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."
Idea (Score:5, Insightful)
Stop wasting all those antibiotics on beefing up our cattle and giving a bunch of supergerms a tolerance for the stuff?
Thanks (Score:5, Insightful)
Blame Docs with No Backbone or Are Just Plain Lazy (Score:3, Insightful)
And the soccer moms as well who scream for antibiotics for everything from the common cold to a skinned knee.
These prescriptions are thrown around like candy whether they are warranted or not.
Re:Thanks (Score:1, Insightful)
I don't understand why this particular bit of misinformation has become so widespread, EVEN AMONG SLASHDOT USERS who are supposed to be of a slightly higher academic caliber than your typical person. Disinfectants ARE NOT the problem. They are the nuclear bombs of the microbial world and you will likely never breed a species of bacteria immune to disinfectants.
Re:Thanks (Score:5, Insightful)
Sanitizers that lyse microbes with high doses of ethanol don't contribute to these antibiotic resistant critters, but over prescribing antibiotics definitely does.
However, a major player is also the improper use of properly prescribed antibiotics. People who stop taking their medicine for strep as soon as they feel better instead of completing the course, as is required.
This isn't entirely upon the doctors, but also upon those of us who don't follow doctors' directions.
Re:Idea (Score:5, Insightful)
No, it's obvious that we need even less government regulation so that the free market can allow doctors and sick patients to reach stable equilibrium with the bacterial hordes! There's a basic game theory model that proves my position!!!
It's not only their fault... Moving Forward (Score:4, Insightful)
There's plenty of blame to go around, but of course the trick is what we do moving forward. Some of the simple techniques, such as ensuring hospital staff wash their hands, are very useful in terms of preventing the contraction of bacterial infections and should be something where we encourage, expect, and ultimately demand a 100% success rate (i.e. always wash your hands), without blaming people for not having done it in the past. Nurses at the hospitals with poor discipline stopped washing their hands once disposable gloves started being commonly used in medicine. At this point, for many of them, they have been told or taught to always wash hands or put on new gloves before touching a patient after touching nonsterile surfaces, but they're not part of a hospital culture where that is the unbreakable rule, so they get sloppy.
It's not everyone, nor every hospital, but it's common enough that it's not even frowned on at some hospitals. Simply attacking someone about doing it wrong isn't enough, nor helpful, and our goal isn't to blame, it's to move forward and say, "all right. No more! Let's get this right! Let's cut down on staph infections by twenty percent in the next year." There should be intense competition for objectively defineable metrics of success, where the higher the number the better the patient care (so no race conditions), with conservative results and massive penalties for failing to report properly (so it's in everyone's interest to do well but nobody's interest to cheat), and each year the hospital should be able to report, "we saved X lives this year, and Y of those are lives we saved because of these particular programs and improvements we've achieved since last year."
The goal isn't to blame, it's to achieve. It's to save lives. And ultimately, of course, to save the world. *Flash Gordon Theme plays*
Party like it's 1899 (Score:5, Insightful)
Welcome back to the world before antibiotics were discovered.
However, a few decades of not using antibiotics at all and the bacteria around the world will again mostly be susceptible to the more common, low-risk ones. The mutations that make for antibiotic resistance have negative effects on bacteria's ability to reproduce... except in an environment with significant antibiotic use.
Re:Taking Kidneys offline (Score:4, Insightful)
Of course that's assuming the bacteria isn't in your kidneys...
It just occured to me (Score:3, Insightful)
In general, pharma companies benefit from heavy use of antibiotics: immediately because they can sell more, but also in the long run because it makes their old products (for which they no longer hold a government-issued monopoly) obsolete faster, improving the market for newly developed drugs that fix old problems.
On the other hand, when it comes to these gram-negative bacteria the above idea does not hold true. They can't benefit from it if they don't have a product to sell that fixes the problem.
Re:Taking Kidneys offline (Score:3, Insightful)
Re:Use the Immune System (Score:2, Insightful)
When antibiotics and antiviral research was first being used, they used methods of stimulating the immune system to a better response. But when chemicals proved easier, research switched to that. If we can get the immune system to fight them off itself, we won't have these problems.
Yes but then large pharm companies will have no money.
Stop suggesting things useful and life saving at the expense of profit!
Re:Party like it's 1899 (Score:5, Insightful)
However, a few decades of not using antibiotics at all and the bacteria around the world will again mostly be susceptible to the more common, low-risk ones. The mutations that make for antibiotic resistance have negative effects on bacteria's ability to reproduce... except in an environment with significant antibiotic use.
Immunity to antibiotics would diminish, but I imagine in many cases the neccessary genes would be only supressed or disabled, not completely removed. Plasmids integrated in an inactive part of the genome, point mutations in the promoters and stuff like that.
If we started using antibiotics again, immunities might quickly return.
Re:Thanks (Score:3, Insightful)
However, over use of disinfectants does have some serious issues associated with it. For example, not only do you wipe out the relatively few bacteria that are a problem, but you also wipe out the much larger number of bacteria which are harmless. The ones that actually help by competing for resources with the more dangerous strains. And you're also not giving the body the exposure to bacteria which is really necessary to maintain a healthy immune system.
But the last thing is that if you're not careful what you're using as a disinfectant you can actually spread resistant bacteria around rather than wipe them out. While things like bleach do a great job, you have to be careful just in general do to the health risks associated.
Re:Idea (Score:3, Insightful)
No cost of having resistance is unlikely; having it is an optimal adaptation to given enviroment; if the antibiotics are gone, the envrionment changes, and so do optimal adaptations to it.
Even if there's no cost - that the resistance would suddenly become generally useless means that bacteria having it would need to suddenly compete with "normal" ones on equal terms. The resistance would be marginized and would gradually die out (since, over time, in some populations there would be a mutation that nullifies resistance...but it wouldn't loose out against resitant bacteria this time; repeat over and over again)
Re:Idea (Score:5, Insightful)
It actually works: the resistance is basically the production of some proteins. These cost energy to produce.
Bacteria without the protection will out-compete those with the protection, in the absence of antibiotics: the latter require less energy to live and reproduce.
Re:Idea (Score:3, Insightful)
Wastefulness would probably be still a hindrance if there's some more efficient organism present. It's like the latter has even more plentiful energy.
Re:Idea (Score:3, Insightful)
Re:Idea (Score:5, Insightful)
I'm horrified that you achieved +4 insightful instead of the +5 funny that you were going for.
Re:It just occured to me (Score:3, Insightful)
Re:Idea (Score:3, Insightful)
Homeopathy is maybe the biggest PR stunt in history. You get less and less, call it "potentization", to the point when all you get is whatever you used to dilute your original formula, until nothing of that precious stuff you started with is left and all that remains is the cheap thinner, then sell it for lots of money.
PepsiCo and Coca Cola Co. are still green with envy that they didn't think of that first and patent it.
Re:Ever been on a farm? (Score:5, Insightful)
So, what you're saying is that if you drive to the farm yourself, cut out all the middlemen who are involved in distributing food to grocery stores and coops, etc., then you can buy beef that's reasonably priced (but still above market rates). And if for some reason you can't, then you have to buy from a co-op and pay substantially above-market rates.
You apparently live close enough to a small farm that you can cut out the middleman like this. Most Americans don't. Most Americans live in metropolitan areas and are dozens of miles away from the nearest small family farm. To someone living in a metro area like D.C., going out to a family farm is easily a two- or three-hour round trip. The opportunity costs there jack the $4.75 price up substantially more. You aren't just paying $4.75 per pound at that rate -- you're giving up a substantial chunk of your weekend, too.
Don't make the mistake of thinking that just because something works for you, that it will scale up to work for a nation of millions.
Re:Ever been on a farm? (Score:5, Insightful)
Americans who can't afford beef can do the same thing the rest of the world does (at least those parts of the world that aren't starving). Eat something else.
Chicken is cheaper than beef, eggs are cheaper than chicken, and rice and beans is cheaper still. The cost of one dinner at a steakhouse for two will buy a huge sack of rice and huge sack of beans, including a bunch of stuff to make it taste good. This will easily last a month, even for a family.
Re:Ever been on a farm? (Score:5, Insightful)
If we want to put a hundred pounds on each steer, then that means each steer needs half a ton of feed.
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.
This is why you just eat some vegetarian food. I love a good steak as much as the next guy, but at this point, it seems that the economic/ecological arguments win out. What a waste of societies' resources to turn 1.5 tons of food into 100 pounds of food.
Re:Idea (Score:5, Insightful)
Are you a sociopath? Or do you just go about your life assuming that other people are sociopaths, even when you haven't met them and don't know anything about them?
The current best-of-breed treatment for cystic fibrosis involves having the afflicted person breathe a saline mist for a few hours a day. This has been peer-reviewed and has been found widely effective. It's even been reported in the science section of CNN [cnn.com], among other places.
It's true that Big Pharma isn't pushing this -- but it's notable that (a) this treatment is much more effective and much cheaper than what came before it, and (b) nobody tried to prevent it from getting published. (Quite the opposite, in fact: this thing got published far and wide and fast.)
Want to know why? Because there are people in Big Pharma who have kids with cystic fibrosis. Just like there are people in Big Pharma who have family members with cancer or HIV/AIDS, or emphysema.
Big Pharma wants you to live. Big Pharma wants you to live both for human reasons (the human beings in the company have human compassion for suffering and sickness) and financial reasons (once you're dead, you no longer get sick, which means you no longer need their services). If a doctor talks to a Big Pharma rep and says, "hey, I've got a six year old kid whose lungs are shot from cystic fibrosis, what can you do to help?", the Big Pharma rep will probably talk all about their expensive treatments and how good they are ... and then, off the record, will tell the doctor about the New England Journal of Medicine article that covers saline treatments for CF. Because being a Big Pharma rep is a job... but that rep might also be a father or a mother, and I can't imagine a parent who would stand by and let a little kid live in misery when a cheap and effective treatment exists.
This meme of "Big Pharma wants to kill you so that they can boost their stock price" is insulting. It has taken root only because popular culture has demonized Big Pharma so badly that a disturbing number of people will believe anything unflattering said about them, even if what they're being accused of doing runs counter to their own short- and long-term interests, to say nothing of their humanity.
Re:The slashdot post is kinda funny... (Score:4, Insightful)
It is true that endotoxin A, which is presented to the human body upon cell lysis is heavily immunogenic and can cause disease and/or death. And it is true that it is found as the intracellular component of the gram negative lipopolysaccharides.
But what isn't true is that gram negative = virulent. Virulence is a measure of an organisms ability to cause disease. Many gram negative bacteria simply cannot survive in the human body, so it is false to state or imply that being gram negative is clearly a threat to human health.
Gram negative bacteria that can colonize in the body are dangerous and may cause disease. The point I was trying to clarify was that the characteristic of being gram negative does not mean the bacteria will cause human disease/death. There are various attributes among species of bacteria that will determine if they can grow in the human body.
I hope my point is more clear.
Gram negative != dangerous to human
gram negative + able to colonize in humans = dangerous to human.
Furthermore, there are many bacteria that are gram negative that exist as symbiotic bacteria in the intestinal flora. Need an example? Escherichia Coli is gram negative. If the simple characteristic of being 'gram negative' made a microbe dangerous, we would all be in danger right now.
Re:Ever been on a farm? (Score:5, Insightful)
Re:Ever been on a farm? (Score:3, Insightful)
I am amazed at how many people are reading what I said as a defense of antibiotic-fed beef.
I am not in favor of antibiotic-fed beef. I am opposed to it on humanitarian grounds. Generally, you only need massive amounts of antibiotics if you're raising cattle in such confined conditions that any infection will spread like wildfire. I don't endorse this style of agriculture. I think it's ethical to eat meat -- but I also think we have an obligation to our animals to make their lives at least somewhat comfortable. They give us their lives: the least we can do is give them a few acres to walk around. In the process of treating animals humanely, we also reduce our dependence on antibiotic-fed beef.
The original poster presented grass-fed beef as the solution to our woes. The idea that we can meet current meat demand while feeding animals grass and hay is absolutely ridiculous. That's what I'm pointing out. We raise animals on grain because there are no other economically feasible options, and whether an animal is fed grain has nothing to do with whether it is also fed antibiotics.
Re:Idea (Score:4, Insightful)
Now, I will agree with you that they do not want anyone dead. Dead people don't buy things. However, neither do cured people. So they want expensive life extending treatments, not cures. This isn't even evil boogeyman conspiracy stuff, it is just good business. Unfortunately, in healthcare, good business is frequently not that beneficial to the patient. Good business is zapping everyone that walks in the door with X-Rays and CT Scans and then treating them for cancer at the end of their life because they have been zapped so many times over the years. You get paid on the zappings AND on the cancer treatments. Win Win baby!
Now, on the subject of ethics. Most of the docs that I have worked with are far more ethical than that. In fact, most of them have donated lots of time and effort to various things. I know a few that routinely do the doctors without borders thing. I know at least one that went to Haiti to assist in the relief efforts. However, there was is also a doc in my area that is known to prescribe more pills himself than some of even the larger practices around here. The drug reps are almost permanent fixtures and they pay for large catered meals for the entire office when they come around. So...all it really takes is a few dirty docs to boost the bottom line considerably.
As for drug reps... I have only been around one that didn't make my skin crawl. He did exactly as you described, and talked about some alternate treatments for children with diabetes rather than just stuffing them full of drugs. All of the rest of them show up with oodles of food and coffee and other such garbage. Hell, the cost of health care would go down considerably if they didn't seem to do so much of their training on cruises and other hot vacation spots.
If that wasn't enough, go examine how the whole patent and FDA process works. They spend oodles of bucks tweaking their existing drugs just enough that they can squeeze out a few studies that show enough of a change that they can qualify for a new patent. But wait! There is more! If the changes are above X% they get a new patent, but below Y% and they can put the drug on the market using the previous FDA approval! That's right, they hit that tiny margin of change and they can rush it to market just in time to compete with the generics that will hit the market from their previous patent all without timely and costly FDA approval process. Who gives a shit about side effects and risks when they can get their drugs on the market at just the right time to keep profits up!
Oh...and just for some real fun... throw Thalidomide Babies into Google and enjoy.
Big Pharma does do a lot for the world in their development of new drugs and treatments, but that good is a side effect. They are a big monster that needs very close scrutiny to keep them from doing some unbelievably dirty things.
Re:What about a natural bacterial predator? (Score:4, Insightful)
Re:Ever been on a farm? (Score:2, Insightful)
Re:Idea (Score:3, Insightful)
Business Plan:
1: design new class of antimicrobials
2: patent and market new antimicrobial for widespread use
3: virulent microbes quickly evolve resistance to misapplied product at no cost to corporation
4: repeat steps 1 thru 3 repeatedly to maximize profits at customers' expense
( Hey, it worked for Microsoft, why not biomeds? )
Re:Idea (Score:3, Insightful)
The problem with your comment is it is highly relevant WHICH antibiotic is given to the cattle.
Resistance to one antibiotic does not confer resistance to other antibiotics, since each antibiotic works in a slightly different way.
The original variant of Penicillin is useless today medically. You might get a newer variant (Penicillin G, for example) but you'll never be prescribed the original because it just doesn't work that well any more for treating disease because too many bugs are resistant to it.
So feed it to livestock. It still works as a growth enhancer, and if a bacteria develops resistance to it....so what? It works differently than every other antibiotic.
There are really 3 things that we should be worried about with antibiotic resistance:
1) People who stop taking the pills when they feel better. You need to finish the prescription, or you won't kill off all the bacteria. Those survivors are far more likely to develop resistance, since they suffered a toxic but not fatal dose - they have a lot more chances to develop resistance.
2) People who demand antibiotics for viral infections (such as colds and flu) and the doctors who prescribe them to get the patient to shut up. (And then they do #1 when they feel better)
3) "Antibiotics of last resort" aren't very good sources of income for drug companies. They're rather hard to come up with, and they aren't used very much - they have to be saved for the cases where no other antibiotic works. No profit, no new drugs.
Will someone tell the developing world? (Score:3, Insightful)
Ever been to Mexico? Brazil? Ecuador? Thailand? Vietnam? India?
Walk into any pharmacy. Tell them you've got a little bit of a sore throat. 30 seconds later you're walking out of the pharmacy with a package of antibiotics.
What's worse, is that you get none of the precautionary questions/warnings regarding side effects, possible allergies to antibiotics, instructions to take the whole package, etc.
*This* is where the problem lies. My experience with US and European antibiotics prescriptions has been that there actually is a decent amount of responsibility on the part of prescribers. In other places however, antibiotics are uncontrolled, very cheap, and very very easy to get.
Re:Idea (Score:5, Insightful)
Antibiotic resistance develops when you have widespread use of antibiotics. Currently antibiotics are used widely by corporate farms (chickens are commonly fed antibiotics, etc.). This creates resistant bacteria. Basic evolution. (You can also reverse this by stopping the use of antibiotics and the bacteria will usually lose their resistance.) Antibiotics are also overprescribed for viral respiratory infections where they have no effect.
Fix these problems and we won't need your expensive designer antibiotics (which will become useless in a few years anyway).
So much wrong in that artile ... (Score:4, Insightful)
The article is incorrect in many points. Firstly it is not just the two antibiotics mentioned that are effective against gram negatives, but quite a large range of Aminoglycosides, Quinolones, and even some Cephalosporines for example. Resistance against these happns too, of course.
Furthermore, damage to the kidneys (or hearing nerve) and other severe adverse effetcs can happen, but are rather the exception than the rule. The patient's choice is thus not "to lose his kidneys or die with intact kidneys" but to accept a reasonably small risk of potentially serious adverse effects in exchange for a treatment that is most likely life saving.
Of course it is sad if we gradually lose more and more powerful antibiotics because some reckless idiots overuse them in clinical practice (the USA is one of the worst offenders in that aspect within the "ciilized" realm, especially when it comes to misuse and overuse of Fluoroquinolones) or, even worse, just in order to make cruel intensive meat farming viable.
Re:Blame Docs with No Backbone or Are Just Plain L (Score:1, Insightful)
In some ways this is one of the unintended consequences of patient choice.
If a Doctor wants to keep his patients, he/she not only has to provide high quality-medical care, but also the perception of high-quality medical care. Are you going to tell your friends about the doctor who sent you home telling you to drink plenty of fluids and tough it out, or the one that prescribed you a bottle of pills and sent you out for additional tests "just to be on the safe side".
Plus, no Doctor ever got sued for prescribing antibiotics that wern't needed.The converse isn't true.
Re:Idea (Score:4, Insightful)
"never attribute to malice that which can be explained by stupidity."
That's a good way of thinking positively in everyday interactions. The driver that pulled out in front of me and forced me to jam on my brakes to avoid a collision was just an idiot, not an arsehole. Fine.
When it comes to observing long term trends, and especially as it applies to corporate and government power structures, you might as well reverse "malice" and "stupidity". I constantly hear people talking about all the "stupid" things that come out of Washington D.C. The fact is, the people in D.C. aren't stupid, they're malicious. It just SEEMS like they're stupid when you base the conclusion on the erroneous assumption that they actually have the best interests of the average citizen in mind.
Using Hanlon's Razor to explain away all of the malice directed at you is the same as using it to cut off your head.
Re:Idea (Score:3, Insightful)
We can also target basic proteins on the surface that can't be changed at all (motifs that are found in ALL strains of a given species). "immunity" in this case would force them to literally evolve into a new species.