Antibiotic Resistant Staph Infections 91
oliphaunt writes "This! morning! at! Yahoo! there! is! a! story! about! drug-resistant! bacteria! This is interesting because, as of July 5 of this year, "It was the first case of vancomycin-resistant Staphylococcus aureus in the United States." Nobody can PROVE it of course, but this is probably a result of overprescription of antibiotics, and people not following doctor's directions, combined with stuff like antibiotic hand soap available over the counter. So what do we do when the bugs are resistant to everything we have? The answer is we die."
Re:Hey! (Score:1)
Why! are! you! writing! like! this!?
"Bones! Why! Did! He die?!?!"
Because "Yahoo!" has one (Score:2)
Re:Hey! (Score:1)
We evolve (Score:2)
Re:We evolve (Score:2)
Now germ-line genetic engineering; now you're talking!
Re:We evolve (Score:1)
Re:We evolve (Score:2)
Are you volunteering?
Re:We evolve (Score:1)
Re:We evolve (Score:1)
Re:We evolve (Score:1)
Re:We evolve (Score:1)
Re:We evolve (Score:1)
Re:We evolve (Score:1)
1) Our population combined with its transience is to great. In order to evolve effectively, there has to be a small enough population that the beneficial mutation will make a difference. Unfortunatly, with all 6 billion of us, that mutation is likely to just get lost in the enormous gene pool. Now, I suppose you could quarantine people into blocks within which were the only people they were allowed to mate with, but there are so many things wrong with that that I doubt it will happen. (I for one would be against it)
2) We can only evolve to get better at being 0-30 years old (roughly). This is because as long as we survive long enough to reproduce, evolution has served its purpose. This means that we can't evolve to get better at getting old, nor can we evolve to become resistant to diseases that affect us after we reproduce.
So in order for evolution to provide a viable solution to this problem, first we would have to have a plague that wipes out 90% of the people on this planet, and even then evolution wouldn't be able to help anyone much past 30 years old. If this is what you call a viable solution to the problem of super-bugs, then go for it.
I'm still waiting for nanotech that can be injected into our bloodstream and go around physicallyy combating the bacteria
Re:We evolve (Score:1)
Re:Sensationalism Reigns! (Score:2, Informative)
Re:Sensationalism Reigns! (Score:2)
That was in the dark ages of molecular biology. We have a much learer understanding now of how drug resistance is shared [molgen.mpg.de] between bacteria, but that doesn't mean that we can stop it. In fact, it's pretty clear that as soon as one wild population of bacteria develop a resistance, it's just a matter of time before they all have it.
And the trick is, it's an arms race, and patients are not passive objects to be disinfected. You can wipe a counter down with 100% ethanol, and then set the wet spot on fire, and that's good sterile procedure. You can't do that to someone's bloodstream. If I'm in the hospital with a systemic staph infection, and my doctor wants to start me on penicillin "Just in case your Staph isn't resistant," you can bet your ass that I'll have a new doctor pretty fast. I'm in the hospital, the guy next to me is dying, and I have to wear a dress with no back. I want the best bug-killer he's got, and I want it now!
and anyone who knows better is going to think just like me! How can you, a healthcare provider, reduce the frequency of behavior that encourages resistance, when your patients' most rational demand is for you to break out the big guns right away?
Ahhh Sugar (Score:2)
Some of the studies that have come out make me wonder if our particular pursuit of wellness is such a good idea. Kids who grow up with pets have fewer allergies, kids who play in the dirt are less likely to have asthma. Maybe being dirty and occansionally ill is like immunological exerciese. You always want to stretch first, and should never over do it; but, in general, it's a good thing.
We Die?! (Score:5, Funny)
Poor fellow (Score:4, Insightful)
Suddenly I realize that I am not having such a bad day after all.
Re:Poor fellow (Score:1)
Re:Poor fellow (Score:2)
Re:Poor fellow (Score:2)
Re:Poor fellow (Score:3, Informative)
What happens is first- and second-line antibiotics, like penicillin, get overused. This creates many different strains of bacteria all over that are antibiotic resistant. If you get sick with one of these superbugs and can't shake it off on your own then you go to the hospital and get vancomycin. Since so much vancomycin has to be used in hositals it stands to reason that eventually one strain of bacteria will evolve that's immune to it. If there weren't so many strains of bacteria that were immune to penicillin there wouldn't be as much of a need to use vancomycin as much, resulting in fewer strains of vancomycin.
BTW, hospitals of full of antibiotic resistant strains of bacteria, due both to all the antibiotics used there and to all the people that go there with antibiotic resistant strains ofbacteria already in them.
Mr. Spey
Re:Poor fellow (Score:1)
Woudn't this be somewhat regional, though? I mean, especially here in the Los Angeles area, where Mexico can be reached within a few hours' drive, one can pretty much go to Tijuana and get the drugs of their choice without an Rx. For that matter, one can go to various clinicas in (say) Santa Ana and get those amongst other drugs that are otherwise not available without a prescription. I know there are many cases of people taking amoxicillin for sheer placebo effect (yes, they actually think the amoxicillin is going to kill the viral infection!), but I kind of think that it's largely by accessibility.
Think of it, unless you beg and plead of your doctor (who, if he's worth his salt, will give you a true placebo instead), you're not going to legally get penicillin OTC in (say) Iowa.
Re:Poor fellow (Score:2)
It would be if there wasn't so much travel. It's very easy to be a carrier for a bacteria even if you have no symptoms. One person could easily make 10 or 20 people contagious, and each of them could make 10 or 20 contagious, etc. One of them traveling to NYC could get the entire east coast.
Mr. Spey
Re:Poor fellow (Score:2)
Every time someone uses an antibiotic to kill bacteria, there's chance that some of them are resistant for that antibiotic. This will create an evolutional process where the surviving bacteria are all resistant to antibiotics. The only way to prevent it is to only use antibiotics when needed.
So the only thing this fellow might have left is to trust on his own defense system to kill the bacteria.
Isn't nature evil. (Score:1, Troll)
Re:Isn't nature evil. (Score:3, Insightful)
No, the fittest things survive. In evolutionary biology, fitness is defined as the ability to pass on your genes. This may be related to strength. It may not.
nature is developing a new device
Nature is developing nothing. There is no consciousness guiding the development of these organisms.
vancomycin resistance does not come from hand soap (Score:3, Informative)
vancomycin (an extremely rare antibiotic, used only
in cases of desperation) to the use of hand soap.
in my opinion the body of this article is
sensationalistic hogwash.
vancomycin resistance can come from serendipity,
from vancomycin exposure, or from a mechanism which
creates a much broader resistance to a class of
antibiotics which includes vancomycin, subsequent
to exposure to other antibiotics in that class.
hand soap is not in any structurally related class.
Re:vancomycin resistance does not come from hand s (Score:3, Informative)
The short version is antibiotic hand soap breeds bacteria that are immune to that type of antibiotic. Since there are only three or four different types of antibiotics out there, breeding a resistant strain from hand soap means the strain is also immune to an entire type of antibiotic, so if you have a staph infection and use the soap you could get a strain of staph resistant to whatever particular antibiotic is in the soap. If someone else living in the same household gets infected with this new resistant strain of staph, they can't be helped by an entire type of antibiotic, focing the use of second- or third-line antibiotics. And the only way to breed a resistant strain is to use an antibiotic on it.
Hmmm
Mr. Spey
Re:vancomycin resistance does not come from hand s (Score:2)
Bollocks. There are only three or four different classes of antibiotics, but many more types. The classification of antibiotics groups them according to the way in which they interfere with the bacteria, but resistance to one member of a class doesn't result in resistance to other members of the class under most circumstances.
Re:vancomycin resistance does not come from hand s (Score:5, Informative)
vancomycin (an extremely rare antibiotic, used only in cases of desperation)
this is what vanco is supposed to be, but in fact it is used quite frequently, and is actually gaining popularity given that virtually every major medical centre in the US is now seeing the prevalence of MRSA going through the roof (as MRSA is resistant to pretty much everything except for vanco, linezolid (Zyvox) and dalfopristin/quinupristin (Synercid)). vanco is now the drug of choice in many institituitions until lab sensitivities come back, at which time a patient with a staph infection may be switched to something else or remain on vanco. with infectious disease health care providers simply cannot afford to prescribe nafcillin and wait a day for labs to come back and tell them whether or not the organism is resistant, so they prescribe vanco first and modify later (and you would too if you were on the east coast and 1 in 3 staph infections were nafcillin resistant)...
furthermore:
vancomycin resistance can come from serendipity, from vancomycin exposure, or from a mechanism which creates a much broader resistance to a class of antibiotics which includes vancomycin, subsequent to exposure to other antibiotics in that class
there are currently no antibiotics on the market in use with the same mechanism of action (MOA) of vanco (which is a glycopeptide cell wall inhibitor). the Penicillins/cephalosporins are cell wall inhibitors of a different nature, and do not promote resistance to vancomycin directly, although ceftazidime (Fortaz) independently causes an increased incidence of VRE (Vancomycin-Resistant Enterococcus (not the same as staph a)) for reasons unbeknownst to the medical/research community. Likewise aminoglycosides, flouroquinolones, macrolides, et al. also do not increase the incidence of vancomycin resistance in and of themselves. however all of these compounds increase the selective pressure on organisms, thus favoring strains that more easily acquire resistance than their counterparts... But contrary to your point most of the time when you hear about cross-resistance they're talking about resistances to drugs in the same class or with the same mechanism of action such as all beta-lactams (pens & cephs), all aminiglycocydes (gent, tobra, amikacin), all flouroquinolones (levofloxacin, ciprofloxacin, gatifloxacin, etc) and the like, but this isn't something that normally happens with outliers such as vanco, zyvox, synercid, rifampin, etc.
just as an aside (but of interest), the CDC labels VISA/GISA as staph a with a minimum inhibitory concentration (MIC) of vanco to be greater than 8mcg/mL, and VRSA to be greater than 32mcg/mL. When one does pharmacokinetic dosing for vanco, by the book one looks for a peak serum vanco concentration of 20-40mcg/mL, and a trough of 5-15mcg/mL (usually broken down to 5-10 for normal infections and 10-15 for serious concentrations.) But in real life people don't even look at the peaks (it doesn't improve outcomes and costs too much to do if it doesn't help), just the troughs, and as you probably know vancomycin is a time-dependent killer (like the beta-lactams (with the exception of the carbapenems of course) and macrolides) so a range of 8-32mcg/mL for an intermediate strain won't necessarily tell you if it will work in a clinic, especially since many infections are in areas with poor circulation (necrosed tissue etc) in which the drug levels won't be anything near what they are in the plasma (due to poor tissue perfusion). And thus the distinction between VRSA and VISA/GISA are more of scientific/epidemiological significance than of actual clinical significance (especially if you've only got a vanco peak of 20mcg/mL and your MIC is 25 for the strain). And if you're just looking for hard-to-treat cases of Staph a, then this news is nothing new...
-tid242
Re:vancomycin resistance does not come from hand s (Score:1)
Re:vancomycin resistance does not come from hand s (Score:2)
point taken. But like I just responded to someone else, it's an arms race. Penicillin was overprescribed in the 40's and 50's, people didn't understand that they had to take all the pills, for the whole 12 days, and now 30% of strep pneumoniae bugs are penicillin resistant, and that's in all patients, not just those who have been cross-contaminated in hospital environments. [nih.gov] I challenge you to find public numbers for hospital environments- I bet Kaiser Permanente is going out of their way to keep those stats off the Net.
handsoap is the same thing, on a wholly different scale. What happens when Triclosan stops working, because every bacterium on the planet has been exposed to some base level, and have developed resistance? People still want to buy antibacterial soap, right? So we'd better start putting a stronger chemical in the soap. Lather, rinse, repeat.
Maybe it's over the top to suggest that you'll be able to buy vanco soap over the counter in 50 years- but maybe it won't do you much good by then.
Antibiotic soap? Probably not... (Score:5, Interesting)
Anyway, there are other things we can do. Phage is always there in our armoury, and unlike antibiotics, bacteria have little chance of out evolving it...
(For those not in the know, Phage is the name given to viruses that have coevolved with bacteria. The idea is that you hunt around for a virus that kills the bacteria and spray the viruses around and the bacteria is killed. It seems to work... the Russians use it sometimes, it's cheaper than antibiotics.Viruses mutate faster than bacteria can.)
Re:Antibiotic soap? Probably not... (Score:3, Insightful)
The gain for the farmers is small, but measurable. The cost to the population as a whole is huge, but few people seem to care.
And I agree, antibiotic soap isn't much of a problem.
Re:Antibiotic soap? Probably not... (Score:4, Informative)
What WolfWithoutAClause was talking about is called bacteriophage therapy. A bacteriophage is a type of virus that attacks bacteria. ("Bacteriophage" literally means bacterium eater.) Bacteriophages were discovered in 1917. In the 1920's and 1930's, bacteriophages were used to treat bacterial infections like typhus and cholera. The results were very mixed.
In the 1940's, bacteriophage therapy fell out of favor as penicillin became more and more popular.
Recent studies of bacteriophage therapy in Eastern Europe and in Asia have tentatively concluded that it can, when properly employed, approach the effectiveness of antibiotic therapy.
But there is a problem. Bacteriophages and antibiotics work in pretty much the same way, albeit through different mechanisms: the agent in use attacks the bacteria population present in the patient, killing all those that are susceptible. Neither antibiotics nor bacteriophages kill 100% of the bacterial infection, because bacteria mutate and evolve quite rapidly. If bacteriophage therapy were in as widespread use as antibiotic therapy is today, we'd see the same basic problems: resistant strains appearing thanks to therapeutic culling of the susceptible populations.
Re:Antibiotic soap? Probably not... (Score:2)
Re:Antibiotic soap? Probably not... (Score:2)
Re:Antibiotic soap? Probably not... (Score:1)
not to mention they'd be highly antigenic (much moreso than the antibiotic haptens people are oft allergic to), which would provide a major problem in repeat-treatment...
damn, didn't see your post before i posted my last one, guess i could do a little more RTFMing before posting eh? :)
-tid242
Re:Antibiotic soap? Probably not... (Score:1)
It is a really bad idea to be sure, but vanco resistance doesn't arise directly from cattle feed, as you'd have to be crazy to put vanco in there as vanco has a 0% oral bioavailability (0% absorbed)... although you're right, if it was in there it would because it's still be in their manure and get sprayed around on crops etc, etc...
Phage is probably short for "Bacteriophage" which is just a virus (it's the one in high-school science books that looks like some sort of a phallic lunar-lander) that infects bacteria. yes bacteriophages do kill bacteria from time to time, but ironically are one of the primary vectors in spreading resistance genes from one bacterium to another... probably not the strain the Russians use though if it's highly bacteriocidal, :)
-tid242
Re:Antibiotic soap? Probably not... (Score:1)
"Bad idea" doesn't even begin to cut it, however it has unfortunately been done [soilassociation.org].
Blame Amercia! Blame America! (Score:1, Informative)
Do you know how much antibiotics are put into your milk and meat? Those hormones and antibiotics put into your food are also one of the reasons of obesity in the USA.
It's just like fighting McDonalds- remember how we got them to switch from those nasty poly boxes?
Well, it's time to let those dairy and milk producers know that we refuse to eat antibiotic and hormone contaminated food!
It's only a matter of time untill a super-bug evolves. Aids is going to seem like kids' poo.
You can help- call for not using antibiotics except when they are needed.
Don't buy meat and dairy unless they are antibiotic and hormone-additives clear.
Don't use antibacterial soap.
And don't ask your doctor for an antibiotic pill to cure your cold or flu!It won't help anyway.
Another thing to remember, is that you have to take the full one or two week course on treatment if you're ever prescribed antibiotics! Othervise, your bacteria become resistant.Even skipping one day is enough to let that hundred semi-resistant bacteria multiply into thousands,then millions. If you go for treatment, stick to it.
No, blame industrial agriculture (Score:1)
Is this legal to do in the US ? Anybody know if it is illegal in all European contries ?
Soap industry opinion (Score:2, Informative)
From the Soap and Detergent Association:
http://www.sdahq.org/health/faq.html [sdahq.org]
One statement they make is "Washing with plain soap and water removes many germs from the hands. Antibacterial soaps contain an active ingredient that keeps the number of germs at a reduced level for an extended period of time, providing improved germ control."
So don't let the advertising con you into thinking that plain soap has suddenly stopped working. Triclosan just makes your hands temporarily unsurvivable for germs. Everything is an issue of degrees, and this seems like using a scorched earth policy on your hands.
Take it for what it's worth.
Re:Soap industry opinion (Score:2)
Re:Soap industry opinion (Score:1)
Re:Soap industry opinion (Score:2)
Antibacterial Vs Antibiotics (Score:2)
IE, clorax is Antibacteria, but not Antibiotic.
While i suppose when you throw all the permutations of evolution as a denominator of the probability it becomes 'possible' it's still, unlikely, that a super antibacterial resistent bacteria is going to be evolved by using antibacterial soap instead of other soap.
Abuse antibiotics though, and we could be up the creek.
Re:Antibacterial Vs Antibiotics (Score:2)
Mr. Spey
Re:Antibacterial Vs Antibiotics (Score:1)
Wouldn't bleach be antibiotic, rather than just antibacterial? It kills mold, etc. as well.
caffeine (Score:3, Funny)
Re:caffeine (Score:2, Funny)
Re:caffeine (Score:1)
That was funny, well, never.
That is quite a bummer (Score:4, Informative)
Incidentally, new research has focused on interrupting the communication that Staph does to announce its population is large enough to attack. It doesn't attack right away but waits for numbers to be large enough to overwhelm the immune system. If it can either be triggered to attack before numbers are large enough, or never recieve the attack signal, staph infections would likely be dealt with by the immune system.
Antibiotic armor for bacteria - planned disuse (Score:2)
Antibiotics come in families, and a given family will work against bacteria in largely the same way. Imagine if we could take an entire antibiotic family out of use around the world for some period of years.
As mentioned earlier antibiotic resistance comes with a cost. If an antibiotic family is intentionally unused, under evolutionary pressure bacteria would now tend to drop their resistance. I have no idea how long it would take, but I'm sure it could be estimated by someone 'skilled in the art.'
This would suggest a worldwide policy of antibiotic rotation. Of course doing anything on a worldwide basis is tough, as is telling someone to quit making money on penicillin-family antibiotics for a decade.
Re:Antibiotic armor for bacteria - planned disuse (Score:2)
Or as tough as telling someone who is allergic to penicillin to a life-threatening degree that other means of fighting an equally life-threatening disease are 'off-limits' until the next rotation period.
Re:Antibiotic armor for bacteria - planned disuse (Score:1)
> equally life-threatening disease are 'off-limits' until the next rotation period.
I would certainly hope that any rotation scheme would leave some sort of overlap to handle allergies, etc. My brother and son are allergic to penicillin, but there are numerous other antibiotics that they can take. Of course I don't know what the situation is with multi-allergic people.
Re:Antibiotic armor for bacteria - planned disuse (Score:1)
TCP/IP seems to be pretty universally accepted.
if it becomes a big enough problem somebody rich will pay to fix it
Re:Antibiotic armor for bacteria - planned disuse (Score:1)
I do wonder if any one has checked out the prevelance of antibiotic resistant bacteria in a situation like an isolated, war-torn country that has not had a drug supply available (or outside visitors) for some time. In theory the bacteria would have lost unneccessary resistance genes, but it only takes one cell with the resistance gene to restart the cycle....
It's not all doom and gloom.. (Score:1)
Don't panic (Score:1)
First off, your diabetic, sicky, infected, catheterized patient was pretty much on death's door anyway (and the staph my have been a blessing -- diabetics in that kind of condition often die, literally, by inches as the doctors cut gangrenous chunks off.)
Second, there's more than one way to skin a cat, or a bacterium. "Augmentin", for example, is a common antibiotic that many bugs are immune to, augmented with an enzyme that blocks the mechanism that make the bacteria immune.
It's also worth remembering that we survived for hundreds of thousands of years without antibiotics, anyway.
Re:Don't panic (Score:1)
Are we forgetting about the plague that wiped out a good chunk of the human population just a few short centuries ago?
Re:Don't panic (Score:1)
If not, we must have survived the plague somehow.
Re:Don't panic (Score:1)
Yes - with an expected (adult) lifetime of about 35-40 and an infant mortality rate at well over 50%. I'd rather not come back to that 'idyllic' life.
Antibacterial and Antibiotic (Score:3, Interesting)
The compound used in most soaps, triclosan, isn't related to penecillin, erythromycin, etc. I certainly wouldn't recommend you eat Dial.
So washing your hands with antibacterial Dial isn't going to doom you to death by vancomycin resistant staph.
There are good reasons to avoid antibacterial soap, like killing of beneficial organisms, but don't confuse that with antibiotic resistant organisms caused by misuse of prescribed antibiotics.
Staph carrier (Score:2)
The last big flare up occured in 1998 when I was sent to Calgary during my first wedding anniversary (I felt real bad after this.) She had a major flare up of staph A and was recordered for Galveston county. I look at the MMWR at the CDC and think of her when I see the staph #s. Anyway, the doctors had said they had not seen so many different staph infections in one person since college and then only in a text book.
She's fine now and it's just as I said, they are all weak strains. I've never caught any from her, but she always has them.
this is bullcrap (Score:1)
One of the doctors thought that he was causing these infetions himself "using needles" and whatnot. This was, of course, not true, but I wonder how often this happens in these super bacteria cases.
Environmental aspect of article (Score:1)
Unsurprising (Score:3, Interesting)
Now, this is obviously a problem in terms of antibiotics. Many antibiotics are still generated from natural sources, and some fairly harmless bacterial species has probably developed immunity to that (by virtue of happening to live in the soil around the ferns that secrete it, for example). The genes providing that immunity can pass to pretty much ever other bacterial species on the planet. This isn't a rapid process, but it will be sped up by imposing additional selection pressure - for instance, treating bacteria with that antibiotic.
Overuse or inappropriate use of antibiotics isn't really the trigger here. Imposing any degree of selection pressure will result in the same thing happening - it's only a matter of timing. More careful use of antibiotics may give us a few hundred years more if we're lucky, ten years more if we're not. The point to remember is that no matter how clever your antibiotic, there will be a gene in some bacterium somewhere that provides immunity to it. And, if you wait long enough, that will end up in the bacteria you're trying to kill.
It's not an intractable problem. There's likely to (somewhere) be an enzyme that will digest your antibiotic, but if you develop something that degrades that enzyme you're back in business. The chances of a random bacterium having both the resistance and an unrelated gene that protects the resistance mechanism is the square root of the probability of it having the resistance alone (probably less - having the resistance is likely to have proven useful in nature, and so will be more popular. The probability of having both genes will therefore be corespondingly less), which gives us a fighting chance. New techniques in drug development are likely to mean that we can design new drgs that can defeat any resistance mechanism that turns up.
Remember though, antibiotics have only been around for a hundred years or so. Humanity survived before then. Antibiotics increase average life expectency, but they're not required for continued human survival.
My final year dissertation was on this topic. You can find a copy at www-jcsu.jesus.cam.ac.uk/~mjg59/resistance.pdf [cam.ac.uk]
Noooo! Only the WEAK shall die... (Score:2)
"Stupid f*^$ing white man..." - Dead Man
-grin-
I've stopped buying antibacteria/antibiotic hand-soap. What doesn't kill me makes me stronger, right?
Re:Noooo! Only the WEAK shall die... (Score:1)
As for the second point, a study conducted in the UK over the last five years concluded that children who had been overprotected, ie not allowed to get dirty or play outside, bathed frequently, had weaker immune systems and suffered from more illnesses than those with a less restrictive regime.
Note: anyone reading this and trying to use it as an excuse to get muddy or not to bathe is probably too old to benefit!
One word: bacteriophages (Score:1)
A new (old in the Soviet Union) method of treating bacteria is being brought to market. Virii that infect bacteria and kill them while leaving animal tissue unaffected.
I believe this will have the additional advantage of giving us an evolutionary advantage (by proxy) rather than the evolutionary disadvantage that we have right now. The bacteriophages will evolve with the bacteria to keep killing them, unlike antibiotics which must be created by human beings.
Here [google.com] is a Google search that points to many pages about the workings of bacteriophages.