Antibiotic resistance 'a time-bomb'
belfasttelegraph.co.uk
belfasttelegraph.co.uk
Here's a short snippet from a BBC Television programme (Horizon - 'defeating the superbugs').
It shows E.Coli developing anti-biotic resistance. There's a tray of nutrient jelly. The jelly is divided into sections. It starts with no antibiotic. Then there's a normal dose. Then there's a 10x dose, followed by 100x dose, followed by 1000x dose. They reach the limits of solubility. They cannot dissolve any more antibiotic into the jelly.
Then they drop E.Coli onto the normal jelly, and use a time lapse camera to show the growth.
After just two weeks the bacteria is able to live on the 1000x dosed jelly.
It's pretty impressive demonstration.
(Apologies for the suboptimal hosting site. YouTube's contentID blocks this video worldwide.)
We've essentially created vast plateaus within the evolutionary landscape and these are beginning to be occupied by pioneer species that will quickly take the advantage to adapt.
Scary stuff indeed.
Between the lack of solid contact precautions, doctors who think they are above them, the over-use of antibiotics which lead to this etc. this is a huge problem. The number of instances of MRSA are growing every year which is the scariest part of this. I can vividly remember my mother reading and recommending a book about the coming superbugs back in the 90's when MRSA was rare. It was quite ironic that this ended up killing her.
Can someone explain, even if there are resistant pathogenic bacterial strains floating around, where the entrypoint for infection is? Operating rooms are cleanrooms, and after that, with good dressings on the wounds, bacteria should be prevented from entering.
"Flesh eating bacteria" due to scratching is one thing; bacteria that gain a foothold through the GI tract is another; I understand how those infections get started.
However, internal infections caused somehow by surgical wounds? Are surgical suite clean rooms not a low enough class and therefore not sterile enough? Is wound aftercare not good enough? Are surgical tools getting contaminated after sterilization but before the surgery?
Maybe hospitals should be turned into high-class[1] (lower-effectiveness) cleanrooms. I realize laminar flow in such a chaotic environment is impossible, and of limited effectiveness if people are not gowned and so shed contamination all the time, but there could at least be an attempt to push some of the contamination to vents on the floor. How much would that increase costs? It wouldn't have to be entire hospitals, only the recovery wards.
Other than that, a major initiative to clean up hospitals could be undertaken. Surfaces and floors and everything else commonly touched should be sterilized more often, to start with. Any area that sees a lot of patient turn-over is going to be heavily contaminated. Anyone who goes from room to room (doctors, nurses) should wear gloves before entering a room to avoid cross-contamination. Donning new gloves once in a room is not good enough; doorknobs, clipboards, light switches, etc. are all still subject to cross-contamination.
Recent studies on hotel rooms made me never want to check into one again:
http://www.cbc.ca/news/canada/story/2012/11/07/marketplace-d...
http://www.scientificamerican.com/podcast/episode.cfm?id=hot...
[1] http://en.wikipedia.org/wiki/Cleanroom#Cleanroom_classificat...
http://thechart.blogs.cnn.com/2011/04/08/hospital-checklist-...
But how often are doctors prosecuted for this kind of negligence? Something is very wrong with our medical system and it's worse than MSRA.
Also, let me tell you, IV Benadryl is some good shit...
This article is from the UK. Our media's focus on drug-resistant bacteria isn't oversimplified, it's FUD. The whole nation is scared stiff of MRSA because the papers all used "the lab that gets results" - aka some dude in his shed who had no idea what he was doing. They used this lab because it repeatedly confirmed that large numbers of journalists samples (taken from various areas in hospitals) did indeed contain MRSA.
Not that there isn't a problem, and it merits attention, but the hysteria they whipped up was unwarranted.
I'd be less angry, but despite all this antibiotic fear, people still keep taking them for colds. Grr.
I would never encourage anyone to think of a hip replacement as "routine." It is majorly invasive surgery, and any number of things can go wrong. Post op infections are not uncommon. And just being under deep anasthesia for that long is not without suspected long-term side effects.
http://www.dailymail.co.uk/health/article-2291314/Superbugs-...
This is also a problem in North America. Try buying a simple disinfectant (e.g. for small cuts) that doesn't contain antibiotics.
http://en.wikipedia.org/wiki/Antiseptic http://en.wikipedia.org/wiki/Disinfectant
But peroxide and iodine and rubbing alcohol are all also available, and plain petroleum jelly is available. And then most small cuts should probably just be washed with soapy water and left open to the air.
(also, the Wikipedia roundup on triclosan suggests it isn't a problem yet: http://en.wikipedia.org/wiki/Triclosan#Resistance_concerns
Not that it is particularly useful to put it in soap)
Having said that, even with what ie now learned, I think it's still the case that _most_ disinfectants and antiseptics, even in the USA, are not antibiotics.
Thanks for the correction, I certainly learned something.
Nobody is saying this will destroy the human race or anything like that. Clearly, as a species, we don't need this stuff. But it will be a huge negative change for individuals.
Yeah, but you could die from a small wound in the leg or something.
For some values of "lived", including "often died of things that today are trivial".
Like species which were forced out of the water, onto dry land, because they were out-competed -- one of our evolutionary advantages is that we can survive in space.
[1] http://www.gainesville.com/article/20130305/ARTICLES/1303098...
[2] http://www.thenational.ae/news/world/middle-east/iran-deploy...
Doubtful. They may impact our growth or even trim back our numbers, but we're numerous and have lots of mutations too. If technology doesn't save us, it's likely that we'll experience some sort of evolution that allows us to adapt. Even back before modern medicine, the Plague only managed to wipe out 2/3 of the population.
one of our evolutionary advantages is that we can survive in space
I doubt we'll be getting many humans out into space any time before some sort of Singularity beyond which we're all just guessing anyway.
If you have a viral infection, taking an antibiotic is like setting mousetraps to kill mosquitos.
Meanwhile, your unnecessary antibiotic 1) has side effects, 2) costs money, 3) helps breed superbugs.
Many patients feel that "if I waited 2 hours to see the doctor, he/she had better give me something." Many doctors cave to these demands. We need to stop both.
And we need some serious work on bacteriophages. Those little buggers are _awesome_ and have a faster evolution than bacteria.
As a practical matter, it's nearly impossible to breed therapeutic quantities of a virus without having a wide range of mutations present. We'll probably end up using phages because we won't have any other choice. But they won't be as safe as antibiotics.
According to the World Health Organization, tuberculosis antibiotic resistance kills 150,000 people per year [1], so I believe your statements on this topic are much too sanguine.
Antibiotic resistance is a real threat, that will only get worse. It's just harder to sensationalize than the latest middle-eastern bogeyman.
Dame Sally Claire Davies, DBE (born 24 November 1949) is the Chief Medical Officer for England, and previously Director General of Research and Development and Chief Scientific Adviser for the Department of Health and National Health Service in the United Kingdom.
Yeah, she sure sounds like a quack to me...
Did you read your reasonable source? That page links to:
http://www.cdc.gov/getsmart/antibiotic-use/antibiotic-resist...
"Antibiotic resistance has been called one of the world's most pressing public health problems... antibiotic resistance is among CDC's top concerns."
Swimming pools: worse than terrorism. Check.
Driving: worse than terrorism. Check.
The common cold: worse than terrorism. Check.
Sitting at a desk for 40 hours a week: worse than terrorism. Check.
Terrorism is a useful cudgel for tyranny because it hits the convenient sweet spot of high profile incidents to rally around, nationalist xenophobia, and maximally invading the civil liberties of otherwise thoughtful citizens.
Drug-resistant bacteria sounds like a paranoid tinfoil fear, but hospitals already deal with the problem. Doctors do not want to hear the words "drug-resistant MRSA", ever.
Probably the worst culprit is the abuse of antibiotics in factory farming. The animals live in disgusting conditions that require antibiotics to keep them viable. (As a side effect, the drugs also make them fatter, producing more meat per head.) This is a huge contributor to the problem.
Regarding the antibiotics, it's not completely clear why giving them to animals makes them bigger, and it may well not have anything to do with poor living conditions. It seems to work in humans, too, and these results were discovered as early as the 1940s [citation needed].
But those are just quibbles; on the key points, I'm with you.
[1] http://www.cdc.gov/hai/organisms/cre/index.html
[2] http://www.who.int/tb/challenges/mdr/tdrfaqs/en/index.html
I think the explanation that I heard which sounds plausible is that the antibiotics free up a certain amount of energy in the organism that would have gone to fighting micro-organisms that can instead be applied to growth.
From the 'Germs Are Us' article:
"In August, Ilseung Cho, of the New York University School of Medicine, published a study showing that antibiotics eradicated bacteria, commonly found in the digestive system of mice, that help the animals metabolize calories efficiently; without the microbes, the mice absorbed more calories from the same amount of food and rapidly became obese."
http://www.newyorker.com/reporting/2012/10/22/121022fa_fact_...
[1] http://nationalhogfarmer.com/health/be-ready-antibiotic-rest...
That would be a start. Then we put a ban on the sale, for human consumption, of animals that were treated with antibiotics. If you want to save your pet cat's life-- or your pig's-- that's fine. Just don't sell it as food.
That's the low-hanging fruit. It will make meat slightly more expensive, but I'm okay with that. People in the developed world eat too much meat for their own health anyway.
What remains is educating people about antibiotics so they stop asking for them when they get colds and flus (they don't do a damn bit of good for a viral infection). Doctors in the US tend to be over-liberal with the drugs, even knowing that they have no effect on viruses.
Western fertility rates are on average ~2. Development and education in poorer nations - especially for women - also results in declining birthrates.
Interesting side point though: reduced birthrates don't result in any benefits to drug-resistant bacteria though, since a small population can still run high density feedlots which promote them!
Side-note is incorrect. It's a probability game. Going from (hypothetically) 1000 CAFOs to 10 would drop the rate of production by 100x.
Literally nothing about reducing the population density of an area addresses the horrific practices of the meat industry. They would still be a bad idea if there was exactly 1 next to a town of 1000 people, because that town would still be wiped out by drug-resistant bacteria.
We don't need current meat production practices - they're about corporate profit, not long-term efficiency.
http://www.slate.com/articles/technology/future_tense/2013/0...
In my experience, "those people" are indistinguishable from "people who have the same skin colour as me" after a generation or two.
Oh, and here a some studies with, you know, numbers and statistics that bear that out:
Migrant birthrates falling in Germany, study finds -- http://www.thelocal.de/society/20100811-29073.html
"Fertility rates among foreign-born women start to decline relatively soon after they arrive in Canada, and eventually reach those of women who were born in Canada" --http://www.statcan.gc.ca/daily-quotidien/031222/dq031222c-en...
Of course, affluence is where most of the problem lies. The difference in environmental impact between a rich human and a poor human is much greater than between a poor human and no human.
Which leads to a more accurate description of the problem: how do you make not destroying the planet more appealing than destroying the planet on an individual level?
Lagoons of shit. Literally.
You may be okay with that, but there are a large number of low-income people who are not.
I'm not disagreeing with you - I think factory farming and antibiotic usage for farm animals should be banned. I just think it's worth keeping a broad perspective so that we can appreciate that these problems are in fact very difficult to solve.
... or we could all deal with the fact that meat isn't a human right, and the lack of it would be a slight inconvenience compared to the implications of antibiotic resistance.
So yeah, low-hanging fruit.
Neither is food, if you really want to go that route. The point of civilization is that we try to provide for ourselves things that are not just our rights, but our desires.
(Show me where nature will automatically provide food for humans.)
Access to basic nutrition is a de facto human right, in the modern civic sense. Nature doesn't guarantee that humans are fed, but many governments try to, with welfare and food stamps.
It is for some people. Or is their culture wrong to you?
Not in the slightest, and I wonder where you've lived that that's ever been the case. Not on Earth, certainly.
The only things Nature provides free are sunlight, weather, and parasites.
I'm not sure how nature automatically providing food has anything to do with it. The point of human rights is to provide for ourselves things that are not just facts of nature, but satisfy our ethical beliefs.
This is an interesting proposal I haven't heard before, and it sounds like a good idea. I think it's going to be difficult to convince ranchers that they have to suck up the loss of a $5000 steer to a bacterial infection that could have been cured with $10 of antibiotics.
> Probably the worst culprit is the abuse of antibiotics in factory farming.
That's certainly a problem, but misuse of antibiotics in humans is still a big big problem.
Antibiotics were routinely used for illnesses where they shouldn't have been - ear infections, viral coughs and colds.
In developing nations people often use antibiotics in the worst way - a short course until they feel better, not a long course until the bacteria are all killed. This is partly because they don't know any better and partly because they buy what they can afford.
I wish I could say this was limited to developing nations.
This brings up an important topic in infectious diseases right now: in many cases, long courses of antibiotics increase selective pressure and favor the antibiotic-resistant bacteria. One strategy to reduce drug resistance is to (rationally) minimize duration of treatment [1]. This isn't to say that medication nonadherence is good, but it is to say that the field is moving towards a shorter duration of treatment for many infections.
In developing nations people often use antibiotics in the worst way - a short course until they feel better, not a long course until the bacteria are all killed. This is partly because they don't know any better and partly because they buy what they can afford.
On the contrary, I would like to point out that its not limited to developing nations. When I first arrived in the US, one of the advice that my US settled relatives gave me was that American doctors routinely prescribe antibiotics even for the simplest illness. This fact was confirmed when I took my Mum to a doctor when she felt unwell when visiting me: light fever, and the prescription was some very potent antibiotics. My mother refused to take them and got better on her own after a few days. There seems to be a reluctance to take antibiotics in my family.
What I meant to say was something like "Another misuse of antibiotics is caused by poor people not being able to afford a complete course".
It doesn't seem to lead to resistance either, but that doesn't make using those products any more sensible.
That said, I think the concerns about antibacterial hand soaps leading to resistance are overblown. The bacteria on your hands are not an isolated population; you're exchanging bacteria with the environment all the time. Applying intermittent selection pressure to a tiny fraction of a population at a time causes little if any genetic drift in the entire population.
Say you wash your hands with triclosan soap, and all but a few bacteria are killed. When those bacteria are transferred to a doorknob, say, they have no advantage against the other bacteria that are already there; indeed, whatever mutation allowed them to survive the triclosan probably puts them at a disadvantage in a triclosan-free environment. Even the ones that stay on your hands don't have a competitive advantage against newcomers until the next time you wash.
Conversely, the bacteria in your body are an isolated population. When you subject them to strong selection pressure by taking an antibiotic, if any manage to develop a little resistance, they continue to have an advantage as long as you're taking it. If you don't take enough to kill them despite their resistance, you'll wind up with a pretty pure population that has this new level of resistance. Pass that to a few other people, and repeat the process a few thousand times, and you have a problem.
Also antibiotic resistant c-diff. I have heard about klebsiella pneumoniae, but don't know any cases personally.
Eventually, advanced societies will realize that immune systems need to be exercised just like the rest of the body, but good luck telling helicopter moms that Jr shouldn't have antibiotics for his ear ache.
An article was published in December 2006 that described how Smithfield, America's largest pork meat producer, manages all the excrement from the 27 million hogs it slaughters every year. The article at the end is worth a read, but I'll give you a summary: 27 million hogs produce an unbelievable amount of shit. This shit is collected in what Smithfield calls "holding ponds" - which are actually lagoons - that can run 30 feet deep. These ponds contain many extremely toxic substances in addition to good old pig shit. Even light rains can cause them to overflow. And the stuff is so vicious that people are often overcome by the fumes and are hospitalized. And if someone falls into the stuff, they die.
How does this stuff affect humans? Well, gravity causes the toxic material in the lagoons to seep down into the groundwater supplies. From there it arrives in people's sinks, showers, and drinking water.
http://www.globalresearch.ca/pork-s-dirty-secret-the-nation-...
Switching away from meat will certainly help to address the development of resistant microbes, but if you can make a switch instead to meat that was raised with regenerative pasture management practices, you can additionally have a large positive impact on many other environmental factors. Look for terms like "high-density grazing," "holistic grazing," "holistic management," or "management-intensive grazing (MIG)."
This TED talk [1] covers some of the information, for more you can google around for the above terms (sorry I don't have a good link handy). Correctly managing grazing livestock can actually reverse desertification and trap tons of carbon per year per acre in the soil. Of course, doing it wrong can have the opposite effect, so if you go this route it's important to know whether your farmer is running his operation with land restoration in mind.
Conventional vegetable production also comes with a slew of its own problems (breeding of herbicide-resistant weeds [2] being something closely related to the topic at hand). Eating in a way that doesn't cause harm is a tricky thing these days.
[1] - http://www.ted.com/talks/allan_savory_how_to_green_the_world...
[2] - http://www.sciencedaily.com/releases/2012/10/121002092839.ht...
*edited for formatting
I'm not trying to be inflammatory, I'm just curious.
[1] http://www.southpoll.com/History.html
[2] http://www.amazon.com/The-Lasater-Philosophy-Cattle-Raising/...