few care about treatment, they just want to prescribe and send away.

Medicine is in a second dark age.

I agree

[jbov]

The last "line drugs" are surely nasty. I was hospitalized for a week with a systemic staph. infection I got via a brush burn at my grappling school. At the time, I was given vancomycin. I think it was _the_ last resort drug at the time. I was told this has now been trumped by newer antibiotics due to vancomycin resistant infections.

It is also worthy to note that this had to be administered intravenously, which means the resistant strains emerging would not be related to doctors prescribing oral antibiotics. The intravenous modality of these drugs decreases the occurrence of over-prescribing. This drug would quickly "ruin the site" as they said in the hospital, which meant the intravenous entry point had to be relocated frequently.

Re:I wonder

[bill_mcgonigle]

Is that because you are stupid or ignorant?

Stay classy, geekoid.

http://en.wikipedia.org/wiki/Triclosan#Health_concerns