
Person carrying bacteria resistant to antibiotics of last resort found in U.S. - dak1
https://www.washingtonpost.com/news/to-your-health/wp/2016/05/26/the-superbug-that-doctors-have-been-dreading-just-reached-the-u-s/
======
tjohns
Relevant story: As a kid, one of my friends would frequently get strep throat.
So his mom would give him amoxicillin until he appeared better... and then
save the rest of the bottle for the next time he'd (invariably) get strep
throat.

And that's how antibiotic resistance happens.

~~~
superuser2
Erm. Strep throat is pretty severe, and also actually a bacterial infection.
That's not a great example of antibiotic overuse.

Better example is doctors writing prescriptions for common cold infections
that are viral anyway so they can appease patients by "doing something."

~~~
hanklazard
Primary care doc here. I agree that strep is "severe" as in "makes you
uncomfortable with a fever, sore throat, enlarged tonsils, etc" but the
infection generally resolves without antibiotics, if given proper time. The
main rationale for treating strep pharyngitis (aside from appeasing patients)
is prevention of rheumatic fever, a rare but devastating heart condition that
occurs as a sequelae of untreated strep throat. Given the rareness of RF in
the developed world, there are those in the infectious disease and primary
care communities who think it is an excellent example of antibiotic overuse.

~~~
danjayh
I had untreated strep when I was a kid, because the strep screen came back
negative. Turns out it was group C, which didn't show up on the strep screen,
but also didn't resolve itself. Some months later it got much worse. Somebody
finally did a culture, figured it out, and gave me antibiotics (which cleared
it up). Fast forward to age 29, when I had to have open heart surgery to get a
mechanical mitral valve, for which I have to be on warfarin for the rest of my
life (which comes packaged with increased risk of stroke and hemorrhage for
the rest of my life) along with a beta blocker ('bystolic', aka nebivolol)
because something happened to mess up my heart rate regulation during the
surgery. I'd call strep pretty serious.

~~~
hanklazard
I'm very sorry to hear about your medical situation. I agree that RF and RHD
are very serious ... my comment was only to say that treatment of a
(frequently) self-resolving condition with 10 days of strong antibiotics has
been an ongoing topic of debate due to the likely contribution to antibiotic
resistance among other concerns. Here's a representative editorial from a few
years ago:

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949249/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949249/)

Your condition is the reason that I find myself prescribing courses of amox
even when chances of chronic strep colonization are much more likely than true
acute infection. It's a real diagnostic quandary.

------
af16090
The cover story for this past week's Economist was about antibiotic
resistance: [http://www.economist.com/news/briefing/21699115-evolution-
pa...](http://www.economist.com/news/briefing/21699115-evolution-pathogens-
making-many-medical-problems-worse-time-take-drug-resistance)

And from that story, it talked about Colistin (the drug this patient's E. coli
is resistant to): "Some of the antibiotics farmers use are those that doctors
hold in reserve for the most difficult cases. Colistin is not much used in
people because it can damage their kidneys, but it is a vital last line of
defence against Acinetobacter, Pseudomonas aeruginosa, Klebsiella and
Enterobacter, two of which are specifically mentioned on the CDC watch list.
Last year bacteria with plasmids bearing colistin-resistant genes were
discovered, to general horror, in hospital patients in China. Agricultural use
of colistin is thought to be the culprit."

Considering the same article says that "In America 70% of [antibiotics] sold
end up in beasts and fowl" it seems that an easy thing to do would be to stop
giving antibiotics to animals

~~~
LeifCarrotson
It would be easy, if the agricultural industry was concerned about antibiotic
resistance. Unfortunately, like most markets, externalities like that are hard
to price in. If Farmer Bob takes the high road and stops using so many
antibiotics, he'll lose some stock and get outcompeted by Farmer Bill. If the
turkey farmers band together heroically and agree to reduce their use of
antibiotics, uninformed consumers will choose chicken instead. And there's not
enough governmental desire for them to regulate it - and local government
would be outcompeted by imported goods that use antibiotics.

~~~
Filligree
Well, that sounds like an excellent case for tariffs.

~~~
brianpgordon
It sounds like an excellent case for legislation to outright ban the use of
human-safe antibiotics on animals.

Working antibiotics are among humanity's most precious and most limited
natural resources. In a century they'll be gone, with devastating impact on
routine medical care. We're living in the one glorious sliver of humanity's
history that we have access to antibiotics, and we're squandering them to make
meat a few cents/pound cheaper. It's criminally irresponsible toward future
generations.

~~~
aminorex
But meat is flourishing. Antibiotics are meat's way of making more meat. Call
it the "selfish meat" theory.

------
ChrisArgyle
TL;DR

Modern medicine is over! Get to the zombie apocalypse shelter!

Not really though; everything scary in this article is either wrong,
exaggerated or both. Ars Technica explains it expertly:

[http://arstechnica.com/science/2016/05/everybody-be-cool-
a-n...](http://arstechnica.com/science/2016/05/everybody-be-cool-a-nightmare-
superbug-has-not-heralded-the-apocalypse-yet/)

~~~
JSoet
Yes, but although the arstechnica article points out a lot of problems with
the original article's claims about this specific bacteria and points out the
fear mongering about this specific case, even the ars article admits that the
overlying problem of antibiotic resistance is still a bigger issue: "For now,
the case serves mostly to highlight the ongoing crisis of rising antibiotic
resistance and furthers the need for better stewardship of old antibiotics and
development of new ones."

~~~
chris_va
Agreed, but the level of research in novel antibiotics is really quite
limited, mostly due to a lack of return on investment.

This actually means there is almost certainly a lot of unexplored potential,
but getting drug makers interested is quite difficult (though in the last 5
years the field has been 10x more popular).

Most antibiotics on the market are just penicillin variants (well, β-lactam
variants), mostly because that was one of the first things to blow onto a
petri dish, was non-toxic, easy to manufacture, small molecular weight, and it
happened to work quite broadly. Most bacteria share β-lactamase encoding
plasmids with each other, so resistance is conferred within years (I think the
original penicillin made it 4 years). Honestly we have done very little
outside of this space.

β-lactamase inhibitors (basically blocking the method of resistance with a
separate drug) have a lot of potential, as do many other combination therapy
techniques. There are also many other non-β-lactam templates we could play
around with.

With modern sequencing, you can actually identify the exact resistance
mechanism of each strain you encounter. If we move to rapid diagnostic
sequencing, we can tailor the treatment to avoid any existing resistance for
the specific infection.

------
adrusi
Look, this is scary and a big problem, but can we please stop talking about
the "end of the road" for antibiotics?

The worry here isn't that antibiotics will suddenly become useless and
whenever anyone gets a bacterial infection they'll have no hope. The worry is
that there will be a number of prevalent bacterial illnesses which can't be
treated with antibiotics.

Currently antibiotics work for an overwhelming majority of bacterial
illnesses, that's not going to change overnight. What will change is the idea
that bacterial illnesses are trifles because they can be cured every time by
antibiotics. A few diseases will emerge, more and more over time, that have
much worse consequences than we are used to thinking about right now, but the
rest will be the same.

I don't mean to underplay the threat, but if we keep pushing this rhetoric,
people will discredit the threat when it turns out that 50 years later we're
still using antibiotics for most illnesses that people actually get (because
antibiotic-resistant strains are effectively quarantined). People will compare
it with the "we're going to run out of oil" scare.

~~~
gerbilly
We shouldn't forget that antibiotic resistant bacteria become that way by
giving up a metabolic pathway. Calling them 'superbugs' is actually
misleading, because the resistant bacteria are usually less efficient.

If you remove the exposure to the antibiotic, they will revert back to the
wild strain pretty quickly.

If we just stopped using antibiotics in agriculture, especially to promote
growth, this could actually be possible.

~~~
infinite8s
The scary situation will be when they evolve resistance without a reduction in
fitness.

~~~
gcr
How often does that happen?

------
slg
The article doesn't touch on it, but the obvious followup question from the
laymen is why can't we develop new antibiotics? I was curious and according to
Wikipedia we haven't developed a new class of antibiotics in 30+ years. Can
someone with knowledge on the subject explain why we seemingly can't
discover/develop new forms of antibiotics to combat these resistant bugs?

~~~
FooBarWidget
From what I have read, the problem is that antibiotic development is not
profitable. If a new antibiotic gets developed then it will be out on the
shelf as a last-resort antibiotic, preventing the developing company from
extracting a lot of revenue. And it is more profitable to develop drugs for
chronic diseases. So pharmaceutic companies don't bother with antibiotics.

~~~
gooserock
...displaying a great example of why the free market is not the best way to
handle healthcare and medical research. The availability of treatment has
everything to do with profit, and little to do with need.

~~~
mobilefriendly
Given the heavy involvement of the state in funding and directing care and
research, I don't think anyone would describe healthcare and medical research
as a free market.

~~~
TallGuyShort
Yeah but that's more because of lobbying and politics than logical, economic
approaches to problems. It's not like when I go to the doctor everyone's
incentives are aligned. The insurance company is still actively working
against me, just now it's really complicated how they do it due to regulation
so only they can play the game and I just have to take their decision until
it's worth getting lawyers involved.

------
c3534l
> Health officials said the case in Pennsylvania, by itself, is not cause for
> panic. The strain found in the woman is treatable with some other
> antibiotics.

Thanks for completely ignoring that advice with a headline and three
paragraphs of misleading information designed specifically to cause panic.

------
searine
The are three solutions needed here :

1\. Stricter regulation of antibiotics, particularly in farming.

2\. Better government funding of antibiotic discovery.

3\. Stricter regulation of antibiotic use. No solo-drugs, all antibiotics used
in stacks of 3 or more. Better monitoring of complete antibiotic use cycles.

Biologic resistance can be managed, HIV is more than enough evidence of it
working. We have to get serious about it, the age of reckless antibiotic use
needs to end, now.

~~~
semi-extrinsic
I'm going to go out on a limb here, and say antibiotics overuse in third world
countries is a big part of the problem, and the hardest one to fix.

This is purely from anecdotes, but I've heard from several friends who were
exchange students from Pakistan/China/India that we have such a ridiculous
system here, that back home they can just buy random antibiotics from the
pharmacy whenever they catch a cold.

~~~
hanklazard
That's definitely been my experience. A few years ago, I went to a pharmacy in
Thailand with what was clearly a common cold. Instead of handing me the
Sudafed I wanted, the pharmacist recommended I take a weeks supply of low-dose
amoxicillin. Not only would this do absolutely nothing for my viral cold, it
would have increased the risk of creating amox-resistant bacteria in body.
Truly concerning to imagine how often this scenario repeats itself every day
all over the world ...

~~~
Cerium
Exactly, I was in China and had a fairly bad sore throat. I didn't really
think it was bacterial, and it ended up being just a cold. I went to a doctor
(roll up door in a street). He shined a light in my mouth and decided that I
should take vitamin C and some antibiotics. I paid about 2 USD for the whole
experience, pills included.

------
tokenadult
Another Hacker News user submitted a better story yesterday

[http://arstechnica.com/science/2016/05/everybody-be-cool-
a-n...](http://arstechnica.com/science/2016/05/everybody-be-cool-a-nightmare-
superbug-has-not-heralded-the-apocalypse-yet/)

but I see that this story with the alarmist headline got more traction on the
main page of HN. That's unfortunate for understanding the underlying issues.

~~~
umanwizard
Please submit this.

------
jrk
"Colistin is widely used in Chinese livestock" oh for fuck's sake…

------
rdtsc
Wonder if we'll see a resurgence of phage therapy due to this.

Phage therapy is using viruses which will infect and attack the bacteria.
Viruses can mutate and adapt just as well as bacteria (while say antibiotics
are static in a way). So they can keep up with the mutations.

It is a pretty crazy but also ingenious approach.

[https://en.wikipedia.org/wiki/Phage_therapy](https://en.wikipedia.org/wiki/Phage_therapy)

~~~
bhickey
Phage therapy is super interesting, but there are a lot of technical problems.
If I ever leave software engineering, it'll be to go back to mucking around
with phage.

Immune clearance: The immune system really enjoys soaking up phage. Blood
titers drop stupidly fast. Maybe we could flood the colon with a phage-bearing
solution to handle GI infections, but in general I'm really skeptical. There
was a paper ~8 years ago describing serial passages in rabbits to enrich for
immunocompatible phage. Don't know if further work has been done here.

Specificity: Phage really, really like their hosts. I had a strain of Phi X174
in lab that would simply never infect wild type E coli. To deploy phage
effectively, you need to culture whatever it is that you're after. Next you'd
want to infect the pathogen in culture and pass your phage for O(many)
generations. A lot of human pathogens are just miserable to grow.

Efficacy: Antibiotics are just better at killing bacteria (resistance aside.)

Regulatory: You'd need to convince the FDA to approve a viral cocktail that is
potentially going to kill the patient through anaphylaxis.

~~~
Fomite
Indeed, the name of one of the major hospital-acquired human pathogens,
Clostridium difficile, literally means "Clostridium pain in my ass to
culture".

~~~
bhickey
I once tried to grow magnetotactic bacteria. For the growth media, you had to
prepare a witch's brew of unusual chemicals which sent me on a goose hunt
around a few friendly chem labs. The protocol called for making a couple of
litres; smaller quantities would just exacerbate measurement errors. After
cooking it up, you were supposed to add 2mL to the growth media and incubate
the whole mess for four weeks.

Needless to say, I could never get them to grow.

Edit: I found the protocol!

NTA 1.5g

MgSO4 3.0g

MnSO4 0.5g

NaCl 1.5g

FeSO4 0.1g

CaCl2 0.1g

CoSO4 0.1g

ZnSO4 0.1g

CuSO4 0.025g

AlK(SO4)2 0.01g

H3BO3 0.01g

Na2MoO4 0.4g

NiCl2 0.01g

Phew. Did I mention: it was an anaerobe? Flushing an exotic growth media with
nitrogen is a dull way to spend a Friday afternoon.

------
Zelmor
This is what happens when you raise livestock on antibiotics as the de facto
standard. You are what you eat.

------
ifdefdebug
Two lines in the article:

> Colistin is the antibiotic of last resort for particularly dangerous types
> of superbugs

and further down:

> Colistin is widely used in Chinese livestock ...

This is absurd. Preventive use of antibiotics on livestock works just like a
giant training camp for hostile bacteria, and horizontal gene transfer will
spread the necessarily created resistances to human microbes rendering them
useless sooner or later.

------
rtpg
I don't get the deal here.

>Health officials said the case in Pennsylvania, by itself, is not cause for
panic. The strain found in the woman is treatable with some other antibiotics.

So the last resort doesn't work, but other stuff works. It's totally
reasonable to assume that if bacteria becomes resistant to more common
antibiotics, that some other kind of antibiotic could do the trick.

Though I guess it would be nicer to have some sort of "proof" that the
bacteria _does_ get weaker to stuff it's less exposed to.

Actually, side note but wouldn't mass feeding of antibiotics for certain kinds
of bacteria let us completely wipe it out, a la smallpox?

~~~
URSpider94
In a word, no. Here's why:

\-- Viruses can't reproduce outside their host. They have a limited lifetime
in the environment before they degrade. \-- Immunity lasts a long time, even a
lifetime. \-- So, if you successfully immunize everyone in the population
against a virus (like smallpox), and keep doing it for a few years, then
eventually that virus will die out

This is not true for bacteria. Many bacteria can live in the wild, and in fact
only opportunistically infect humans. Also, antibiotics are only effective
while you are taking them, and many of them have negative consequences if
taken for long times in therapeutic doses (stomach upset, light sensitivity,
yeast infections, just to name a few). Next, 60% to 90% of a dose of
penicillin is excreted into the urine fully intact, so our sewers, which are
teeming with bacteria, would also be flooded with sub-therapeutic doses of
antibiotics. Finally, bacteria can exchange DNA with each other, even inter-
species, so if we train the sewer germs to survive an antibiotic dose, then
they can transfer that capability to other more virulent bacteria that can
infect humans. This is, in fact, probably the mechanism for formation of some
of these multi-drug resistant strains.

------
Practicality
It might be time to start editing our (DNA) code to fight the bacteria. It
seems like the only thing that will be fast enough to keep up with the
mutations.

~~~
Quanticles
Or make little robots to fight the bacteria

~~~
mstromb
Our bodies already make little robots to fight bacteria

------
rdl
I wonder if you could create a new antibiotic and restrict it to supervised
inpatient use only, to preserve efficacy for as long as possible.

------
tedd4u
There is an interesting RadioLab episode that covers antibiotic resistance and
an unlikely source of new antibiotics.

Staph Retreat - Nov 2015 [http://www.radiolab.org/story/best-
medicine/](http://www.radiolab.org/story/best-medicine/)

Or load it up in your favorite mobile podcast app.

------
jwatte
If we can't kill these infections after they happen: Can we develop vaccines
against them to prevent occurrence?

~~~
gph
There are pneumonia vaccines[1], but they mostly cover the main bacterial
strains that cause it. A lot of diseases like pneumonia can be caused by
multiple strains of bacteria. It's hard to vaccinate against all of them.

[1][http://www.cdc.gov/vaccines/vpd-
vac/pneumo/default.htm](http://www.cdc.gov/vaccines/vpd-
vac/pneumo/default.htm)

~~~
jwatte
Hard, yes. Harder than curing resistant infections?

~~~
Fomite
Potentially, yes. There are many, many microbes who have antigenic profiles
that make them very poor candidates for vaccines.

------
dctoedt
Time for Congress to authorize a very big monetary prize for the company that
comes up with a better solution, with that solution then being licensed for
free to all U.S. manufacturers (or something like that to make it politically
acceptable to the xenophobic elements in the GOP).

~~~
coryrc
There already is a free and better solution:
[https://en.wikipedia.org/wiki/Phage_therapy](https://en.wikipedia.org/wiki/Phage_therapy)

Sorry for the redundant comments, but it's important for people to hear this.
More people die from MRSA than AIDS in the US, and the FDA is structurally
against adaptive therapies.

~~~
Fomite
As much as I love phage therapy, there are some very real problems with it.

And characterizing it as "free" is...flawed, at best.

~~~
coryrc
The parent comment mentioned "licensing", so I used free as in libre, not
beer.

~~~
Fomite
Even then, generalized, FDA-approved "Phage Kits" that don't require bespoke
lab solutions for each and every patient likely won't be free as in libre.

~~~
coryrc
Requiring there not be bespoke lab solutions for any patient is the problem --
it's why people are suffering and dying from MRSA now in the USA, but some can
travel to poor areas of the former USSR and get cured. We can already take
bacterial cultures and breed them in an automated fashion, breeding effective
bacteriophages is the next step. We need to be funding R&D into doing this
safely and in an automated way. It's already possible to do with 1930s
technology so we should only be able to do better now.

~~~
Fomite
It's a scientific and medical requirement, not a regulatory one. Using that on
a mass scale, rather than for occasional one-off treatments for particularly
unresponsive infections, is going to require kits, or a massive investment in
laboratory capacity in the U.S.

This is the field I work in. Phage therapy is awesome, and actively being
explored, but there is a reason antibiotics won out. Phages are anything but
easy and general-purpose.

~~~
tim333
Wikipedia has "In the West, no therapies are currently authorized for use on
humans, although phages for killing food poisoning bacteria (Listeria) are now
in use"

which sounds like a regulatory issue. And a bit of an unnecessary one it seems
as the treatments seem harmless to humans.

~~~
Fomite
It's a regulatory issue, but it's also a clinical one. Even if it gets
approved, it will still need a general purpose kit-based form, and that's a
massive clinical and scientific hurdle.

Also, phage therapy killed people in the past. Mostly due to poor
purification, but it's not inherently harmless.

~~~
aminorex
So has orange juice.

------
leot
Relevant: [http://www.foodsafetynews.com/2015/02/study-e-coli-
vaccines-...](http://www.foodsafetynews.com/2015/02/study-e-coli-vaccines-are-
effective-but-economic-incentive-needed/)

------
GigabyteCoin
I wonder if antibiotic resistance will be the reason that people move out of
the cities back to rural areas.

You can't get sick if you're not near anyone else.

~~~
gonzo41
More likely that we'll start seeing bleach and ozone being used in hospitals
to clean again. Probably radiation too.

I know that bleach is used, but hospitals used to smell of the stuff.

Amputations are going to make a comeback big time.

Its going to be interesting if you can't go into surgury for fear of getting
post op infection.

This will be interesting to watch.

~~~
nwmcsween
Hospitals generally don't use bleach as a multipurpose
germicide/virucide/fungicide as it is really bad at doing that, they use an
specialty chemical solution that can kill things that bleach won't.

~~~
Fomite
They use a great deal of bleach (Chlorox frequently has a booth at conferences
I go to) along with other specialized cleaners, ozone foggers, UV radiation
robots...

------
PythonicAlpha
And still, the (mis-)use of antibiotics in meat production carries on (at
least in Europe) -- even using last-resort antibiotics.

------
ams6110
Meta: something about washingtonpost.com locks my browser every time.

~~~
MrTolkinghorn
Open the link in incognito mode, should bypass their monthly article limit.

~~~
readams
firefox self-destructing cookies extension. Greatest thing since adblock.

