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

[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: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

[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.

Progress!

[Gaygirlie]

So now we can train bugs to say no to drugs, next step is to move to animals and then finally humans!

I wonder

[HerrWolfe]

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

Re:I wonder

[Gideon Wells]

Alchohol based and similar antibiotics don't have a drug to build a resistance to. It is just deadly in a high enough dose. Those that live are through dumb luck. So these products are safe to use without fear of adding to drug resistance.

Re:I wonder

[Fuzzums]

It will just train bacteria to become alcoholics :)

Re:I wonder

[Fuzzums]

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.

There is enough talk about reducing antibiotics for humans and animals though, but the pharmaceutical industry is lobbying against this kind of regulation for obvious reasons. The more they sell, the better. For them that is. Go free economy where only money rules and common sense comes last...

Making antibiotics ridiculously expensive and inaccessible for people who really need them is indeed one way to "regulate" the use of antibiotics instead of simply not prescribing it for a simple cough.

But also for over consumption. Everybody knows this will become a huge problem sooner or later, but everybody also decides to look the other way and hope it will go away. It's human nature I think. But nature will definitely find a new balance. It's like a nuclear reactor. If you don't regulate, things will get out of hand. We might like the outcome. We might not. :)

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:I wonder

[Phydeaux314]

There is a *slight* difference in the function of alcohol and penicillin in how they serve as antiseptics: Penicillin interferes with cell wall construction, whereas alcohol flat-out denatures all the proteins. Random mutations that use completely different protein structures that aren't attacked by alcohol are a fair bit rarer, to say the least.

Re:I wonder

[Tsingi]

Yes, you're the fourth person to say that, I get it, I fucked up.

I was prompted to go to Wikipedia and it turns out my preconceptions were in left field. The main point though is this: Livestock consume 70% of the antibiotics in the United States. (Albeit for different reasons than I stated) They are also injected with synthetic growth hormones.

I'm Canadian, and the article suggests that we haven't deregulated the cattle industry yet. i.e. it's still illegal to sell meat contaminated with antibiotics and hormones in this country. Comforting.

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:I wonder

[PCM2]

The banana story has absolutely nothing to do with drug resistant bacteria. The reason an entire species of banana can be wiped out by a single pathogen is because farmed bananas, as they are produced today, are all genetic clones. (They are not necessarily even GMO; they are just clones.) Thus, cultivated bananas do not have the same genetic diversity that other species do; you're unlikely to find a single banana that has resistance to something that another banana does not. And that's why when one plant goes, they can all go. But this is a completely separate issue from how bacteria evolve resistance to antibiotics.

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

[Rogerborg]

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.

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:...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.

Farmers feed cattle with 12000 tons of antibiotics

[advid.net]

Indiscriminate use of antibiotics for livestock also lead to resistance, do not only blame doctors and hospitals.

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 -

I think our etiology of antibiotic resistance is..

[einhverfr]

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.

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.

Re:Farmers feed cattle with 12000 tons of antibiot

[einhverfr]

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.

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.

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:Farmers feed cattle with 12000 tons of antibiot

[inviolet]

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").