Nightmare Bacteria. Real? Hyped? Both?

Probably an attention seeking headline, but for decades, bacteria have been getting more drug-resistant due to evolution against misapplication of antibiotics; these resistant strains are now becoming a bit more widespread. Another reason to avoid hospitals... too many sick people.

Add west-nile virus last summer, and this past winter's flu , ... just another thing to put up with until we get better medicines, health practices, and delivery systems. Though bad, remember cholera, plague, malaria, and the infamous Spanish flu of 1919 put down a lot of people until the science of the last 100+ years.

http://www.cnn.com/2012/08/29/health/west-nile-virus

http://www.dshs.state.tx.us/idcu/disease/arboviral/westnile/

http://www.bloomberg.com/news/2013-01-18/flu-related-deaths-rise-above-epidemic-levels-in-the-u-s-.html

The name is hype, but the phenomenon is real, and it is worrisome. The fact that this is happening with species of bacteria that are able to transfer their antibiotic resistance to other, related species is particularly bad.

Having worked in a hospital lab where cases of resistant bacteria have been identified in increasing numbers and varieties over the years, I can tell you that microbiologists are worried about the potential for disaster with these bacteria.

There has been such an overuse of antibiotics in the world over the past 50 years, both in humans and prophylactically in farm animals. We know bacteria become resistant, and no one is really spending much time or money researching new drugs to fight these infections (not very sexy, not much payout).

Eventually we will have crazy amounts of antibiotic resistant bacteria out there - with literally no way to fight it. We truly will be just as we were before we discovered antibiotics...

As a student and during my first year of practice I spent a lot of time in hospitals...the numbers of patients with MRSA or VRE (both bacteria resistant to antibiotics) was jaw dropping. And to think there was only one medication that could help these folks. What happens when the bugs overcome that? We have no more defenses.

The conspiracy theorist in me wonders if a drug company or two really are working on this, then when all the known antibiotics are ineffective, they'll march it out and charge $10k a dose for it like they do cancer drugs.

But no, it is very real, and I don't think they can hype it enough because it really is a massive public health problem that big agriculture refuses to acknowledge.

I don't doubt the threat is real, but this has been going on for decades! Is there no medical / political leadership in arresting this deterioration?

I heard a bit of Science Friday on NPR today discussing this topic. One very salient point they made was that so much of modern medicine - advanced surgery, chemotherapy, intensive care medicine - is all predicated on the availability of effective antibiotics. Without antibiotics, none of those things can be successfully and safely done, and we are mostly back to medicine as it was practiced in the 1930's before the advent of antibiotics.

And research on developing new antibiotics is not very interesting to manufacturers; they are much more interested in developing drugs that you take for the rest of your life, rather than something you take for 7-14 days then stop, for obvious financial reasons. So not much money is being spent researching the next steps in antibiotic therapy, and when the current ones cease to be effective, we are truly up the proverbial bacteria-laden creek.

Apparently Israel had a serious problem with CRE and was able to institute protocols to decrease its incidence in all their hospitals. In a country like the USA where much of what happens in medicine is driven by the almighty dollar, I am not sure I have full confidence that we will do the same.

What, Ben, you mean have "big government" controlling our lives???? (sorry, I just couldn't help myself - I don't know how much of that attitude has actually kept us from having some nationwide political leadership and regulation on this).

I agree that we have been hearing CDC, NIH, AMA, and other government-run or professional organizations warning us on this issue for decades, but I don't think they necessarily have the clout to mandate anything at this point. I hope that the current "hype" will, if nothing else, put pressure on regulatory agencies (such as TJC) to require that stringent policies be put into place.

Much of what is done to counteract spread of resistant bacteria is done on a hospital by hospital basis in this country. I know that the public hospital I worked in for 32 years was very attuned to the issue of antibiotic resistance, and managed to dramatically reduce incidents of MRSA and VRE. But not all hospitals have either administration or staff on the cutting edge of awareness of things like this. And then there is what goes on outside hospitals: over-prescribing antibiotics for patients with viral infections, just to keep them happy (but no more healthy), feeding antibiotics to livestock to enable overcrowding and factory farming, widespread addition of antibacterials to items such as toothpaste, soap, etc., which are not really necessary for good health or safety. All of these things contribute to creating populations of bacteria that are resistant to the substances used.

I read this morning that China uses 10 times the amount of antibiotics per capita that the U.S. does; I'm sure many countries where prescriptions are not required may also abuse antibiotics. It's ultimately a global issue and not just a local one.

Additionally, there's another problem in poorer communities, such as on the border, in that the patient does not take all their prescribed antibiotics (saving them up for later to save money, doesn't like the side effects, and feeling better/doctor doesn't know what they are talking about).

Makes the problem worse since the normal strains of the bacteria were killed by the antibiotic but more resistant strains make it through and multiply (bonus: the competing susceptible bacteria are gone), .... even though the patient may "feel fine".

It's not modern medicine...it's big ag. The huge farms that produce cows and pigs and whatnot for food pump their animals full of antibiotics to make them grow faster and to withstand all sorts of nasty bugs while they cram them all into massive feedlots.

The FDA continues to try to regulate this, but year after year they are stopped by the very powerful farm lobby. Yes, we've known about this for years but no one seems to be able to stand up to all that money and power. I read a statistic that more than 90% of all antibiotics consumed is on farm animals.

http://www.propublica.org/special/a-history-of-fda-inaction-on-animal-antibiotics

Edited by Jenmitol on 03/08/2013 17:53:57 MST.

I agree; not sure if you thought that my comment about modern medicine being predicated on having effective antibiotics meant that it was somehow at fault (not my aim - just that if we render these antibiotics useless, we're back to 1930's medicine, since we can't really do major surgeries, chemo, intensive care medicine without them). Overuse/misuse of antibiotics in clinical settings does contribute to the incidence of resistant organisms, at least in those locations and probably to a lesser degree in the community at large, but I agree that the bulk of antibiotics used (and hence bacteria exposed/rendered resistant) is probably in agribusiness.

I listened to that NPR piece also

There are way more bacteria than cells in our bodies. They do useful things like extracting nutrition. They help immune system to work properly. Mostly they prevent bad bacteria.

Don't use those anti-bacterial soaps - they make things worse. If you kill all the bacteria on your skin, then there will be a void - opportunity for bad bacteria to get foot hold.

Quit worrying about bacteria

And if you fed cattle grass rather than corn, they wouldn't get sick all the time and require anti-biotics, plus the meat would be healthier

Actually, here's one researcher that is a fantastic speaker, and may have an interesting insight to what may be the next step in "antibiotics".

http://www.ted.com/talks/bonnie_bassler_on_how_bacteria_communicate.html

P.S.--I'm not a doctor, but I am a veterinarian. I'm still a doctor, I'm just not a "real doctor". That means that I just play with the puppies and kitties all day, and spent 8+ years going to school to learn how! ;-)

Edited by dipink on 03/19/2013 19:02:53 MDT.

>"P.S.--I'm not a doctor, but I am a veterinarian. I'm still a doctor, I'm just not a "real doctor"."

Veterinarians impress me. My wife deals with only one age group of one species of mammal and then only between their clavicle and their hips (Internist). Whereas you deal with the whole mammal, all mammals, from gestation to end-of-life. In clinical, in-patient, AND surgical settings. Plus the odd bird and reptile as well.

I play a game when I bring the dog in for shots, a check up, or surgery. I estimate what it would have cost for a human. And then I divide by 10. I'm usually pretty close in estimating the bill.

So not only are you tremendously versatile, you're also very cost effective.

Diane,

Great TED talk.

Thanks

"My wife deals with only one age group of one species of mammal and then only between their clavicle and their hips"

This has also been how I approach dating. Do you think that might be why I'm still single?

"This has also been how I approach dating. Do you think that might be why I'm still single?"

It could be a factor. I have a friend who has struck out more times than I can count and part of his problem is that he stares at this area of women in a very obvious way........obvious that is to everyone but him.

Edited by lyrad1 on 03/24/2013 19:10:43 MDT.

"Makes the problem worse since the normal strains of the bacteria were killed by the antibiotic but more resistant strains make it through and multiply"

This is how you create resistant strains. By keeping individuals that have a bit of resistance alive, spreading them to the next one and starting all over again. Given enough time and a high enough mutation rate you will get new resistant strains over time. Works in the lab and in humans too.

As for the regulation: As far as I know there isn't much that can be done. Except not prescribing antibiotics in case of the common cold or other viral infections – a lot of patients here in Germany demand them though because medicine is good and evolution is hard. Not taking antibiotics isn't just a problem of poorer communities sadly. The biggest trouble comes from the fact that antibiotics have to be taken longer then the symptoms last in order to be effective (as in kill everything bad). So people start to forget taking them, think medicine is poison and should not be taken longer then the symptoms last, save them for later, etc.

And as far as I know about every hospital in the western world will have resistant strains of something and about the only thing you can do is prevent infection of patients – the strains that are resistent to *every* antibiotic are relatively new however, well, okay, maybe 10 to 15 years. You can also try to use other disinfection methods, but I bet bacteria will adapt to just about anything given enough time – except maybe to heat everything up to about 200° C.

EDIT: The TED talk is great. Thanks for the link.

Edited by karl-ton on 03/24/2013 19:30:08 MDT.

Jennifer is entirely right, except that it is a combo of the farm lobby and Big Pharm which does the blocking. That doesn't help.

Big Pharm has given up developing antibiotics in favour of 'life-long' drugs. The costs of research are enormous, the costs of getting approval in the USA are unreal, and the cost of the insurance against all sorts of lawsuits is unpayable.

So who is going to do the R&D? The Republicans say 'industry', but industry has refused. Um ...

Cheers