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The growing problem of antibiotic resistance

A Superbug That Resisted 26 Antibiotics

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This illustration depicts Klebsiella pneumoniae bacteria, which can cause different types of infections, including pneumonia, bloodstream infections and meningitis.
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"People keep asking me, how close are we to going off the cliff," says Dr. James Johnson, professor of infectious diseases medicine at the University of Minnesota. The cliffside free fall he is talking about is the day that drug-resistant bacteria will be able to outfox the world's entire arsenal of antibiotics. Common infections would then become untreatable.

Here's Johnson's answer: "Come on people. We're off the cliff. It's already happening. People are dying. It's right here, right now. Sure, it's going to get worse. But we're already there."

His declaration came in response to a report of a woman in Nevada who died of an incurable infection, resistant to all 26 antibiotics available in the U.S. to treat infection. Her death was reported in the Jan. 13 Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention. That kind of bacterium is known as a "superbug," which belongs to a family of bacteria resistant to antibiotics. In cases like the Nevada woman, who was infected with Klebsiella pneumoniae, the term "nightmare superbug" has been coined because this particular specimen was even resistant to antibiotics developed as a last resort against bacterial infection.

The Nevada case is different in that resistance was discovered early in treatment, but even the drugs seen as the last line of defense didn't work. "This one is the poster child because of resistance across the board," Johnson says.

The woman described in the report was in her 70s and treated in a hospital in Reno. About two years ago, on an extended visit to India, she broke a thighbone, according to the report. She had several hospitalizations in India because of infections, says Dr. Lei Chen, of the Washoe County Health District in Reno and an author of the MMWR report. When the patient was admitted to the Reno hospital, health workers discovered that the bacteria specimen tested was resistant to a class of antibiotics called carbapenems — carbapenem-resistant enterobacteria.

"Before, we could go to carbapenems, and they could reliably squash the bugs," says Johnson. "This case broke down even our last great gun."

The woman's most recent hospitalization for infection in India had been in June 2016. She was admitted to a hospital in Reno in August, and state health department officials were notified that she had CRE. "Lab results showed she was resistant to all 14 drugs we tested," says Chen. Further tests at the CDC lab showed resistance to 26 antibiotics. She died in September of multiple organ failure and sepsis. "This was my first time to see such a resistant pattern," says Chen.

CRE infections are rare in the U.S. The CDC does not require that hospitals report CRE cases but estimates that some 175 cases have been reported in the states as of January 2017. "The majority of [CRE] cases still respond to one or two classes of antibiotics," says Chen.

CRE infections are more common in India and Southeast Asia. The reasons aren't clear, but all infections spread more easily in parts of the world with inadequate sanitary facilities. Then, as people cross borders and board airplanes, the bacteria spread in the same way that brought CRE to Reno. That's why Dr. Randall Todd, director of epidemiology and public health preparedness at the Washoe County Health District, says all hospitals should double down on preventive efforts, including a travel history. "It's important that health care providers and hospitals keep in mind that our world is ever shrinking," he says. "When someone comes in, it's important to know where in the world they've been."

Then, if CRE or other resistant infections are diagnosed, the hospital can set up appropriate precautions, like isolating the patient, and immediately start lab tests to try to find an effective antibiotic.

But in this case, there was no effective antibiotic. "And we're going to see more of these, from a drip, drip, drip of cases to a steady drizzle to a rainstorm," predicts Johnson. "It's scary, but it's good to get scared if that motivates action."

The action needed is to use antibiotics wisely, in people and in animals, so strains of bacteria don't get a chance to develop resistance, says Johnson. And to continue research into development of new antibiotics. "We do have some new drugs coming along, so there's hope," he says. But as new antibiotics become available, "we have to use them selectively, not willy-nilly."

SOURCE 1.
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How You Can Stop Antibiotic Resistance (And Still Eat Bacon)

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A pig stands in a pen at an antibiotic-free pig farm in Tongxiang, China.
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Optimism. That's what we could all use right now.

So here at Goats and Soda, we're going to give you a whole heaping tablespoon of it. And we'll do it by answering a question from a reader named Ian Matthews that seems to bring the opposite reaction: "How can we stop the spread of antimicrobial resistance?"

As it turns out, the answer has a surprisingly positive message.

New drug-resistant pathogens are cropping up around the world every year. Many have adapted to resist a few drugs. Others are "superbugs," resistant to many, many drugs, including last-resort antibiotics.

Eventually, all the antibiotics we have could become ineffective, scientists say. Medicine would step back in time to the 19th century, when doctors' hands were tied, when a simple cut on your finger could be deadly. Basic medical procedures, such as C-sections, would be too dangerous to perform.

But this medical dystopia is not inevitable, says Ramanan Laxminarayan, who directs the Center for Disease Dynamics, Economics & Policy in Washington, D.C.

"This is an avoidable disaster," he says. And even reversible — maybe, to a degree, he says.

Other experts we talked to share Laxminarayan's optimism. They say individuals can take a few precautions and really help stop the spread of antibiotic resistance globally — and keep their home and communities safer, at the same time.

So what can you do?

1. Put down that strip of bacon.

In the U.S., doctors and nurses prescribe about 8 million pounds of antibiotics each year, says Lance Price, who directs the Antibiotic Resistance Action Center at George Washington University.

But farmers use more than four times that much — or 34 million pounds, Price says. That's about the weight of two Eiffel Towers.

Farmers use antibiotics to prevent disease among livestock but also because the drugs — for reasons that are still unclear — boost animals' growth.

"This is a big driving force of antibiotic resistance," he says. "The conditions in modern farms are perfect for the spread of bacteria. You've got 10,000 pigs or birds all crammed together, all defecating on each other. Introducing antibiotics is the magic ingredient for creating drug-resistant bacteria."

And to make matters worse, this wellspring of resistance is all attached to a massive distribution system — America's supermarkets.

"The meat is inevitably tainted with these bacteria," Price says. "So they end up in stores across the country."

To stop the spread of these superbugs, Price says, Americans need to stop buying meat raised with antibiotics. Period. "This is a really, really important choice to make," he says. "It's the only way to make progress in this area."

"This makes demands on retailers to stock antibiotic-free meat," he says, "which then places demands on producers to raise animals without antibiotics." Look for meat labeled as "No antibiotics," "Raised without antibiotics" or "USDA-certified organic." For organic meats, animals can't be given antibiotics, although this doesn't apply to eggs and small chicks destined to be chicken.

Raising animals without antibiotics is typically more expensive. So if your budget can't afford organic meat, then think about simply cutting out pork.

With pigs, farmers often use massive amount of antibiotics, Price says.

"It's the way they're typically raised," Price says. The animals spend almost their entire lives in confined pens. And they're given antibiotics throughout almost their entire life.

2. Have a heart-to-heart with your GP — and close friends.

We often hear that antibiotic resistance is like climate change: A few countries ruin it for everybody. Any one person's contribution is a tiny drop in the world's vast ocean of antibiotic use.

That is true, Price says. But with antibiotic resistance, you can have an impact on your local community — or even state — which can protect you and your family from superbugs.

There's even proof of this: Sweden.

Every time you use an antibiotic, you raise the risk of developing resistant bacteria on your skin or inside your body. Those pathogens can spread through households, classrooms and communities.

But Sweden has been ultravigilant about keeping antibiotic-resistant bacteria out of the country. Doctors are extremely prudent about prescribing antibiotics. The health care system constantly monitors for the presence of resistant strains. And the government banned the use of antibiotics as growth promoters on farms way back in 1986.

As a result, the country is a sanctuary for antibiotics. The drugs have preserved their potency. And doctors can prescribe antibiotics that here in the U.S. we've essentially abandoned because of built-up resistance.

"America can revitalize these amazing antibiotics, too, if we start using them more carefully," Price says adds. "But everybody needs to change. It needs to be across the board."

To make your home, town or country an antibiotic sanctuary, don't demand antibiotics from doctors. Better yet, be proactive, says James Johnson, an infectious disease doctor at the University of Minnesota.

"Tell your doctor, 'We'd like to talk about ways to avoid using antibiotics. Are there alternatives we can try or use a wait-and-see approach more often?' " he says.

"When a doctor offers antibiotics, challenge it!" Johnson adds. "Ask, 'How confident are you in the diagnosis? Are you sure it's caused by bacteria, not a virus? If it is a bacterial infection, how sure are you that this drug will work?'

Sometimes doctors need permission not to prescribe antibiotics, and they might be relieved."

Then try out a similar conversation at your kids' play groups, he says. Try something like: "We're working to keep superbugs out of our home. So we're being careful about using antibiotics and eating meat raised with antibiotics. Are you interested in doing the same?"

Bacteria easily pass around families and communities, Johnson says. Every time an antibiotic gets used, resistant strains gain an advantage and can crop up. Once they're out in the community, everyone is vulnerable.

3. Get a flu shot!

Ok, that sounds crazy. A virus causes the flu. And antibiotics don't stop viruses!

That's right, the CDDEP's Laxminarayan says. "But getting the flu is the major reason people in the U.S. get prescribed antibiotics," he says.

SOURCE 2.

Additional links:
-Antimicrobial resistance (at the WHO).
-Antibiotic/Antimocrobial resistance (at the CDC).
-Antibiotic (antimicrobial) resistance (at the Government of Canada).
-Antimicrobial resistance and antimicrobial consumption (at the European Centre for Disease Prevention and Control, which is an EU agency).
-Antimicrobial resistance (at paho.org -PAHO is the Pan American Health Organization).
-Antibiotic resistance: the last resort. Health officials are watching in horror as bacteria become resistant to powerful carbapenem antibiotics — one of the last drugs on the shelf (at nature.com).
-Resistance to antibiotics. The other global drugs problem. A neglected health problem is debated by the U.N. (from The Economist, Sept. 2016). From this article: "[O]
n current trends, drug-resistant bugs could kill as many as 10m a year by 2050".

OP: Scary.

(I put the 'capitalism…' tag because… well I'm sure you can see why from the article -see the mention on livestock.)

Source: ONTD_Political

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