Slashdot Mirror
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."
Any reason why this would not be the case in the US?
So now we can train bugs to say no to drugs, next step is to move to animals and then finally humans!
I wonder if such a common thing as antibiotic soap can increase resistance over a period of time.
The same whiny hypochondriacal medieval idiots who demand antibiotics to fight a virus.
I often think that 19th century physicians had it figured out. Blue pill (placebo), slime draught (nasty tasting placebo) and let some blood. Treat the root cause, i.e. the hypochondria.
If you were blocking sigs, you wouldn't have to read this.
What's the "K"? You can only abbreviate it if you've already written it in full beforehand
All true but the majority of resistant strains come from countries where antibiotics are unregulated (i.e. you can buy them over the counter without prescription)
The concern centers on farmers' routine use of antibiotics. Its use on livestock accounts for roughly half of the 25,000 tons produced in the United States each year. - link -
The question of whether we are creating ‘resistances' in zoomatic organisms (that affect both species) out in the feedlot and pastures and passing this on to humans with veterinary use of drugs, however, is still a very up-in-the air question. - link -
> > > which encourages bacteria to develop new ways of overcoming them.
> > which encourages bacteria to **evolve** new ways of overcoming them.
> which encourages god to design new ways for bacteria of overcoming them.
which encourages god to increase his research and development funding to develop evolution to allow new ways for bacteria of overcoming them.
which is totally what she said
So if we eat meat that has been fed antibiotics, it will effect our resistances as well?
Bacteria on the continent are allowed a little antibiotics with meals even at a young age, so they grow up with a much more mature attitude towards it. That's why they're much better at handling antibiotics than British and American bacteria.
oversimplified.
It's based on the idea, seen in insects with pesticide use, that if you kill x percentage of insects, some may survive and their offspring may have a much higher level of tolerance, meaning more pesticides are needed to kill the insects. No doubt this happens with bacteria too and is *a* cause of antibiotic resistance.
Consider that livestock may be given antibiotics, and they may have bacteria, like E. coli or Salmonella sps which can make humans ill. This represents an additional vector not generally covered in analysis.
However there may be several other big issues that are not currently included in the analysis. Many species of bacteria are known to assimilate genetic material from other bacteria even from other genuses. This means that there is a possibility that antibiotic resistance can spread between bacterial species as a result of hospital waste, causing a form of genetic pollution.
Nature is fundamentally more complex than we can model. Any sufficiently complex model would be nature itself.
However, the rise of superbugs is fascinating to watch.
LedgerSMB: Open source Accounting/ERP
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'...
.: Max Romantschuk
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.
People who think our ingestion of antibiotics from animals is a factor in antibiotic resistance are crackpots who don't pay attention to the fact that we've been eating trace amounts of penicillin for tens of thousands of years. That's not a serious concern. There are however a few serious concerns:
1) Some bugs like E coli and Salmonella sps can be hosted in animals or humans. Antibiotic resistance they pick up in animals will be a factor when the human gets sick.
2) Some bugs are known to swap DNA. This means that antibiotic resistance in a harmless bug could turn up in a harmful one later.
3) Bugs which are harmless today could jump species and become harmful tomorrow.
4) Environmental pollution around concentrated animal feeding operations could lead to antibiotic resistance in soil-borne bacteria.
Now, in the US, there is supposed to be a clear separation between classes of antibiotics used on animals and those used on people, although this is more porous than we might like to think. There are however no guarantees that other countries have the exact same divisions. Moreover even assuming that this is the case, it deprives us humans of the effectiveness of certain classes of antibiotics which might prove useful in the future.
LedgerSMB: Open source Accounting/ERP
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.
This is a sobering article. A quarter of people think antibiotics cure colds?
Actually given a lot of people I come across day to day I find that very reassuring. Three quarters of people know that antibiotics don't cure colds! I would have expected at least a third to say "What's an antibiotic?" and one in ten to say "what's a cold?".
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.
LedgerSMB: Open source Accounting/ERP
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.
LedgerSMB: Open source Accounting/ERP
Recent inspections in Germany showed that over 90% of all chicken produced for consumption contain remains of antibiotics. So I guess you are right.
http://www.spiegel.de/wissenschaft/mensch/0,1518,797970,00.html (german),
http://de.babelfish.yahoo.com/translate_url?doit=done&tt=url&intl=1&fr=bf-home&trurl=http%3A%2F%2Fwww.spiegel.de%2Fwissenschaft%2Fmensch%2F0%2C1518%2C797970%2C00.html&lp=de_en&btnTrUrl=%C3%9Cbersetzen (Yahoo Babelfish Translation)
Nope, I think you mistook me for someone else.
"that we've been eating trace amounts of penicillin for tens of thousands of years."
Some modern antibiotics can get into the soft tissue of an animal and stay there until it is slaughtered and can then survive the cooking process. Penicillin can't.
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.
I prefer the "u" in honour as it seems to be missing these days.
which encourages creationists to evolve new arguments to overcome all evidence.
-
- - You can't take something off the Internet! That's like trying to take pee out of a swimming pool.
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.
The creatures outside looked from Alt-Right to Antifa; but already it was impossible to say which was which.
Probably because in the EU it's been banned (since 2006 for growth promotion purposes).
But while you're blaming agriculture - don't forget the GM crops which use antibiotic resistance as a marker for the bacteria carrying the required genetic modifications.
This has been banned in the EU (for the last 5 years).
I'm not sure I entirely agree with this - my mum trained as a nurse in Germany (instead of national service), nurses then were the ones who cleaned everything (not orderlies as is now the case, who appear to liken it to cleaning a supermarket). She also remembers everything being absolutely spotless.
Also, from the memoirs of a WWII nurse in the UK, she said they were drilled by the matron that any dirt was not allowed. When preparing beds coming into new wards (due to a large influx of caualties from D-Day), they weren't allowed in from outside until they'd been scrubbed down with carbolic, and then it was done again once they were actually in the ward.
Visiting hours were also limited, so that patients were allowed to rest, and it made it a lot easier to keep conditions sanitary.
Cleanliness isn't the main problem (to a point, I had a housemate who insisted on regularly bleaching the kitchen floor), it's the fact that people don't understand the difference between bacterial and viral infections and insist on having antibiotics for everything.
What pisses me off is that I'm very rarely ill, and the last two times I've been given antibiotics I haven't taken them - I was on the mend at that stage, and I was buggered if I wasn't allowed to drink on my birthday. However, if I end up in hospital, being healthy isn't going to be of any help if I end up contracting MRSA due to a generation of hypochondriacs (I exaggerate, but the point stands).
Virtually *everything* we eat has traces of penicillin in it. The point is that if consuming trace amounts of antibiotics would cause antibiotic resistance generally, penicillin should never have worked in modern times but it did quite well (also despite sporadic uses in the ancient world I might add too).
For resistance to be developed, bacteria have to be exposed to enough of a background level to start killing the bacteria. Otherwise there is no natural selection.
"Worse bacteria under stress have a horrible habit of taking up random bits of DNA from the environment" which include those bacteria that are not human pathogens, and this is why the antibiotic pollution issues around CAFO's is such an issue, and why bacterial, whether pathogenic or not, which pick up antibiotic resistance inside animals in these areas can spread it to other bacteria which may be pathogens.
Either way the problem is entirely independent of whether or not we consume trace amounts of the antibiotics.
LedgerSMB: Open source Accounting/ERP
And farmers pretty much feed all of their animals antibiotics because it's easier? cheaper? than only feeding it to animals once they're sick (in general it's a lot harder to tell when an animal is sick than a human). Or at least that's my understanding, I could be wrong.
Modern industrial cattle operations feed cows corn because calorie-for-calorie it is the cheapest food available for cows. The problem is that cows evolved to eat grass, not grains, so their stomachs aren't suited to it. They come down with stomach acidosis, and they will only live about six months once the corn diet begins.
While they are alive, they get infections via the stomach ulcers. So antibiotics are mixed into the corn to somewhat protect the stomach at least long enough for the cows to get obese for market.
I didn't choose the word 'obese' lightly. Industrial cows are literally obese, which is why their meat is so fatty. Fatty meat is easier to cook, and us dumb Westerners have been trained to prefer fatty meat ("nicely marbled").
FATMOUSE + YOU = FATMOUSE
"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, too, base my health maintenance plan on comedy routines.
It doesn't mean much now, it's built for the future.
Modern industrial cattle operations feed cows corn because calorie-for-calorie it is the cheapest food available for cows. The problem is that cows evolved to eat grass, not grains, so their stomachs aren't suited to it. They come down with stomach acidosis, and they will only live about six months once the corn diet begins.
Actually, it's more of a meat-per-acre argument. Cattle are often raised where there isn't enough land to let them graze, so they have to be fed with imported (read: more rural) food. Feeding them grass isn't feasible because the raw tonnage of grass would cost too much to transport, so they resort to corn (calorie/weight). In more rural areas, they are fed grass (every farmer I personally know).
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.
There was a wired article a while back about the amount of antibiotics used by farm animals in the US:
http://www.wired.com/wiredscience/2010/12/news-update-farm-animals-get-80-of-antibiotics-sold-in-us/
I would imagine this is a potentially good place to start reducing the amount of antibiotics being used. I'm no biologist, but prophylactic antibiotic use on this scale is probably unnecessary. Don't count on the farming industry to do this on their own though....
-ted
Posting this kind of absurd fiction only helps discredit the very real problems caused by overfeeding with grains. A six-month death sentence?
The problem began with New Deal-era crop subsidies. Naturally, every progressive treats government power like violence (if it doesn't work, just use more of it) and instead of removing the subsidies, they want to tax the meat or corn and thus continue to cause hardship.
I agree that crop subsidies are teh stupid, but the corn health problems are real. In addition to acidosis, corn-fed cows have problems with liver failure from (corn) aflotoxin concentration, as well as founder and ulcers. It's not a secret either, just do some googling.
FATMOUSE + YOU = FATMOUSE
A couple of points:
1. You're correct that just 'not finishing the prescription' isn't a big part of antibiotic resistance. It's complicated (sigh). And feed lot supplementation is a big, big problem however, it alone doesn't explain, for example, floroquinolone resistance (as such drugs aren't usually given to feedlot animals). So there are multiple issues in play which makes it virtually impossible to stop the process.
2. I suspect that the 'ideologically taken' physician is relatively rare (never say never in medicine). It is much more likely that the first physician did not see a clear reason for using antibiotics, the second doc already had the benefit of the first doc being 'wrong' and he/she did the obvious second thing - start the antibiotic. The rationale gets mistranslated or misunderstood by the patient - or simply was never explained in the first place. In that respect, the system did it right - try to avoid the antibiotic if at all possible, if not use it wisely. We're still missing quite a bit of basic clinical information on how to do this. Much of what we "know" comes from "learned wisdom" - things that have seemed correct and been deemed correct even if the intellectual underpinnings are pretty shaky. Question you assumptions!
Faster! Faster! Faster would be better!
Do you drink milk?
If you aren't part of the solution, then there is good money to be made prolonging the problem
I believe you're making some unjustified presumptions. It wasn't relevant in the original post to go into so much detail, but the patient in question was an insulin-dependent diabetic, and the first physician certainly should have seen a clear reason for using antibiotic in an infected -- or even a probably infected -- patient of this category. There was no mistranslation or misunderstanding by the patient, but there are frequently a whole lot of unjustified putdowns of patients by folk who assume with much hope but little reason that the physician is always right.
btw, you also mis-represented my earlier post, which did not mention any role of 'not finishing the prescription': What I did mention was antibiotic courses being too short. There are two causes, not one, of antibiotic courses being too short, the patient may not finish the course, as you suggest, or the course prescribed may not be long enough. So here is another example of presuming in the absence of facts that the patient is to blame: it seems you could not conceive of any cause of the too-short course other than the patient not taking the medicine as prescribed.
-wb-
[]ColdWetDog wrote:]
I suspect that the 'ideologically taken' physician is relatively rare (never say never in medicine). It is much more likely that the first physician did not see a clear reason for using antibiotics, the second doc already had the benefit of the first doc being 'wrong' and he/she did the obvious second thing - start the antibiotic. The rationale gets mistranslated or misunderstood by the patient - or simply was never explained in the first place. In that respect, the system did it right - try to avoid the antibiotic if at all possible, if not use it wisely.