Antibiotic resistance 'a time-bomb'

http://www.belfasttelegraph.co.uk/news/local-national/uk/antibiotic-resistance-a-timebomb-29121193.html

by clicks • 13 years ago

119 102 13 years ago

belfasttelegraph.co.uk

Antibiotic resistance is scarier than terrorism. A once-in-a-century terrorist attack killed 3000 people. TB still carries off more than a million people per year, and used to be incurable.

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.

carbocation4• 13 years ago

I'm with you on basically all points. For a good time, take a look at carbapenem-resistant enterobacteriaciae [1] and totally resistant TB [2].

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

dmiladinov• 13 years ago

> Regarding the antibiotics, it's not completely clear why giving them to animals makes them bigger

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.

ericb• 13 years ago

Do antibiotics make people taller, fatter, or both?

arvin• 13 years ago

> Regarding the antibiotics, it's not completely clear why giving them to animals makes them bigger

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_...

nodata• 13 years ago

But what do we do about it, when it seems that nobody at all cares?

carbocation4• 13 years ago

People care a ton about this, enough so that the FDA has released guidance on it and even industry magazines are talking about it [1]. This is a huge issue with major visibility in the health professions.

[1] http://nationalhogfarmer.com/health/be-ready-antibiotic-rest...

michaelochurch2• 13 years ago

Factory farming should be outlawed for a number of reasons. It's inhumane, devastating to the environment, and bad in a million other ways. It's not even efficient, except in jurisdictions that allow the farms to (freely) dump their effluent-- an externalized cost. Factory farms are literally putting huge quantities of shit into their local water tables.

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.

DanBC4• 13 years ago

MRSA is already drug resistant. That's what the MR bit is - methicillin resistant.

> 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.

Smudge• 13 years ago

> 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.

carbocation4• 13 years ago

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.

[1] http://cid.oxfordjournals.org/content/46/4/491.short

pm90• 13 years ago

>Antibiotics were routinely used for illnesses where they shouldn't have been - ear infections, viral coughs and colds.

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.

enraged_camel3• 13 years ago

I think another huge trend worth noting is the use of anti-bacterial products. They do nothing other than killing a large portion of both good and bad bacteria indiscriminately and leaving a small, drug-resistant strain, which then does not have to compete for resources with all the non-resistant bacteria and reproduces freely to ultimately make people sick.

RougeFemme• 13 years ago

Though less prevalent, even people in developed countries do this (short course). Slightly off-topic, but with the "complete" and "short" courses now available (e.g., a complete lasts only 2-3 days), how is resistance affected? Is it better, worse, or the same? Better, since people are more likely to complete a course?

jpdoctor• 13 years ago

> "drug-resistant MRSA"

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.

InclinedPlane• 13 years ago

A point of correction: 9/11 may be an outlier but it's unfair to characterize it as a super unique event. Terrorist attacks routinely kill dozens and even hundreds of people, and this continues even today. Though such attacks are for the moment much less common in the developed world.

enraged_camel3• 13 years ago

Factory farming is insanity, not just in its contribution to antibiotic resistance but also because of its devastating impacts on the environment.

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-...

100982• 13 years ago

time to become a vegetarian

adventured• 13 years ago

I agree, although the real once-in-a-century attack that obviously concerns people for the next century is a nuclear attack, or a biological attack, that kills hundreds of thousands or millions (not to mention killing technology that is likely to exist in the next century that we can't imagine today). The prior century was extremely limiting for terrorists by comparison to what the next century is likely to make possible.

DanBC4• 13 years ago

(http://v6.tinypic.com/player.swf?file=24goih4&s=6)

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.)

jacquesm• 13 years ago

That's scarier than any horror movie that I've ever seen. It also makes perfect sense. You're providing nature with an evolutionary pressure and it adopts by breeding the most resistant strains until they are undefeatable.

sbirchall• 13 years ago

Exactly why industrial scale monoculture is the single greatest threat to humanity. We rely almost entirely on a few dozen animals, vegetable plants, grasses and a handful of other organisms that have all have their comfort zones artificially inflated and their genetic variance severely compromised by human intervention.

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.

kragen3• 13 years ago

It might help you feel better to know that E. coli is harmless, perhaps actually healthy, and competes in your intestines with other bacteria that might make you sick. (Except for some recent strains of E. coli that produce toxins.) The usual reason people get worried about E. coli contamination of food is not that the E. coli itself is dangerous, but rather that it's a reliable and easily-detectable indicator of fecal contamination.

ryusage• 13 years ago

Awesome. Thanks for that. Do you know if there are any examples showing the opposite approach? If they force the bacteria to go directly from no antibiotics to the maximum concentration, with no stepping stones, I wonder if that just slows down their mutation or if it actually makes it completely impossible.

sliverstorm2• 13 years ago

The antibiotics will probably diffuse in the gel to a degree, so a step-function concentration might be difficult to establish.

alvarosm2• 13 years ago

Yeah, well, good luck convincing, say, chinese farmers not to give tons of antibiotics to their livestock. Nobody is interested reducing pharmaceuticals' revenue either. On a side note, take into account we didn't have antibiotics centuries ago, and people just lived. Endure whatever comes, just live. And don't look so shocked, we have democracy and we're surrounded by morons, the shocking thing is that there's still any prosperity at all.

andor• 13 years ago

Yeah, well, good luck convincing, say, chinese farmers not to give tons of antibiotics to their livestock

This is also a problem in North America. Try buying a simple disinfectant (e.g. for small cuts) that doesn't contain antibiotics.

jrmg2• 13 years ago

I think you're thinking of antiseptics or disinfectants, not antibiotics. Resistance to these is not such a problem, and many work on a level that it would be very hard for a microorganism to develop resistance to (for example, by physically destroy the organism).

http://en.wikipedia.org/wiki/Antiseptic http://en.wikipedia.org/wiki/Disinfectant

droopyEyelids• 13 years ago

Hey! We have improved quality of life and expected lifespan quite a bit since then, and antibiotics were a big part of that change.

mikeash2• 13 years ago

A lot of people just died without antibiotics.

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.

100982• 13 years ago

> On a side note, take into account we didn't have antibiotics centuries ago, and people just lived.

Yeah, but you could die from a small wound in the leg or something.

DanBC4• 13 years ago

> take into account we didn't have antibiotics centuries ago, and people just lived

For some values of "lived", including "often died of things that today are trivial".

btipling4• 13 years ago

The comments here are a little over the top "antibiotic resistance is worse than terrorism!" Drug resistance is a problem, but check a reasonable source: http://www.cdc.gov/drugresistance/about.html and don't gravitate toward panic and fear. Fear is the path to the dark side.

carbocation4• 13 years ago

People shouldn't be afraid of antibiotic resistance so much as they should be outraged, diligent, and cautious.

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.

[1] http://www.who.int/mediacentre/factsheets/fs194/en/

btipling4• 13 years ago

There is no shortage of outrage on Hacker News, there seems to be an infinite supply every other day so you've tapped a good market.

lgleason2• 13 years ago

Not really, the number of deaths from it are much higher.

misnome• 13 years ago

Slightly ironic that you are warning against fear and panic to retort against statements that this is worse than terrorism, considering that the "Threat of Terrorism" is almost entirely fear and panic.

Antibiotic resistance is a real threat, that will only get worse. It's just harder to sensationalize than the latest middle-eastern bogeyman.

btipling4• 13 years ago

Well in that case I hope you are able to achieve the requisite amount of panic and fear you think is warranted.

JshWright• 13 years ago

>The problem is a "ticking time-bomb" and should be put on the Government's National Risk Register - which also includes "catastrophic terrorist attacks" and other civil emergencies, Professor Dame Sally Davies said.

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...

ceejayoz2• 13 years ago

> Drug resistance is a problem, but check a reasonable source: http://www.cdc.gov/drugresistance/about.html

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."

btipling4• 13 years ago

There's a difference between "top concerns" and the tone on this ridiculous HN thread. You'd think the world was ending. I hope all the downvotes help these people find relief from their vexing anxiety.

mikeash2• 13 years ago

"Worse than terrorism" is an extremely low bar. It's hard to see how saying that antibiotic resistance could not be worse than terrorism, since terrorism is an extremely minor problem.

scarmig2• 13 years ago

Indeed, it gets pretty tricky to think of something that fails to pass that hurdle.

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.

kragen3• 13 years ago

Comparing antibiotic-resistant bacteria to terrorism gives terrorism far too much credit. Non-state terrorism is only a distraction from things that actually matter.

lgleason2• 13 years ago

A year ago my mother went in for back surgery, a week after she had a sharp pain, and ended up with MRSA which had turned into sepsis. It damaged her heart and in the end, after a two month fight led the ARDS and took her life. The hell this put her through was extremely real.

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.

harshreality2• 13 years ago

My condolences.

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...

aplusbi• 13 years ago

Hospitals really can be that bad. People get sloppy if they aren't constantly reminded that they need to be vigilant. I have personally witnessed doctors open doors with bloody gloves and then interact with patients.

http://thechart.blogs.cnn.com/2011/04/08/hospital-checklist-...

wissler2• 13 years ago

As I said in a different comment, doctors can be exceedingly sloppy. There are no consequences. There's no clear evidentiary trail pointing back to the doctor (there could be -- but hospitals have no interest in that). And the worst thing is that we have a culture of sheep who treat doctors as if they are a kind of God. They aren't. Some of them are heroes, but some are worse than the average car mechanic.

wissler2• 13 years ago

If a doctor didn't follow proper procedures and ended up spreading MSRA to your mother, then in effect that was negligent homicide. I think this happens all the time. I've seen it happen myself, where a doctor touches an open wound without having washed his hands first.

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.

AaronBBrown• 13 years ago

I had a "minor" bought with MRSA a few years back that put me in the hospital for 2 days. Several weeks after getting a tiny little scratch near my elbow my entire forearm swelled up a couple inches. I went through several oral antibiotic treatments before they had to stick me in the hospital to give me the crazy IV stuff. The one that ended up solving the infection was vancomycin, which has been historically the "drug of last resort." During that little incident, I developed an allergy to two different antibiotics, so on top of bacterial resistance, now I have to be concerned with my own body's inability to deal with particular antibiotics.

Also, let me tell you, IV Benadryl is some good shit...

nathan_long• 13 years ago

To help, spread this message: you often don't want an antibiotic.

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.

tomjen3• 13 years ago

What we really need is something that can do to viruses what penicillin did to bacteria.

And we need some serious work on bacteriophages. Those little buggers are _awesome_ and have a faster evolution than bacteria.

tsotha2• 13 years ago

That evolution part is the problem. There's a chance we'll breed superviruses in our effort to stop supergerms.

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.

ams6110• 13 years ago

A bit of a tangent, but... from the posted link: Routine operations such as hip replacements could become deadly in just 20 years time if we lose the ability to fight infection

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.

to3m• 13 years ago

Better yet, the daily mail quotes the uk chief medical adviser describing organ transplants in the same terms!

http://www.dailymail.co.uk/health/article-2291314/Superbugs-...

boas• 13 years ago

I've worked in a US hospital for a few years, and I've never seen a bacteria that was resistant to all antibiotics, but I have seen people die from bacterial infections. So I think the media focus on drug-resistant bacteria is oversimplified. Why would someone die from a bacterial infection while receiving appropriate antibiotics? One reason is that the antibiotics can't reach the bacteria -- for example if the bacteria are organized into an abscess or biofilm. Another reason is that the body can overreact to the infection, and the patient can die from their immune response rather than the infection itself -- this is called sepsis. Other problems with antibiotics: culture results (which tell you which antibiotic to use) can take a few days, antibiotics frequently have side effects, and it's frequently unclear when the infection is fully treated and the antibiotics can be stopped. I felt a need to respond because a politician reading articles in the popular media will get a distorted view of what is actually needed in hospitals, potentially leading to inappropriate research funding priorities.

ZoFreX• 13 years ago

> So I think the media focus on drug-resistant bacteria is oversimplified.

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.

stephengillie• 13 years ago

Antibiotic resistance, giant mosquitos [1], mutant rats [2]. Pests are evolving to continue living despite our pesticides. We aren't going to make the Earth too hot to live on, or block out the sun with pollution. We're going to be forced off of the planet by evolved pests and predators.

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...

lysol2• 13 years ago

We can survive, for short periods of time. But we can't thrive yet.

crusso• 13 years ago

We're going to be forced off of the planet by evolved pests and predators.

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.

hugoc• 13 years ago

I think you just spoiled the plot for After Earth

jsherry• 13 years ago

The ROI on antibiotics is much lower than that of a "lifetime drug" such as an anti-depressant that a patient will take for years and years. Pharmaceuticals are mostly privatized and that's not changing, so the government is going to have to find some ways to incentivize innovation in the antibiotics market. Counting on government isn't a popular option these days, but this is the perfect role for them actually.

jballanc• 13 years ago

I think this Wikipedia page does the best job of succinctly summarizing the severity of the issue:

http://en.wikipedia.org/wiki/Timeline_of_antibiotics

jbhernan• 13 years ago

What about how most of the soap you can buy in stores these days is antibacterial soap? I would think the huge use of antibacterial soap might play a part as well. Antibacterial soap probably is not necessary for most people yet it has become the default soap for most, and you have to go out of your way to buy non antibacterial soap.

Antibiotic resistance 'a time-bomb'

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