The post-antibiotic era

[Doc]

Mutating Gonorrhea and 'Superbugs' Coming Soon to a Town Near You?

By: Jason Kane

This World War II advertisement informs the soldiers about a new "wonder drug" that can cure gonorrhea. The disease is one of many diseases -- including the infamous "superbugs" -- now showing resistance to all modern medicines. Photo courtesy of the National Library of Medicine.

Here are three good reasons the nickname "superbug" doesn't cut it anymore for the drug-resistant crop of bacteria showing up in U.S. hospitals under the more formal title Carbapenem-resistant Enterobacteriaceae:

They kill about half the people they attack
They've appeared in at least 42 states
And their resistance to drugs has quadrupled in the last decade or so

That's why Dr. Tom Frieden -- director of the Centers for Disease Control and Prevention -- came up with another name: "Nightmare bacteria."

Pretty startling language from the head of the CDC. But Frieden told reporters recently that the hype is justified. "Our strongest antibiotics don't work and patients are left with potentially untreatable infections," he said.

Before panicking, here's a caution: these germs aren't very common. For the moment, they're confined mostly to inpatient health care facilities. And while the exact scope of the problem isn't known -- largely because medical facilities in most states aren't required to track and report the number of CRE infections and deaths -- the CDC estimates that only 4 percent of U.S. hospitals and 18 percent of long-term acute care centers had a patient with CRE in the first half of 2012.

That's why Frieden stressed that if the proper steps are taken, "we now have a window of opportunity to prevent its further spread."

The same is true for a number of other germs that seem to be growing more indestructible against modern medicine by the year.

A drug-resistant form of gonorrhea reached North America earlier this year and a "virtually untreatable" type of tuberculosis is currently spreading in some parts of the world.

If nothing is done, CDC officials warn that a "post-antibiotic era" may be around the corner -- an era in which diseases commonly cured today with a few pills could once again run rampant. And it may be closer than most people realize.

"It's not something that's theoretical," said Dr. Arjun Srinivasan, associate Director for Healthcare Associated Infection Prevention Programs at the CDC. "It's not a statement that someday, we might encounter bacteria that are resistant to all antibiotics. That day is here. And it really calls upon us to take action now."

Srinivasan joined PBS NewsHour last week to discuss the CDC's latest findings on antibiotic-resistant infections -- including gonorrhea and tuberculosis -- and what Americans should be doing to protect themselves.

Dr. Srinivasan, thank you so much for joining us. Let's cut right to the chase: How concerned should Americans be? Is this a crisis in the making?

Dr. Srinivasan: I think crisis is probably not too strong a word for it. A number of factors add up here.

Antibiotic resistance writ large is a huge and global issue. It is a challenge in America. It's a challenge in every country in the world -- in both our health care facilities and also out in the community. We are reaching a situation where we are running out of effective antibiotics to treat a host of different infections. We talk about resistance in malaria, in tuberculosis, in gonorrhea, in Methicillin-resistant Staph aureus, or MRSA, and most recently in these Carbapenem-resistant Enterobacteriaceae. So it's really a far-reaching and global problem. And it's something that is going to impact many, many people all over the world.

Dr. Frieden called this a 'nightmare' for public health. How, specifically, is that the case?

Dr. Srinivasan: It is absolutely a nightmare scenario. The prospect of having bacterial infections that we can't treat with antibiotics is indeed a nightmare. It has the potential to undo so much of the progress that we've made in medicine. A lot of the medical advances that we enjoy today are directly dependent on our ability to treat infections that patients might develop. For example, organ transplants, cancer chemotherapy, bone marrow transplants and a host of the other treatments that we give people for rheumatoid arthritis -- all of these treatments have the undesirable effect of weakening a patient's immune system, which means that all of them put patients at high risk for infection. We can offer people these treatments because we can treat infections, for the most part, that the patient is likely to develop as a result. So if we lose the ability to effectively treat those infections, we will lose the ability to safely offer people many of the modern medical advantages and advances that we take for granted every day

More at the link:

http://www.pbs.org/newshour/rundown/201 ... r-you.html

[Nonc Hilaire]

The problem is animal husbandry. The odd MD who prescribes a useless Z-pak to pacify the patient with a viral cold isn't a big issue, but stuffing every animal headed for slaughter with prophylactic antibiotics is what is causing the problem.

[Typhoon]

The problem is animal husbandry. The odd MD who prescribes a useless Z-pak to pacify the patient with a viral cold isn't a big issue,

Unfortunately it's not the odd MD.

Two counterexamples that have been recently identified: all [known] antibiotic resistant gonorrhea [Japan] and TB [S Africa].

but stuffing every animal headed for slaughter with prophylactic antibiotics is what is causing the problem.

Also a serious problem.

[Taboo]

Well, my guess is that since the previous generations of drugs have been doing such a great job until recently, there has been no (financial or moral) impetus to try and develop new antibiotics and the like. As soon as the first big superbug strain goes out and causes a few tens of thousands of deaths outside of hospital sickbeds, this will change:

Political add: "Your CHILD could get this at SCHOOL ... or on the BUS! <Cue to image of cute coughing kid in bed and covered in sweat. Switch to ominous music, and a man getting out of an official car> Yet Senator Limprick has voted AGAINST the 2017 New Drug Appropriation Bill. Want to protect your children? Vote Lizzie Halewell in November!"

We are now close to having the molecular biology know-how to tear these little bio-machinery shits apart. All it will take is probably under $300bn investment or so. The problem will be not so much murdering the little bastards, as it is avoiding collateral damage to the rest of our benign microbial fauna (and our own cells, of course).

[Typhoon]

Well, my guess is that since the previous generations of drugs have been doing such a great job until recently, there has been no (financial or moral) impetus to try and develop new antibiotics and the like. As soon as the first big superbug strain goes out and causes a few tens of thousands of deaths outside of hospital sickbeds, this will change:

Political add: "Your CHILD could get this at SCHOOL ... or on the BUS! <Cue to image of cute coughing kid in bed and covered in sweat. Switch to ominous music, and a man getting out of an official car> Yet Senator Limprick has voted AGAINST the 2017 New Drug Appropriation Bill. Want to protect your children? Vote Lizzie Halewell in November!"

We are now close to having the molecular biology know-how to tear these little bio-machinery shits apart. All it will take is probably under $300bn investment or so. The problem will be not so much murdering the little bastards, as it is avoiding collateral damage to the rest of our benign microbial fauna (and our own cells, of course).

RSC | New antibiotics: what's the hold up?

This all means, it’s sad to say, that the limiting factor in antibiotic drug discovery probably isn’t the amount of money to be made at it. That’s too bad. Money’s a factor that could be adjusted by regulatory agencies, governments, and foundations. But no amount of cash will keep resistant bacteria from being the hard targets they are.