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Medicine EU

Drug-Resistant Superbugs Sweeping Across Europe 433

Posted by samzenpus
from the and-you-thought-the-old-nuclear-reactors-were-bad dept.
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."
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Drug-Resistant Superbugs Sweeping Across Europe

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  • VS (Score:5, Interesting)

    by Anonymous Coward on Friday November 18, 2011 @06:46AM (#38096206)

    Any reason why this would not be the case in the US?

    • Re:VS (Score:5, Informative)

      by WillKemp (1338605) on Friday November 18, 2011 @06:55AM (#38096254) Homepage

      It is the case in the US.

    • Re:VS (Score:4, Insightful)

      by yog (19073) * on Friday November 18, 2011 @01:27PM (#38100328) Homepage Journal

      Drug-resistant tuberculosis (extensively drug-resistant tuberculosis - XDR-TB) and drug-resistant staph (Methicillin-resistant Staphylococcus aureus - MRSA) have been reported in the U.S.

      Very worrisome trend. Over-prescribing of antibiotics combined with misuse (taking a little, then stopping, instead of taking a full regimen to completely eliminate the pathogen) can result in the survival of resistant strains of microbes. It was bound to happen anyway, but now the trend has accelerated.

      We'll have to resort to novel approaches very soon to attack these critters--nanotechnology holds a lot of promise, some forms of radiation, and new drugs.

      We should be treating this as a public health emergency and providing appropriate funds to develop cures.

      • by geekoid (135745)

        " (taking a little, then stopping, instead of taking a full regimen to completely eliminate the pathogen)"

        that is the cause, far more the over prescribing. Over prescribing means you piss way antibiotic, and impact the good stuff. Which should be stopped, but it is foolish to say over prescribing is what is driving the evolutionary change.

        • by jasno (124830)

          So a few weeks ago my neighbor, a blue collar, beer drinkin, pot smoking guy in his 50s, gets a spider bite on his finger which gets infected. It keeps getting worse, his finger doubled in size, turned bright red, with red streaks going up his arm. Finally I convince him to go to the doctor.

          He goes, gets powerful antibiotics, and starts to get better. I ask him a few days later how he's doing... his response? "Oh it's getting better, but I don't like how the antibiotics make me feel so I stopped taking

  • Progress! (Score:5, Funny)

    by Gaygirlie (1657131) <gaygirlie@NOsPAM.hotmail.com> on Friday November 18, 2011 @06:46AM (#38096208) Homepage

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

  • I wonder (Score:5, Insightful)

    by HerrWolfe (1829238) on Friday November 18, 2011 @06:47AM (#38096210)
    I wonder if such a common thing as antibiotic soap can increase resistance over a period of time.
    • Re:I wonder (Score:5, Informative)

      by tsa (15680) on Friday November 18, 2011 @06:51AM (#38096232) Homepage

      Of course it does. The fact that these soaps haven't been banned yet shows how serious the EU takes this problem.

      • Re:I wonder (Score:5, Informative)

        by Fuzzums (250400) on Friday November 18, 2011 @07:32AM (#38096414) Homepage

        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 (Score:5, Interesting)

          by hairyfeet (841228) <bassbeast1968@gma i l . com> on Friday November 18, 2011 @08:26AM (#38096716) Journal

          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 (Score:5, Interesting)

          by tibit (1762298) on Friday November 18, 2011 @09:17AM (#38097100)

          and genetically mutilated crops is an other example of the same problem of making bacteria drug resistant

          I agree with most of the post, but this is just silly. Kinda takes away from credibility of the rest of it. WTF has GM food got with drug resistant bacteria, for crying out loud?

    • Re:I wonder (Score:5, Informative)

      by WillKemp (1338605) on Friday November 18, 2011 @06:54AM (#38096246) Homepage

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

      Probably. It's very unlikely to kill every bacterium, and the ones it doesn't kill may go on to breed stronger strains.

    • Re:I wonder (Score:5, Informative)

      by Gideon Wells (1412675) on Friday November 18, 2011 @07:03AM (#38096276)

      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 (Score:5, Funny)

        by Fuzzums (250400) on Friday November 18, 2011 @07:14AM (#38096326) Homepage

        It will just train bacteria to become alcoholics :)

        • Re:I wonder (Score:5, Interesting)

          by captainpanic (1173915) on Friday November 18, 2011 @07:57AM (#38096538)

          The smiley suggests you think you're making a joke... but it's actually true: it will train the bacteria to become alcoholics, and build up a tolerance.
          But there are good reasons to expect the bugs to need a lot longer to develop a resistance against alcohol. They will need to reinvent their cell walls for example, which is quite a dramatic change.

      • by Trepidity (597)

        It's not really that they don't have a drug, as that the gap between a given current bacterium, an a super-bacterium version of it that can live in alcohol-rich environments, is large enough that it's basically a completely different organism, so less likely to appear via the usual evolutionary processes. If you had a species of bacteria that was just on the edge of being able to live in high-alcohol environments, somewhat but not highly tolerant of alcohol, it's plausible that they would actually evolve gr

    • Re:I wonder (Score:5, Insightful)

      by Attila Dimedici (1036002) on Friday November 18, 2011 @09:10AM (#38097028)
      I have never seen "antibiotic soap". There are many anti-bacterial soaps, however, none of them contain antibiotics (at least not in the US and I was unable to find anything that indicates that it is any different in the EU). I am not a fan of anti-bacterial soaps because they kill not only pathogens but also beneficial bacteria. With the rare exceptions of certain places where the incidence of pathogens is likely to be significantly higher than normal (and just because your co-worker is sick does not make your work one of those places) , antibacterial soap is no more effective at preventing the transmission of disease than ordinary soap.
  • by Rogerborg (306625) on Friday November 18, 2011 @06:49AM (#38096216) Homepage

    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.

    • by tsa (15680) on Friday November 18, 2011 @06:54AM (#38096248) Homepage

      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.

      • Also consider that up until recently there were classes of illnesses where antibiotics were defensively prescribed, such as in the case of ear aches, not because they were likely to do good in any particular case, but because the doctor feared malpractice suits if it was bacterial and happened to be the rare case that lead to hearing loss.

        • by bryan1945 (301828)

          Don't know about you, but every ear infection I've had (many, eventually causing a burst eardrum) was nicely cleared up by antibiotics. (No, I didn't sue)

      • by Anonymous Coward on Friday November 18, 2011 @07:17AM (#38096334)

        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.

        • Which makes them better (or different) from medieval idiots... how, exactly?

          It doesn't it makes them worse. People in medieval times didn't know any better and didn't have any resources to know better. Ignorance is unfortunate but understandable, willful ignorance is no acceptable.

  • by WillKemp (1338605) on Friday November 18, 2011 @06:49AM (#38096220) Homepage

    What's the "K"? You can only abbreviate it if you've already written it in full beforehand

  • All true but (Score:5, Informative)

    by Chrisq (894406) on Friday November 18, 2011 @06:51AM (#38096236)
    All true but the majority of resistant strains come from countries where antibiotics are unregulated (i.e. you can buy them over the counter without prescription)
  • 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 - [purefood.org]

    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 - [cattletoday.com]

    • So if we eat meat that has been fed antibiotics, it will effect our resistances as well?
      • While I think there are concerns that the antibiotics for livestock may get passed on to people a little bit through the meat it's more that some bacteria affect both people and livestock.

        Create a resistance in the bacteria (to the antibiotics) attacking the livestock and then, maybe, the new and improved bacteria could be passed to humans (either from the animals themselves or improper handling of the raw meat).

        And farmers pretty much feed all of their animals antibiotics because it's easier? cheaper? than

        • 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").

          • Modern industrial cattle operations feed cows corn because calorie-for-calorie it is the cheapest food available for cows. The problem is that cows evolved to eat grass, not grains, so their stomachs aren't suited to it. They come down with stomach acidosis, and they will only live about six months once the corn diet begins.

            Actually, it's more of a meat-per-acre argument. Cattle are often raised where there isn't enough land to let them graze, so they have to be fed with imported (read: more rural) food. Feeding them grass isn't feasible because the raw tonnage of grass would cost too much to transport, so they resort to corn (calorie/weight). In more rural areas, they are fed grass (every farmer I personally know).

      • Antibiotics tend to be big, complex molecules. They won't last long in the organism, and they'll last even less time in the oven.
        • 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.

          • "that we've been eating trace amounts of penicillin for tens of thousands of years."

            Some modern antibiotics can get into the soft tissue of an animal and stay there until it is slaughtered and can then survive the cooking process. Penicillin can't.

        • by shugah (881805)
          Do you drink milk?
    • by einhverfr (238914)

      Also I don't think we *know* what sorts of antibiotic resistance may be created in other countries through this practice. Consider simply that there are bugs that can use livestock and humans as hosts, and our insistence on routine feed of antibiotics to animals should be quite frightening.

    • by stiggle (649614)

      This has been banned in the EU (for the last 5 years).

  • by Nick Fel (1320709) on Friday November 18, 2011 @07:03AM (#38096272)
    Bacteria on the continent are allowed a little antibiotics with meals even at a young age, so they grow up with a much more mature attitude towards it. That's why they're much better at handling antibiotics than British and American bacteria.
  • oversimplified.

    It's based on the idea, seen in insects with pesticide use, that if you kill x percentage of insects, some may survive and their offspring may have a much higher level of tolerance, meaning more pesticides are needed to kill the insects. No doubt this happens with bacteria too and is *a* cause of antibiotic resistance.

    Consider that livestock may be given antibiotics, and they may have bacteria, like E. coli or Salmonella sps which can make humans ill. This represents an additional vector not generally covered in analysis.

    However there may be several other big issues that are not currently included in the analysis. Many species of bacteria are known to assimilate genetic material from other bacteria even from other genuses. This means that there is a possibility that antibiotic resistance can spread between bacterial species as a result of hospital waste, causing a form of genetic pollution.

    Nature is fundamentally more complex than we can model. Any sufficiently complex model would be nature itself.

    However, the rise of superbugs is fascinating to watch.

    • by erroneus (253617) on Friday November 18, 2011 @07:35AM (#38096432) Homepage

      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.

  • Often, not always (Score:5, Insightful)

    by Max Romantschuk (132276) <max@romantschuk.fi> on Friday November 18, 2011 @07:20AM (#38096352) Homepage

    I've had a doctor tell me that I / my kid has a bacterial infection but it's not that serious, so the best option is to rest and let the body's own immune system take care of it.

    Yet, something tells me that those doctors would have prescribed antibiotics if I had cluelessly demanded that I get 'proper medicine'...

    • by spectrokid (660550) on Friday November 18, 2011 @07:42AM (#38096468) Homepage
      This is were state-run health systems like in scandinavia have the upper hand. Doctors can just tell their patients to fuck off.
    • by Rich0 (548339) on Friday November 18, 2011 @08:11AM (#38096622) Homepage

      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).

  • Not a parasite bug but a bacteria. The human body is not a piece of software to call every problem a bug.

  • by DavidShor (928926) <{supergeek717} {at} {gmail.com}> on Friday November 18, 2011 @07:38AM (#38096448) Homepage
    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.
  • by WindBourne (631190) on Friday November 18, 2011 @08:23AM (#38096692) Journal
    I have argued here and elsewhere that there is a high costs to our legal system. Sadly, just about every liberal screams that it only costs 3%. But the issue is that due to quick ability to sue, docs have adopted protective medicine. Not protection for the patient, but protection against lawsuits. As such, they give a number of antibiotics that we would not do.

    However, a big issue is that ag makes propholatic use of antibiotics. That is more true in Asia esp. china, than it is anywhere else.
    That is what is about cause a massive lowering of the world population.
  • TOTAL BS (Score:5, Interesting)

    by PortHaven (242123) on Friday November 18, 2011 @09:53AM (#38097410) Homepage

    "Experts say primary care doctors are partly to blame for prescribing antibiotics for patients who demand them unnecessarily"

    Sorry, I have seen from personal experience over and over again. Patients never "demand them unnecessarily".

    Rather, patients go to the doctor. And the first thing the doctor almost always tries is "Here's a prescription for antibiotics." It's almost more akin to a diagnosis test. Take these and we'll determine if it's viral or baterial.

    Occasionally the doctor will call for a test such as flu, strep, etc. Just recently we were concerned about my 4 yr old daughter having been bit twice by ticks in a 2 week period. Short time later all her lymph nodes were swollen, she ached, and was generally miserable.

    Rather than evaluate for any of the tick born infections. Our doctor was convinced it was the flu. We knew it was NOT the flu. They did a flu test, and guess what. We were right.

    The truth of the matter is most American doctors are arrogant. 1/2 the time they are wrong. And very few care about treatment, they just want to prescribe and send away.

    Medicine is in a second dark age.

  • by zerofoo (262795) on Friday November 18, 2011 @10:44AM (#38097990)

    There was a wired article a while back about the amount of antibiotics used by farm animals in the US:

    http://www.wired.com/wiredscience/2010/12/news-update-farm-animals-get-80-of-antibiotics-sold-in-us/ [wired.com]

    I would imagine this is a potentially good place to start reducing the amount of antibiotics being used. I'm no biologist, but prophylactic antibiotic use on this scale is probably unnecessary. Don't count on the farming industry to do this on their own though....

    -ted

If a subordinate asks you a pertinent question, look at him as if he had lost his senses. When he looks down, paraphrase the question back at him.

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