New Wave of Antibiotic-Resistant Bacteria 404
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."
Re:Thanks (Score:5, Informative)
Life lesson (Score:5, Informative)
And this, children, is why you always, always complete the full course of antibiotic treatment, even if you think the problem's cleared up half-way through. If you stop early you leave the small subset of bugs, not enough to cause a visible problem, that are the most resistant to the antibiotics. Lather rinse repeat a few times and you end up with bugs that laugh at antibiotics and proceed to run rampant.
The slashdot post is kinda funny... (Score:5, Informative)
The language of the slashdot post seems to suggest that the presence of gram negative bacteria is recent. It also suggests that the gram negative characteristic of the bacteria is the definitive characteristic of its virulence. Also, the Gram test isn't a 'so called' test, which somehow suggests or implies doubt.
The test has been done for decades; our knowledge of the two major types of bacteria (gram positive and gram negative) has been around for decades as well. And while gram negativity is characteristic of bacteria that must be approached with different antibiotic means than gram positive, due to their extracellular topology/materials, it does not mean that being gram negative makes the microbes virulent or specifically dangerous.
And to debunk the loose implication that gram negativity might have evolved from human antibiotic applications I will say this: it didn't.
General Bacteriology ftmfw.
Re:Idea (Score:5, Informative)
They wouldn't need to use antibiotics on our cattle if we just fed them grasses instead of corn feed.
Unfortunately corn feed and antibiotics is cheaper than feeding them grasses.
Re:Taking Kidneys offline (Score:5, Informative)
Re:Thanks (Score:5, Informative)
"Only" lab experiments, but this shows the problem is not as simple.
I guess, like samurphy21 says [slashdot.org], the only way to be sure is to nuke them from^W^W^W use a high-ethanol concentration.
Re:Idea (Score:1, Informative)
Re:Idea (Score:3, Informative)
The nice thing is, if we stopped RIGHT NOW, Darwin's invisible dead hand would be on our side... if there is no reason for the germs to have a resistance to antibiotics because they're everywhere, those germs lacking the resistance become more 'fit' since they use less energy supporting the requirements of that resistance. Instead they put their energy to reproduction or getting by on less sustenance, and will breed out the resistant bugs in fairly short order.
Re:Hand Sanitizer (Score:3, Informative)
Re:Idea (Score:3, Informative)
Meat includes fat.
If you only want the protein, then just mix up a whey protein isolate-shake. MM-mmm. I recommend the strawberry flavor. Also use ice if possible, it covers up the graininess.
Re:Idea (Score:5, Informative)
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.
Re:Thanks (Score:3, Informative)
What the label says is not always how the product functions. It should probably say "in most cases, when used properly and according to directions, all bacteria will be killed but just in case there is a lawsuit we're going to claim 99%."
If you wash a surface evenly with alcohol or bleach, you're going to get 100% disinfection. If you get sloppy and rinse immediately, or end up diluting the poison, you can get exposure without death, leaving some bacteria. If you then repeat the process, the bacteria are no more resistant.
You'd have to have an extremely rare mutation that allows extremophile behavior in order for anything to have hope of evolving resistance.
I'm not sure about triclosan and other chemicals, but bleach and alcohol are really quite effective at preventing resistance. And most of the bleach-based cleaners say 99%.
Re:The slashdot post is kinda funny... (Score:5, Informative)
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.
Re:Taking Kidneys offline (Score:5, Informative)
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.
Re:Party like it's 1899 (Score:5, Informative)
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 [fftimes.com] )
Ever been on a farm? (Score:5, Informative)
My family raises cattle on a farm in Iowa. Speaking from our experience, I'll tell you that putting a pound of meat on a steer takes in the neighborhood of ten pounds of feed -- and much more than that, if you're feeding them exclusively grasses (including hay).
So. Take a hundred head of cattle and turn them loose on a hundred acres of land. These animals are still growing (since, when they're ready for the slaughterhouse, well... they get taken to the slaughterhouse). If we want to put a hundred pounds on each steer, then that means each steer needs half a ton of feed.
Good luck getting 50 tons of grass from a hundred acres of land. It's not going to happen. The farmer has two choices at this point: raise fewer cattle (and thus raise meat prices for the consumer), or convert some of the cornfields into pasture (and thus raise grain prices for the consumer).
Either way you're talking about raising the prices of basic foodstuffs. You won't inconvenience the rich: the rich will still be able to afford filet mignon and Kobe beef. After all, they're rich.
But the elderly, who live on fixed incomes... poor families who depend on food stamps... or just a college student burdened with debt who wants to be able to take his girlfriend to a steakhouse for a special occasion... all of these people are seriously impacted.
The name of the game in modern farming is efficiency. Reducing prices is the overall goal.
Re:Idea (Score:5, Informative)
I don't know about the new organisms, but the older resistant strains DO spend considerable metabolic energy on their resistance, either producing enzymes that have no other purpose or supporting active pumps on their membranes to remove the antibiotics that get in. In either case, in an environment free of the antibiotics, the resistant strains waste energy for no benefit.
Re:Thanks (Score:1, Informative)
They're quite likely referring to quaternary ammonium detergents, including the mildly notorious benzalkonium chloride. It's a safe and effective antiseptic, but it isn't inconceivable for bacteria to become resistant to them.
http://en.wikipedia.org/wiki/Benzalkonium_chloride
Perhaps one of the best and easiest things to do would be to use copper doorknobs, which are self-disinfecting. Doorknobs are an excellent way to transmit disease.
These infections are indeed spongeworthy... (Score:2, Informative)
Good news for us, Elaine Benes, and Squidward:
http://www.mrsapedia.com/sea-sponge-antidote-to-mrsa/ [mrsapedia.com]
I heard about this a while ago. I'm wondering when it'll happen.
Re:Probiotics (Score:3, Informative)
by flooding the system with beneficial bacteria that will compete with the harmful ones for resources and eventually starve them out.
That's all very well in the lab. However in a patient those "resources" also happen to be things the patient's cells need. Guess who also is going to be "starved out". Just my 2 cents worth but don't mind me, I'm just a physician.
Re:The slashdot post is kinda funny... (Score:3, Informative)
Sure LPS might be inflammatory but that doesn't make all (e.g.) E.coli pathogenic - it's the aquired attachment/invasion/toxin genes that confer pathogenicity. Similarly, it's the aquired antiobiotic resistance genes that are important in most cases of multiple resistance.
It has been said before and will be said again -- nothing to see here folks, move along.
Phage therapy: Where communism succeeded.. (Score:5, Informative)
"The programme revealed that we - ie humankind - had discovered a superior cure (to antibiotics) for bacterial infections around the same time that penicillin was being discovered. The research programme on bacteriophages (phages for short) began in Stalin's Georgia in the 1930s. To this day, our knowledge of each of the many thousands of phage viruses remains concentrated in a now rundown laboratory in Tbilisi, Georgia. The arrival of capitalism in the Caucuses threatens a repository of knowledge, built up over 50 years, that could prevent the superbug pandemic that threatens us all next century. ...
While there are some genuine reasons why phage treatments of bacterial diseases were overlooked in the 1930s and 1940s, the failure to develop a western research program into bacteriophage treatment in the 1980s and 1990s represents an inexcusable failure of western capitalism. By the 1980s, ther e could be no denial that antibiotic resistance was going to be a major problem in (if not before) the twentyfirst century. Yet, we just didn't want to know about what will probably turn out to be the most important medical breakthrough in the twentieth century; a breakthrough made in communist G eorgia, in Stalin's Soviet Union.
It is embarrassing when western science is out-trumped, especially by the "communists". Usually, when out-trumped, we don't tell anyone. That's what happened here. Not only did we not have the nous to start a western programme in bacteriophage research; we looked the other way when the files of phials threatened to be destroyed following the breakup of the Soviet Union, and during the little reported civil war that engulfed Georgia a few years ago. So much for the knowledge economies of the west. How can such valuable knowledge be so cheap?
It's not too late for western medicine to enter the post-antibiotic bacteriophage era. Our grandchildren will hardly thank us if we persevere with our corporate-profit-motivated conservatism.
The Soviets were able, eventually, to admit that they were wrong to follow Lysenko. Will we in the west be equally able to admit that we were wrong to put all our medical eggs into the one antibiotic basket, in the process ignoring the most basic tenets of the theory of evolution?
"""
From:
http://www.scoop.co.nz/stories/HL9910/S00096.htm [scoop.co.nz]
(I'm glad to see several people have posted links to phage therapy information.)
Re:Idea (Score:4, Informative)
Actually it's not surprising. Hospitals are amongst the "cleanest" environments, due to necessity. Lots of people with open wounds that infect easily, lots of people with failing or failed immune systems. So they use more antibiotics and cleaning agents than even the most overprotective mother ever could (which, btw, is about the worst thing you can do to your kids, right after the opposite and having them play with infected needles).
Killing off most germs means that you kill off the weakest of the herd. The ones that are easily affected by aggressive cleaning agents. What you do this way is simply building a better home for the ones that survive, because you never kill them ALL. By the very nature of bacteria, it is virtually impossible to kill them off for good. You will even find a few in intensive care, and one is already enough to create a new culture. They multiply FAST.
The ones that survive the aggressive cleaning agents and the whole antibiotic bombardment are the ones that are toughest, strongest and most resistant. And when they get to multiply, you have a strain of supergerms at your hands.
So, in a nutshell, if you want to kill off your family fast, buy some antibiotic cleaning agents today!
Re:Idea (Score:3, Informative)
I'm always reminded of this. [scienceblogs.com] Long story short, cancer researcher's mother-in-law dies of cancer. Then there are these douchebags out there saying that people like that are out to suppress all the cheap miracle cures, meaning that that guy could have saver his in law, but was too greedy to let the wonder cure slip just this once. People actually believe that. What assholes.
Re:Thanks (Score:3, Informative)
If you wash a surface evenly with alcohol or bleach, you're going to get 100% disinfection.
Not quite true. For example, alcohol hand cleaners don't work all that well against some spore-forming bacteria, such as the nasty C. diff.
Re:Taking Kidneys offline (Score:4, Informative)
[hemo] dialysis is using a counter current "dialysate" to effect a net removal of solvent and solute from the blood...aka accomplishing a filtration the way a kidney works by using a semi-permeable membrane. Can also be done via a process of peritoneal dialysis using a catheter inserted into the abdominal cavity.
plasmaphoresis is the process of removing the plasma from the body and replacing it with albumin or other colloid solution (fresh frozen plasma). This is used to reduce the immune components of the blood e.g. antibodies. Most commonly used for auto-immune disorders.
lukopheresis is selectively removing the white cells from blood. This is mostly commonly used in packed red cells used in transfusions.
The latter two procedures would be contraindicated in the face of a bacterial infection as they would severely inhibit the immune function of the body.
Re:Idea (Score:3, Informative)
Re:Thanks (Score:4, Informative)
Reading this article earlier today, about conquering resistant infections in Norway [miamiherald.com]. Sounds like they've basically figured it out. What are the chances that we can get that kind of smarts imported into the US?
Cheers.
Re:Ever been on a farm? (Score:4, Informative)
My family raises cattle on a farm in Iowa. Speaking from our experience, I'll tell you that putting a pound of meat on a steer takes in the neighborhood of ten pounds of feed -- and much more than that, if you're feeding them exclusively grasses (including hay). ...
Either way you're talking about raising the prices of basic foodstuffs. You won't inconvenience the rich: the rich will still be able to afford filet mignon and Kobe beef. After all, they're rich.
If your family raises cattle, then you should know that farmers have been culling cattle herds like crazy for the last ~5 years or so. Beef prices have gone through the floor because the recession seriously dampened demand and caused a glut in the market. At the same time, corn prices have been zooming up because of the ethanol push. This isn't just limited to cattle, as the pork and chicken industries have been cutting production too.
Just so no one things I'm pulling this out of my ass, here's the first relevant google result for "culling cattle herds"
http://www.businessweek.com/news/2010-01-27/u-s-cattle-herd-falls-to-1958-low-as-losses-climb-survey-says.html [businessweek.com]
Here's another article, this time from April 2009, talking about 2008 herd numbers for the various industries:
http://www.avma.org/onlnews/javma/apr09/090415a.asp [avma.org]
Moving to grass fed beef would resolve the market price problem (grass fed commands a premium) and the cost problem (grass is free, more land is cheap, corn feed is not).
Re:Ever seen a progressive store? (Score:3, Informative)
I suspect that it's ignorance. Oftentimes, we'd feed our cattle a soybean mix. People think that cattle are only ever fed corn, but that's just hogwash. They've got good stomachs: they can digest pretty much anything that grows and isn't poisonous. (They also really like apples. When I was a kid I quickly learned not to enter the pasture after climbing the apple tree.) They also get fed cottonseed, milo, oats, hominy... I've never heard anyone rail against those, though. It seems that people hear, "oh, corn-fed beef!", and leap to the conclusion that corn is the only grain that's fed to cattle.
Bitter Resistance (Score:4, Informative)
Bruce Sterling wrote what is still probably the best article for the layman about the inevitability and dangers of bacteriological antibiotic resistance.
Bitter Resistance [eff.org]
Check it out, peeps.
Summary incorrect (Score:2, Informative)
Here's a link: http://emedicine.medscape.com/article/168402-overview [medscape.com]
Re:Idea (Score:3, Informative)
You are also incredibly naive about costs. Almost all drugs are incredibly cheap to produce but still ending up costing patients "whatever the market will bear" (how much is your life worth). It's not just regulatory approval. It's just greed by the pharma companies. You definitely do want drugs to pass regulation. You don't want untested drugs released.
Anonymous Coward (Score:1, Informative)
Mutations are actually a rare occurrence in nature (one every million or billion copies) but unfortunately with the growth rate of bacteria, this event occurs much more frequently than most people understand. Bacteria are like any other living organism, they want to survive. The healthy WILL survive and as others have posted, total eradication is not possible. The best we can hope for is to CONTROL the organism and subsequent growth.
Mother nature actually has a way to handle this right now...the problem is that sometimes mother nature takes a while to produce these weapons of war. Mother nature uses special viruses that only target bacteria called bacteriophages. Since these viruses mutate faster than the host bacteria, mother nature provides a solution to the mutating bacterial problems. This is not a new science, it was discovered nearly 100 years ago, but since antibiotics seemed more efficient, this science has been taking a back seat. Recently this promising new science is providing an alternative solution when all else fails. It certainly isn't a silver bullet, as it has it's limitations, but if you can find a way of putting these little viruses in contact with the bacteria, they will work and they can control the disease.
Check out www.omnilytics.com