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?
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!!!
Re:Idea (Score:5, Insightful)
I'm horrified that you achieved +4 insightful instead of the +5 funny that you were going for.
Re: (Score:3, Informative)
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: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: (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: (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.
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).
Re: (Score:3, Informative)
You are also incredibly naive about costs. Almost all drugs are incredibly cheap to produce but still ending up costing patients "whatever the market will bear" (how much is your life worth). It's not just regulatory approval. It's just greed by the pharma companies. Yo
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:Idea (Score:5, Informative)
They wouldn't need to use antibiotics on our cattle if we just fed them grasses instead of corn feed.
Unfortunately corn feed and antibiotics is cheaper than feeding them grasses.
Ever been on a farm? (Score:5, Informative)
My family raises cattle on a farm in Iowa. Speaking from our experience, I'll tell you that putting a pound of meat on a steer takes in the neighborhood of ten pounds of feed -- and much more than that, if you're feeding them exclusively grasses (including hay).
So. Take a hundred head of cattle and turn them loose on a hundred acres of land. These animals are still growing (since, when they're ready for the slaughterhouse, well... they get taken to the slaughterhouse). If we want to put a hundred pounds on each steer, then that means each steer needs half a ton of feed.
Good luck getting 50 tons of grass from a hundred acres of land. It's not going to happen. The farmer has two choices at this point: raise fewer cattle (and thus raise meat prices for the consumer), or convert some of the cornfields into pasture (and thus raise grain prices for the consumer).
Either way you're talking about raising the prices of basic foodstuffs. You won't inconvenience the rich: the rich will still be able to afford filet mignon and Kobe beef. After all, they're rich.
But the elderly, who live on fixed incomes... poor families who depend on food stamps... or just a college student burdened with debt who wants to be able to take his girlfriend to a steakhouse for a special occasion... all of these people are seriously impacted.
The name of the game in modern farming is efficiency. Reducing prices is the overall goal.
Re: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:Ever been on a farm? (Score:5, Insightful)
Re: (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 comfo
Re:Ever been on a farm? (Score:4, Informative)
My family raises cattle on a farm in Iowa. Speaking from our experience, I'll tell you that putting a pound of meat on a steer takes in the neighborhood of ten pounds of feed -- and much more than that, if you're feeding them exclusively grasses (including hay). ...
Either way you're talking about raising the prices of basic foodstuffs. You won't inconvenience the rich: the rich will still be able to afford filet mignon and Kobe beef. After all, they're rich.
If your family raises cattle, then you should know that farmers have been culling cattle herds like crazy for the last ~5 years or so. Beef prices have gone through the floor because the recession seriously dampened demand and caused a glut in the market. At the same time, corn prices have been zooming up because of the ethanol push. This isn't just limited to cattle, as the pork and chicken industries have been cutting production too.
Just so no one things I'm pulling this out of my ass, here's the first relevant google result for "culling cattle herds"
http://www.businessweek.com/news/2010-01-27/u-s-cattle-herd-falls-to-1958-low-as-losses-climb-survey-says.html [businessweek.com]
Here's another article, this time from April 2009, talking about 2008 herd numbers for the various industries:
http://www.avma.org/onlnews/javma/apr09/090415a.asp [avma.org]
Moving to grass fed beef would resolve the market price problem (grass fed commands a premium) and the cost problem (grass is free, more land is cheap, corn feed is not).
Re:Ever 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, 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: (Score:3, Informative)
I suspect that it's ignorance. Oftentimes, we'd feed our cattle a soybean mix. People think that cattle are only ever fed corn, but that's just hogwash. They've got good stomachs: they can digest pretty much anything that grows and isn't poisonous. (They also really like apples. When I was a kid I quickly learned not to enter the pasture after climbing the apple tree.) They also get fed cottonseed, milo, oats, hominy... I've never heard anyone rail against those, though. It seems that people hear, "o
Re: (Score:3, Informative)
Meat includes fat.
If you only want the protein, then just mix up a whey protein isolate-shake. MM-mmm. I recommend the strawberry flavor. Also use ice if possible, it covers up the graininess.
Re:Idea (Score:5, Informative)
As for the crack about big pharma, bullshit. Traditional treatments have attracted a lot of investigation for the last couple of decades. If (if!) you find out that the traditional treatment works, then you can isolated the active compound(s) and patent and sell that.
Re: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: (Score:3, Informative)
I'm always reminded of this. [scienceblogs.com] Long story short, cancer researcher's mother-in-law dies of cancer. Then there are these douchebags out there saying that people like that are out to suppress all the cheap miracle cures, meaning that that guy could have saver his in law, but was too greedy to let the wonder cure slip just this once. People actually believe that. What assholes.
Re:Idea (Score:5, Funny)
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: 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: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: (Score:3, Insightful)
Re: (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: (Score:3, Informative)
The nice thing is, if we stopped RIGHT NOW, Darwin's invisible dead hand would be on our side... if there is no reason for the germs to have a resistance to antibiotics because they're everywhere, those germs lacking the resistance become more 'fit' since they use less energy supporting the requirements of that resistance. Instead they put their energy to reproduction or getting by on less sustenance, and will breed out the resistant bugs in fairly short order.
Re: (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: (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
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: (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
Re:Idea (Score:5, Informative)
I don't know about the new organisms, but the older resistant strains DO spend considerable metabolic energy on their resistance, either producing enzymes that have no other purpose or supporting active pumps on their membranes to remove the antibiotics that get in. In either case, in an environment free of the antibiotics, the resistant strains waste energy for no benefit.
Re: (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: (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 fee
Re: (Score:3)
The point of the article (you did bother reading it right?) is that some strains like MRSA are resistance to all but a few classes of current antibiotics. Those particular classes of antibiotics have significant side effects, like Cipro damaging connective tissue, or others causing kidney damage. Even more troubling is the finding of a strain that is resistance to all current antibiotics.
It's not clear yet, what the long term safety or effectiveness of the antibiotics being developed are.
Re: (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
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).
Re: (Score:3, Interesting)
Tyson chicken, Smithfield pork, all the big operators use antibiotics in feed. Look it up. http://www.a [alternet.org]
Re:Idea (Score:4, Informative)
Actually it's not surprising. Hospitals are amongst the "cleanest" environments, due to necessity. Lots of people with open wounds that infect easily, lots of people with failing or failed immune systems. So they use more antibiotics and cleaning agents than even the most overprotective mother ever could (which, btw, is about the worst thing you can do to your kids, right after the opposite and having them play with infected needles).
Killing off most germs means that you kill off the weakest of the herd. The ones that are easily affected by aggressive cleaning agents. What you do this way is simply building a better home for the ones that survive, because you never kill them ALL. By the very nature of bacteria, it is virtually impossible to kill them off for good. You will even find a few in intensive care, and one is already enough to create a new culture. They multiply FAST.
The ones that survive the aggressive cleaning agents and the whole antibiotic bombardment are the ones that are toughest, strongest and most resistant. And when they get to multiply, you have a strain of supergerms at your hands.
So, in a nutshell, if you want to kill off your family fast, buy some antibiotic cleaning agents today!
Thanks (Score:5, Insightful)
Re:Thanks (Score:4, Funny)
Wow. Never heard of that one. I guess I'll just have to hide in the bathroom to wash my hands.
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: (Score:3, Informative)
What the label says is not always how the product functions. It should probably say "in most cases, when used properly and according to directions, all bacteria will be killed but just in case there is a lawsuit we're going to claim 99%."
If you wash a surface evenly with alcohol or bleach, you're going to get 100% disinfection. If you get sloppy and rinse immediately, or end up diluting the poison, you can get exposure without death, leaving some bacteria. If you then repeat the process, the bacteria are
Re: (Score:3, Informative)
If you wash a surface evenly with alcohol or bleach, you're going to get 100% disinfection.
Not quite true. For example, alcohol hand cleaners don't work all that well against some spore-forming bacteria, such as the nasty C. diff.
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*
Re:Thanks (Score:4, Informative)
Reading this article earlier today, about conquering resistant infections in Norway [miamiherald.com]. Sounds like they've basically figured it out. What are the chances that we can get that kind of smarts imported into the US?
Cheers.
Re:Thanks (Score:5, Informative)
Re:Thanks (Score:5, Informative)
"Only" lab experiments, but this shows the problem is not as simple.
I guess, like samurphy21 says [slashdot.org], the only way to be sure is to nuke them from^W^W^W use a high-ethanol concentration.
Re: (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.
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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
Am I the only one? (Score:2, 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.
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.
Death with intact kidneys (Score:4, Funny)
I'd really be pissed if that happened to me.
Re:Death with intact kidneys (Score:4, Funny)
Just long enough to go well with some Fava Beans and a glass of Chianti... or is that liver?
Life lesson (Score:5, Informative)
And this, children, is why you always, always complete the full course of antibiotic treatment, even if you think the problem's cleared up half-way through. If you stop early you leave the small subset of bugs, not enough to cause a visible problem, that are the most resistant to the antibiotics. Lather rinse repeat a few times and you end up with bugs that laugh at antibiotics and proceed to run rampant.
Re: (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:Life lesson (Score:4, Interesting)
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 t
What about a natural bacterial predator? (Score:4, Interesting)
Anyone remember Phage Therapy [wikipedia.org]?
Re:What about a natural bacterial predator? (Score:4, Insightful)
Phage therapy: Where communism succeeded.. (Score:5, Informative)
"The programme revealed that we - ie humankind - had discovered a superior cure (to antibiotics) for bacterial infections around the same time that penicillin was being discovered. The research programme on bacteriophages (phages for short) began in Stalin's Georgia in the 1930s. To this day, our knowledge of each of the many thousands of phage viruses remains concentrated in a now rundown laboratory in Tbilisi, Georgia. The arrival of capitalism in the Caucuses threatens a repository of knowledge, built up over 50 years, that could prevent the superbug pandemic that threatens us all next century. ...
While there are some genuine reasons why phage treatments of bacterial diseases were overlooked in the 1930s and 1940s, the failure to develop a western research program into bacteriophage treatment in the 1980s and 1990s represents an inexcusable failure of western capitalism. By the 1980s, ther e could be no denial that antibiotic resistance was going to be a major problem in (if not before) the twentyfirst century. Yet, we just didn't want to know about what will probably turn out to be the most important medical breakthrough in the twentieth century; a breakthrough made in communist G eorgia, in Stalin's Soviet Union.
It is embarrassing when western science is out-trumped, especially by the "communists". Usually, when out-trumped, we don't tell anyone. That's what happened here. Not only did we not have the nous to start a western programme in bacteriophage research; we looked the other way when the files of phials threatened to be destroyed following the breakup of the Soviet Union, and during the little reported civil war that engulfed Georgia a few years ago. So much for the knowledge economies of the west. How can such valuable knowledge be so cheap?
It's not too late for western medicine to enter the post-antibiotic bacteriophage era. Our grandchildren will hardly thank us if we persevere with our corporate-profit-motivated conservatism.
The Soviets were able, eventually, to admit that they were wrong to follow Lysenko. Will we in the west be equally able to admit that we were wrong to put all our medical eggs into the one antibiotic basket, in the process ignoring the most basic tenets of the theory of evolution?
"""
From:
http://www.scoop.co.nz/stories/HL9910/S00096.htm [scoop.co.nz]
(I'm glad to see several people have posted links to phage therapy information.)
Re: (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 door
The slashdot post is kinda funny... (Score:5, Informative)
The language of the slashdot post seems to suggest that the presence of gram negative bacteria is recent. It also suggests that the gram negative characteristic of the bacteria is the definitive characteristic of its virulence. Also, the Gram test isn't a 'so called' test, which somehow suggests or implies doubt.
The test has been done for decades; our knowledge of the two major types of bacteria (gram positive and gram negative) has been around for decades as well. And while gram negativity is characteristic of bacteria that must be approached with different antibiotic means than gram positive, due to their extracellular topology/materials, it does not mean that being gram negative makes the microbes virulent or specifically dangerous.
And to debunk the loose implication that gram negativity might have evolved from human antibiotic applications I will say this: it didn't.
General Bacteriology ftmfw.
Re:The slashdot post is kinda funny... (Score:5, Informative)
We saw these pathogens emerge in our ICU three years ago and have been using colistin. The side effects are real but not nearly as common with modern supportive care as they were 40 years ago. Which is good, because when the colistin quits working, well, your patient is dead. Currently these pathogens only emerge after many weeks of critical illness and multiple runs of strong intravenous antibiotics.
We go through fairly draconian measures to limit any spread of these organisms, which so far seem to work. Negative pressure rooms, isolation gowns and masks for simply entering the room, disposable stethoscopes, etc. all help. Rooms and gear are disinfected by two different individuals so that personal tendencies don't allow transmission. And we wash our hands. A lot.
Re: (Score:3, Informative)
Sure LPS might be inflammatory but that doesn't make all (e.g.) E.coli pathogenic - it's the aquired attachment/invasi
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.
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: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: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:Party like it's 1899 (Score:5, Informative)
Actually, a few weeks/months is enough.
Give it a year without prescribing antibiotics for anything but the most severe cases, and all the nice little antibiotics are effective again.
Google for 'norway antibiotics' .. ( http://www.fftimes.com/node/229972 [fftimes.com] )
Comment removed (Score:5, Interesting)
Re:Taking Kidneys offline (Score:4, Insightful)
Of course that's assuming the bacteria isn't in your kidneys...
Re: (Score:3, Insightful)
Re:Taking Kidneys offline (Score:5, Informative)
Re:Taking Kidneys offline (Score:5, Funny)
I am a med student studying on renal physiology (test on friday...)
Let me know if you pass, then I'll mod you up.
Re:Taking Kidneys offline (Score:5, Funny)
Congratulations, you just wrote the next episode of House.
Re:Taking Kidneys offline (Score:5, Informative)
Theoretically yes. It would just take rerouting the incoming kidney blood supply into a loop to bypass it into dialysis. However, you would likely have to filter the drugs out, pass it back to the kidney, reroute it out again and restore the drug. Wouldn't help if your kidneys died from lack of blood supply. Last case scenario stuff probably though.
While the idea sounds like a good idea on paper, I have to tell you, as a practicing surgeon, it really sucks.
First let me clear up, the antibiotics themselves are either directly nephrotoxic (damage the kidneys) or their breakdown products are. Its not a matter of taking the kidneys “off-line”. And in addition not all drugs are removed with dialysis.
To access both renal arteries and veins (assuming normal anatomy many people have duplicated renal vascular systems) is not an benign undertaking. The vessels are in the retroperitoneum (behind all the structures in the "classic" abdominal cavity. So it is not a "trivial" procedure. Next to totally bypass the kidneys is not a great idea...extended bypass systems tend to cause a lot of damage to the blood, they can speed up the drestructiong of red cells (oxygen carrying) and platelets (clotting cells). The circuit also tends to active the clotting system and you get a paradoxical, hyper/hypo-coagulable state. This is similar to DIC (Disseminated intravascular coagulation) [http://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation]
Also the bypass circuit itself is made of synthetic material with acts to harbor bacteria. Given large scale infections, we as surgeon, routinely remove all sorts of prosthetics (AV graft material used for dialysis, artificially heart valves, pacemakers, rods and screws from orthopedic procedures)
The information in the article itself is not new. When I did a rotation in a burn unit in 2004, we had a standing problem with the unit harboring several species of Acinetobacter, and these organisms were resistant to all the antibiotics that the lab routinely tested. We routinely had to use Imipenem(tm) [http://en.wikipedia.org/wiki/Imipenem]. And it was not unusual to have bugs start to build resistance to that drug. We usually had to resort to poly-pharmacy as opposed to mono-therapy as we usually prefer.
Again as I posted a few weeks ago: As physicians we need to be vigilant in our use of antibiotics, but patients need to be respectful of them as well and to stop asking for an antibiotic (that is useless for viral infections) for every little sniffle when you have the common cold or flu (both caused by viruses).
Forgive me for quoting wikipedia, but I felt some footnotes were warrented. I usually yell at my students and residents when they quote it to me, but for the level of discussion here, it is adequate.
Re:Taking Kidneys offline (Score:4, Informative)
[hemo] dialysis is using a counter current "dialysate" to effect a net removal of solvent and solute from the blood...aka accomplishing a filtration the way a kidney works by using a semi-permeable membrane. Can also be done via a process of peritoneal dialysis using a catheter inserted into the abdominal cavity.
plasmaphoresis is the process of removing the plasma from the body and replacing it with albumin or other colloid solution (fresh frozen plasma). This is used to reduce the immune components of the blood e.g. antibodies. Most commonly used for auto-immune disorders.
lukopheresis is selectively removing the white cells from blood. This is mostly commonly used in packed red cells used in transfusions.
The latter two procedures would be contraindicated in the face of a bacterial infection as they would severely inhibit the immune function of the body.
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: (Score:3, Insightful)
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?
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.
Probiotics (Score:3, Interesting)
Re: (Score:3, Informative)
by flooding the system with beneficial bacteria that will compete with the harmful ones for resources and eventually starve them out.
That's all very well in the lab. However in a patient those "resources" also happen to be things the patient's cells need. Guess who also is going to be "starved out". Just my 2 cents worth but don't mind me, I'm just a physician.
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?
Do you really want to know the answer? (Score:3, Funny)
Story A - Every pharm company wanting to make a buck has pushed antibiotics into every nook and cranny, eventually creating strains of resistant bacteria.
Story B - An secret organization, funded by __________ has developed resistant strains to maintain and control ___________, and in some cases even __________.
Nope, I really don't want to know the real story.
Bitter Resistance (Score:4, Informative)
Bruce Sterling wrote what is still probably the best article for the layman about the inevitability and dangers of bacteriological antibiotic resistance.
Bitter Resistance [eff.org]
Check it out, peeps.
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: (Score:3, Informative)