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."
Am I the only one? (Score:2, Interesting)
What about a natural bacterial predator? (Score:4, Interesting)
Anyone remember Phage Therapy [wikipedia.org]?
Comment removed (Score:5, Interesting)
Problem solved (Score:1, Interesting)
Remove the kidneys for the duration of the antibiotic therapy and hook the patient up to a dialysis machine.
Who cares if it's a hack if it works!
Re:Idea (Score:2, Interesting)
The keyword is being developed
How many people will die of infection before the FDA gives them their seal of approval?
Re:Life lesson (Score:3, Interesting)
I've always thought that doctors should use shots to deliver antibiotics whenever possible. For many of the most common things like ear infections it is 1 shot or 2 weeks of pills. It also applies disincentive for idiots who ask for antibiotics for problems that don't need them(based on the fact that many people that I know hate getting shots).
Re:Idea (Score:5, Interesting)
Assuming they delay the process by a decade, 200,000-300,000 in the U.S., but that is assuming that all of those people are otherwise healthy.
That's more than AIDs but less than car accidents (and a hilarious footnote compared to heart disease and cancer).
Question from the uninformed (Score:3, Interesting)
Any medical doctors reading? (Score:3, Interesting)
If it's possible to donate a kidney, and possible to remove a kidney intact, and possible to keep someone going with dialysis for a while, can they not develop a procedure to temporarily remove kidneys if the patient is going to have treatment that would damage them?
Prohibitive code? Difficulty keeping the organ alive outside of the body? Risks of surgery whilst infected?
Re:Life lesson (Score:4, Interesting)
Re:Am I the only one? (Score:4, Interesting)
Most medical antibiotics are based on naturally-occuring antibiotics found in soil organisms. Of course, as these organisms evolved the antibiotics the bacteria around them co-evolved defenses. This means that for most antibiotics there are bacteria around that have genes that make them resistant. Since bacteria trade their genes around it's only a matter of time until the resistance genes find their way into disease organisms. Hospitals contain concentrations of people being treated with antibiotics and so that is where the resistant disease organisms tend to appear.
We need antibiotics based on novel modes of action not found in nature, but these are hard to develop. The ability to sequence the genes of bacteria as well as the ability to synthesize proteins with predictable characteristics will help.
Re:Idea (Score:3, Interesting)
A common form of resistance is to build a molecular pump that pushes the antibiotic out of the cell. That definitely takes energy to grow and run.
Re:Idea (Score:3, Interesting)
Here is something to think about, an infection/parasite that kills its host is a failure, since its genetic line does not continue unless it can find a new host within its window of survival time after the original host dies. So these "super germs" may kill off their host but they also ensure that their specific genetic line, plus any little tricks/resistances they may have developed in the current host are most likely lost.
Meanwhile the non-resistant germs would continue to exist and may, through the sharing of genetic information that sometimes occurs between bacteria end up reducing or even eliminating the current levels of resistance.
I may be wrong as I am not a micro biologist but what I can remember from biology class indicates that what I've described is possible.
Unfortunatly it also means that some other way has to be found to keep these bugs from killing people, maybe through the use of bacteriophage based treatments or other methods, I don't know since I'm not a doctor either.
Re:Idea (Score:3, Interesting)
Tyson chicken, Smithfield pork, all the big operators use antibiotics in feed. Look it up. http://www.alternet.org/health/145272/the_overuse_of_antibiotics_in_livestock_feed_is_killing_us [alternet.org]
Re:Thanks (Score:3, Interesting)
I used to think that - there are chemicals that destroy everything, take bleach for an example. Pour it on and watch the little bacterial buggers die horribly.
Except that it doesn't work on all bacteria - even the best brand of bleach in the UK has "kills 99.9% of all known germs" written on the front. That last 0.1% is a bunch of mofo hardnut bacteria.
Extensively-drug-resistant TB (Score:3, Interesting)
Extensively-drug-resistant tuberculosis (XDR-TB) is already a nearly-unstoppable killer. In fact, it could very well be a doomsday bacterium. It is deadly, practically untreatable, survives well outside of the human body (as long as it's away from direct sunlight), rather long incubation period.... Finally, to diagnose XDR-TB you'll currently need anywhere between 2 to 4 MONTHS! All that time you might be curing a person with drugs that are ineffective.
Moving into the pre-antibiotic era (Score:4, Interesting)
In fact, more than 60% of the Gram negative isolates in our hospital (in-patients) appear to be producing an enzyme called extended spectrum beta lactamases (ESBL). These ESBL-strains are often resistant to other classes of antibiotics as well, narrowing therapeutic options. In a subset of cases, these bugs turn up as resistant to almost all the antibiotics we test.
But, I am yet to come across a case where the isolate was resistant to colistin and polymyxin B. No clinician would even think of using these drugs if other options are available. But, if, as the article reports, these organisms turn out to be resistant to even these last-resort drug... we can safely assume that we are in deep shit.
Stop blindly proscribing antibiotics (Score:4, Interesting)
In the USA, he said insurance tells them to just proscribe an antibiotic and if it doesn't work, they'll come back. The ten minutes of lab work isn't covered by insurance, so they don't do it. I asked if I could pay cash for the test with the microscope, but he refused and said he'd get in trouble.
Most doctors follow insurance rules, worry about liability, and treat symptoms, in that order.
Re:Party like it's 1899 (Score:4, Interesting)
I just read somewhere that Norway is taking this approach. Unless you're going to die without them, antibiotics are not prescribed. Antibiotic resistance has plummeted as a result. Between this and banning their addition to farm feed I'd bet things turn around inside of 10 years, except it will take a major catastrophe in the US to overcome the political resistance to farm use.
Re:Idea (Score:0, Interesting)
Does that get administered into your ear canal then? Or is there some more disturbing process?
Yes it does. I was prescribed the same thing for an ear infection and it actually made it worse. Why? It turned out to be a fungal infection which Cipro doesn't affect, but instead it wiped out the normal harmless competing flora that would have kept things in check. The stuff that really worked stunk like railroad ties, but was meant for fungal type infections.
Probiotics (Score:3, Interesting)
Nanobots to the rescue (Score:3, Interesting)
The question I have is, how quickly can we either build nanobots that can be programmed to attack these infections, or else develop custom tailored viruses that target them? In other words, are antibiotics the only way to attack infection, or might we be able to develop other weapons to use against them?
Re:Stop blindly proscribing antibiotics (Score:2, Interesting)
Re:Ever been on a farm? (Score:5, Interesting)
You will be free to continue using expensive antibiotics on your farm...
We raise antibiotic-free beef. Grain-fed, but no chemicals. You generally don't need antibiotics for free-range beef. Antibiotics are needed when you're doing large-scale industrial farming where the cattle are packed together like sardines and an infection in one animal quickly spreads throughout the barn like wildfire.
We give our animals room to roam. We do it for humane reasons -- we think it's inhumane to put an animal in a pen and never allow it to leave. I don't know any family-run farm operations that raise cattle in pens: free-ranging is almost an article of faith among us.
You are not the first person to assume that I'm in favor of putting antibiotics in beef. I'm not. I'm in favor of free-ranging them because I think it's required by the decency standards of animal husbandry.
I am also in favor of grain-fed animals, because we simply cannot produce beef in the amount demanded by the market without it.
Re:Taking Kidneys offline (Score:2, Interesting)
Could someone tell me the differences then, between plasmapheresis and dialysis? Would the former be safer for a patient than the latter? Are these procedures so similar that it wouldn't matter or are any of these procedures (like plasmapheresis or lukopheresis(?)) not even close to being appropriate for treatment when antibiotics fail?
Re:Idea (Score:4, Interesting)
Sadly, government regulations and the money that it takes to over come them have forced us to shift our attention to other applications for our technology.
Re:Idea (Score:5, Interesting)
re: big pharma (Score:4, Interesting)
To be honest, I'm caught in the middle of this "Big pharma? Good or evil?" debate.... On one hand, sure, I agree with you that many people employed in the pharmaceutical industry want to do good, and aren't part of some agenda to kill people and boost stock prices But let's face the facts. That's almost a universal truth, when you start talking about individuals you've singled out in ANY company. It also holds true for the military. (Talk to a U.S. solider who was deployed to Iraq, sometime. Chances are, he signed up for the service NOT because he had some agenda in his head, but simply because it paid pretty well in a bad economy - and he's trying to take care of a family.)
What you always have to examine is what direction the company is headed, on the whole. That's where I start to see the other side of the debate. It's pretty easy (and common) to hire thousands or even millions of employees who practically ALL believe they're doing "good", while the end result is decidedly "evil". Some of the big pharmaceutical firms come from fairly "tainted" backgrounds, too.
Take, for example, Bayer Corp. Today, you think of them mainly as providers of aspirin ... but in WWII, they were cranking out mustard gas, military grade chlorine and phosgene for Germany. In fact, they were stripped of their right to trademark aspirin after WWII in many nations due to their direct involvement in the war.
Re:Idea (Score:3, Interesting)
I had the same problem last summer -- a fungal outer-ear infection that drove me nuts for literally MONTHS, at one point leaving me half-deaf in the affected ear (really... I couldn't hear my phone well enough to use that ear, and couldn't understand conversations coming from that side when sitting at a table). I started with ear drops that were basically a steroid plus one of the antibiotics found in Neosporin (neomycin?). They did nothing at all. Well, that's not true... they did help the horrific itching a bit, but the ear infection got worse. A week later, I was on Ciprofloxacin + the same steroid. Yep, it got worse. My doctor thought I had cotton in my ear, and flushed the ear out. Instantly, my hearing problems went away... but started coming back again a week later, and 3 weeks later I was right back where I started.
I finally got an appointment with a real ear-nose-throat doctor. He took one look, sighed, and informed me that I was yet another patient given antibiotics + steroids for a fungal infection. He flushed it out (instant relief), gave me a prescription for what was basically vinegar ear drops, and another prescription for clotrimazole drops (with a disclaimer that their use for inner ear infections is strictly off-label, but likely to clear it up a LOT faster).
Getting back to the article's topic, it's not the antibiotics in the drops that made my fungal ear infection worse -- it was the steroids (they cause tissue damage), and the fact that I was basically soaking my ear canal with liquids that did nothing to impair fungi, and kept it nice and moist for their reproductive comfort & convenience. My ENT doctor expressed regret that nobody makes ear drops that combine an antibiotic, antifungal, and lidocaine (let's call it "Lotrisporicaine"), mainly because it would give general physicians something better to blindly prescribe for ear infections that actually WOULD work against pretty much anything a normal person is likely to get, without making it worse if it ended up being fungal instead of bacterial. His view was that most family doctors can't reliably tell the difference between bacterial and fungal ear infections, and most really bad fungal infections end up having a bacterial secondary infection anyway by the time the patient ends up seeing a specialist if he hasn't already been treated with antibiotic drops (because by that point, the patient has probably rubbed the ear canal's paper-thin skin raw with Q-tips in a desperate quest to stop the itching).
Re:Idea (Score:4, Interesting)
Big Pharma is pretty much like any Corporation: Intelligence without conscience. And it's not even because corporations are "evil". They're not. Nobody shoots down cheap cures because they want people to die. Nobody pumps oil into the sea because they enjoy to poison the planet. Nobody uses spoiled food in burgers because they enjoy making their customers sick. It's simply the way to make more money. And they don't even do that because they're greedy. They are just doing what is necessary. Actually, they are doing it in their best conscience. No matter at what level you work in a corporation, your conscience actually tells you that you have to be more profitable, and that minor little "evils" are ok for the greater good.
Profit is to be made, not because you want more but because it's your duty to be profitable, because other people placed trust into you. If you're a researcher, you have to come up with a cure because, well, that's what you do. If you're a manager, you have to patent it and make it profitable because your investors put their money into your hands and you have to honor their trust and make the most out of it. If you're their lawyer, you have to defend those patents, for the same reasons. It's all for the "greater good". Yes, that means that some people die because they can't afford the cure, but curing these people would mean you betray the trust of your investors.
The same is true wherever else you see corporations do "evil". Everyone has someone else to shift the blame to. You can shift it on your superior (because if you don't do it, you'll be fired), he can shift it upwards to his, that works 'til we reach management, who can shift the blame to investors who want revenue for their money, investors who in turn don't even know what they invest in because they just handed money to some guy at a bank who, in turn, has to take the most profitable route for his customer because he, again, has been entrusted with money... So, in a way, if you lose your job in the next layoff, it could well be you that fires you if you happen to have stock in the company you work for.
Big Pharma doesn't want to kill me. They want to treat me. They want to profit off me. Just like everyone else. And while the sales rep might be a human being with human feelings who tells the doctor about a cheaper treatment, this is not the most profitable route. If there is a sociopath that does not tell the doc about the cheap cure, which means that 3-4 kids out of 10 will die because they can't afford the cure, and he's competing for the sales rep slot, he will be the one succeeding in the end because the 6 that survived and bought the cure will make him look more successful at selling and that's what counts in the quarter report.
Yes, sociopaths do come out on top. Unfortunately, life is not a prisoner's dilemma game. Mostly because too many people play it. It just doesn't bite you in the ass when you keep cheating, you don't play too often against the same people again, you have plenty of people to choose from...
Re:Thanks (Score:3, Interesting)
Maybe it's time (Score:1, Interesting)
Re:Ever been on a farm? (Score:2, Interesting)
I'm not a vegetarian (though I eat less and less meat, partly because of eco concerns, partly because of the use of non-natural feeds) and I know this doesn't solve the 'meat' problem. You can keep chickens/bees on your roof, though.
But I see it as 'import substitution', some locally produced/non supermarket food for city dwellers and small but pleasant incremental changes in city landscapes and lifestyles until we arrive somewhere different.
Re:Idea (Score:4, Interesting)
> "If you dropped the regulations, "
>> "If the US had a nickle for every time a businessman said that about regulations..."
Try your hand at operating a small manufacturing business at some point, then come back and provide your revised commentary. That was what my family TRIED to do when I was growing up. On the days you weren't dealing with OSHA and EPA, it was planning and zoning, DOT, dept. of weights and measures, etc. Then let's not forget the bloody IRS. Seemed like there was a full time bureaucrat in the Federal, State and local government for every one of the 8-10 people my family employed, and their job was to make our lives miserable and our business inoperable by enforcing the most obscure and idiotic regulations imaginable. That experience forever shaped MY worldview when it comes to the government and their useless bureaucracts.
Re:Phage therapy: Where communism succeeded.. (Score:3, Interesting)
Or maybe someday Canada? :-)
http://www.biophagepharma.net/ [biophagepharma.net]
But thanks for the insight on the regulatory aspect. I had not known that.
Related: ...
"Choosing to let patients with superbug infections die rather than phage them?"
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=103x338050 [democratic...ground.com]
http://www.opednews.com/articles/life_a_pkdkso_080212_choosing_to_let_pati.htm [opednews.com]
"""
In Canada the official body counters tell us that "an estimated 220,000 patients who walk through the doors of hospitals each year suffer the unintended and often devastating consequences of an infection" and they also estimate that 8,000 to 12,000 Canadian patients die annually from such infections and I have read claims that a similar number of limb amputations are done to cure such infections. That means as many as 30 Canadians become victims of superbug infections each day.
In the USA the Centers for Disease Control and Prevention reports that methicillin-resistant Staphylococcus aureus seriously sickened more than 94,000 Americans in 2005 and almost 19,000 died, more than the 17,000 Americans who died of AIDS-related causes.
Yet the French-Canadian microbiologist, Felix d'Herelle, while working at the Institute Pasteur in Paris in 1917 discovered phage therapy which uses highly specific viruses, bacteriophages, which have been observed to be harmless for humans, to treat bacterial infections, including infections caused by superbugs. While there is considerable expertise on phage therapy in Canada and the USA at the research level medical phage therapy is not currently approved or practised in Canada; however, according to a letter signed by the former federal health minister phage therapy can be made available legally to Canadian patients under the Special Access Program of our Food & Drugs Act! Additionally, there are moral and ethical reasons for making phage therapy available in countries that are members of The World Medical Association which states: "In the treatment of a patient, where proven prophylactic, diagnostic and therapeutic methods do not exist or have been ineffective, the physician, with informed consent from the patient, must be free to use unproven or new prophylactic, diagnostic and therapeutic measures, if in the physician's judgement it offers hope of saving life."
Further, the phage therapy file has dramatically changed because the US Food and Drug Administration (FDA) has amended the US food additive regulations to provide for the safe use of a bacteriophage preparation on ready-to-eat meat and poultry products as an antimicrobial agent against Listeria monocytogenes (see http://www.fda.gov/OHRMS/DOCKETS/98fr/02f-0316-nfr0001.pdf [fda.gov] ). An enlightening FDA questions-and-answers document can be found at http://www.cfsan.fda.gov/~dms/opabacqa.html [fda.gov] . Listeria causes an estimated 2,500 cases of mainly food borne infections in the USA annually and as many as 500 deaths; however, they ideas that ready-to-eat meat can be treated if contaminated with Listeria bacteria while a doctor could not get a pharmaceutical grade phage therapy product when faced with a patient suffering listeriosis strikes this author as absurd. Superbugs are everybody's business because sooner or later everybody will be faced with an infection or know a relative or friend who will be suffering or dying with one. Withholding such treatment from patients when antibiotics are failing ought to be a crime; however, those who have the money, knowledge and time to travel when faced with an infection where antibiotics are failing may b
Re:Will someone tell the developing world? (Score:2, Interesting)
Anyway, today as part of the EU it is as terrible as ever. Doctors prescribe the stuff by the bucket. Since I am living in Holland I have been prescribed two times for 10 years!