
The Age of the Superbug Is Here - pmcpinto
http://www.huffingtonpost.com/entry/antibiotic-resistance-crisis-un_us_57d8ea87e4b0fbd4b7bc66c4
======
rm2889
I live in India and despite some improvements, the level of antibiotic abuse
here is shocking. They're available over the counter and people self-medicate
with antibiotics all the time. The attitude is, "if my sore throat doesn't go
away in a couple of days, its time to take antibiotics. No point in going to
the doc coz they'll prescribe antibiotics too and this way I save money."

People self-medicating on antibiotics end up taking an incomplete dose without
fully understanding the implications. This has lead to the rise of superbugs
like [https://en.wikipedia.org/wiki/New_Delhi_metallo-beta-
lactama...](https://en.wikipedia.org/wiki/New_Delhi_metallo-beta-lactamase_1)

~~~
rufius
I'd imagine it's not much different in Central and South America based on my
travels. You can walk into any pharmacy and show them the word "amoxicillin"
and they'll give you a 2 week course.

Edit: a word

~~~
DanBC
That's bad, but at least it's a two week course. Often people in India will
buy a few days because that's all they can afford.

~~~
kamaal
So this is the way it works in India. Most people who know a little english
remember the brand name of the drug.

Others just walk to the pharmacy store and narrate the symptoms to the
pharmacist. Typically: Sore throat, a little fever etc. Then they state their
budget(10-20 rupees), the pharmacist gives two tablets of Azithromycin.

------
rhodrid
It is not difficult to make microbes resistant to penicillin in the laboratory
by exposing them to concentrations not sufficient to kill them, and the same
thing has occasionally happened in the body.

\- ALEXANDER FLEMING, Nobel Lecture, December 11, 1945

~~~
ddlatham
Sounds a lot like live virus vaccines introduced to humans. Weak enough not to
kill us and then we develop resistance.

Improper dosage of antibiotics is like 'vaccinating' the microbes.

~~~
mattnewton
Similar, yes. It works through good old natural selection of generations, just
on a faster scale. I enjoyed this visualizable antibiotic resistance
happening. [http://www.cnn.com/2016/09/08/health/giant-petri-dish-
antibi...](http://www.cnn.com/2016/09/08/health/giant-petri-dish-antibiotic-
resistance/index.html)

------
lossolo
This is an amazing video[1] from Harvard Medical School released couple of
days ago showing evolution of bacteria that evolve in 10 days to become
resistant to antibiotics.

[1] [https://youtu.be/plVk4NVIUh8](https://youtu.be/plVk4NVIUh8)

~~~
biesnecker
Amazing video.

Question that comes to mind is how easy would it be to take the bacteria that
make it to the center, and put them on a new plate with a different antibiotic
in the same configuration, and then repeat until you've gone through all
available antibiotics, then scoop that last batch up and do something really
nasty with it?

It must be harder than it seems, because otherwise why do terrorists and the
like even bother with (seemingly much harder to obtain, though admittedly
flashier) chemical and nuclear weapons?

~~~
grhino
Bioweapons are hard to deploy in a targeted fashion. Also, development of an
antibiotic resistant bacteria that would be truly dangerous to a population
requires great care during development not to kill those doing the development
themselves. Also, I think we tend to overestimate the resources available to
terrorists.

~~~
0xdeadbeefbabe
> to kill those doing the development themselves

Maybe that's considered a noble sacrifice, but I don't know what they think.

------
darawk
I spoke to an MD/biochemist friend of mine about this issue recently, and was
told that this really isn't that big a deal. Specifically that antibiotic
resistance is usually a self-limiting trait, so bacteria that evolve that
capability will quickly lose it when no longer in a hostile environment. So
these 'superbugs' can be an issue in particular settings, like hospitals, but
are unlikely to ever produce major global catastrophes, or spread much beyond
those limited environments.

Can anyone else with more knowledge of this confirm/refute this perspective?

EDIT: I should point out he wasn't saying it was a total non-issue. Just that
some of the fear-mongering about global pandemics and such was completely
unfounded.

~~~
floatrock
Not from a medical background, but I spent some time writing hospital
infection surveillance software so can share a few anecdotes.

What he's saying isn't inaccurate. The idea is antibiotic resistance generally
carries some metabolic cost -- the bacteria disable or find some other way
around whatever pathway is being targeted by the antibiotic. This means they
operate "less efficiently" than their non-resistant peers. When the antibiotic
disappears from the environment, the resistance no longer offers an advantage,
so they get out-competed by their non-resistant "more-efficient" peers.

This is in fact one of the ways hospitals fight outbreaks of resistant
bacteria -- they cycle antibiotics. More subtleties of course, but basically
the head infection surveillance person says "alright docs, this month we're
blacklisting these antibiotics, next month we're blacklisting these." (This is
one of the interventions our infection software helped with.)

On the other hand, there are places where the widespread use of antibiotics
extends far beyond the reaches of a hospital building. Commercial agriculture
is infamous for overusing antibiotics (basically mixing them into the lot's
feedstock so every cow gets it). Outbreaks like SARS and avian flu weren't
antibiotic-resistance outbreaks, but they WERE caused by sizable quantities of
people working in close proximity with livestock and then spreading the
disease through their normal travel and social interaction vectors.

India is known for having antibiotics widely available over-the-counter for
people. There are stories of people coming back from India with an infection
resistant to literally everything (there's only about 50 antibiotics out
there) -- when that happens, it's like the outbreak movies where the CDC comes
in with plastic sheets and wearing bunny suits to quarantine the room.

So will the lower-metabolic-efficiency attribute of antibiotic resistance be
self-limiting enough to prevent it from turning into another 1918 spanish flu
global pandemic? Maybe. But as long as there are large city-scale pockets of
heavy antibiotic over-use with people traveling in-and-out, there are going to
be constant transmission vectors that will still kill people in largely
preventable ways.

~~~
Herodotus38
I am in the medical field and can relate an anecdote, I'm sure which happens
regularly across the US.

Patient visiting from India comes in with sepsis from urinary tract infection,
and she has a history of multiple ones. ER doctor calls me to admit her. I
come down and review her paper chart that the family brought with her and see
where her last E coli UTI was resistant to everything except meropenem, and
possibly gentamicin although I don't recall.

Until I had looked over this, the patient wasn't in any contact precautions
(meaning disposable gloves or gowns for staff) and the ER doctor had given her
the usual treatment for a UTI which in her case was going to do nothing.

------
DonaldFisk
The article mentions phage therapy in passing, and links to this Nature
article: [http://www.nature.com/news/phage-therapy-gets-
revitalized-1....](http://www.nature.com/news/phage-therapy-gets-
revitalized-1.15348)

The Nature article hints that the main barrier to adoption is that it's
difficult to for pharmaceutical companies to make a profit out of phage
therapy: the cure is entirely natural, bacteriophage are the most common
organisms on the planet, they reproduce very quickly, and evolve to overcome
bacterial resistance.

~~~
DiffEq
You used the word "evolve" \- I don't think this means what you think it
means. Evolving means that positive mutations are occurring that assist these
organisms; what is really happening is Natural Selection; where already
present genetic capabilities are being favored and those populations are thus
surviving.

~~~
DonaldFisk
Mutations occur in bacteriophage. Those mutant bacteriophage which can attack
previously resistant bacteria are then selected for and become more prevalent.

~~~
DiffEq
Your assertion has never been observed with any certainty that could withstand
normal scientific inquiry; not even this experiment gives such certainty:
[https://en.wikipedia.org/wiki/E._coli_long-
term_evolution_ex...](https://en.wikipedia.org/wiki/E._coli_long-
term_evolution_experiment)

~~~
barrkel
The parent is talking about a virus; the wikipedia article talks about a
bacterium. Can you explain further what it is refuting and how?

~~~
DiffEq
The article focus, and my focus, is a about how or if there is actual
evolution occurring within DNA. It is separate and apart from the organism in
question. My point is that almost everybody these days mixes up evolution and
natural selection when they are two very distinct things.

~~~
aidenn0
All forms of selection that differ from the current equilibrium cause
evolution in a group that is either sufficiently diverse group (assuming HGT
or sexual reproduction) or has a sufficiently high mutation rate.

------
arethuza
We got a scare a couple of years back when our teenage son got an eye
infection - the doctors and eye hospital went through five different
antibiotics before finally finding something that fixed it, which was quite
stressful.

NB When you are warned not to wear contact lenses in swimming pools - take it
seriously! We're almost certain that's how he got the problem.

~~~
nkozyra
I've been wearing contacts most of my life and have never heard said warning.
Given pools are typically fairly sterile, I'm not sure if understand it.

Now freshwater lakes or oceans under certain conditions I could understand

~~~
foldr
It seems like a lot of these warnings relate to reusable lenses. I use daily
disposables, and I really can't see how, say, getting tap water on them when
I'm wearing them can be any more dangerous than splashing tap water in my eye.

~~~
J-dawg
I don't think that's true at all. I think the issue with contacts (even
dailies) is that they can trap pathogens on the surface of the eye and give
them a place to breed, allowing an infection to take hold. This could happen
within a day while you have your lenses on.

I think dailies are somewhat safer, because you're starting each day with a
sterile pair. But splashing any non-sterile water onto them is a mistake.

~~~
DanBC
I think that one source of infection is dirty storage pots. That's what NHS
Choices says, and they tend to be evidence based (although we can argue about
the evidence they use).

[http://www.nhs.uk/Livewell/Eyehealth/Pages/Contactlenssafety...](http://www.nhs.uk/Livewell/Eyehealth/Pages/Contactlenssafety.aspx)

~~~
J-dawg
That seems plausible. But I was once told that ideally you shouldn't even take
a shower in contacts (Not that I always followed that advice). Maybe I just
had an over-cautious optometrist.

~~~
foldr
It's definitely the standard advice, I just wonder how much evidence there is
to support it. I guess it does make sense that the lens might make it easier
for the bacteria to breed.

------
ocschwar
As per prior stories, let's all take a knee in thanks to our political system
for trying literally to criminalize research into emerging superbugs:

[https://news.ycombinator.com/item?id=12444664](https://news.ycombinator.com/item?id=12444664)

------
livestockboy
easy solution is to just heavily tax dairy, livestock and other industries
that produce hundreds of billions of bacteria testing grounds (animals) per
year at the same time using last-resport antibiotics to spur growth and reap
profits.

or give extreme tax benefits to those that don't use antibiotics.

~~~
zdkl
You think paying more for your food will make bacteria stop reacting to
selective pressure? Or do you think we can stop relying on 'organic' food?(in
the biochemical sense, not the hippie meaning)

Either way I've got some bad news for you

~~~
arethuza
If the choice is cheap meat or antibiotics (and yes I know it's not quite that
simple) then I'll take antibiotics.

~~~
forgetsusername
> _If the choice is cheap meat or antibiotics_

Easy to say when you're wealthy, no so much when you consider yourself healthy
but poor.

~~~
sten
Meat is a luxury.

~~~
sageabilly
Yup. I am an avid meat eater, love BBQ, all of the food I cook has meat in it-
but I am absolutely aware that it is a luxury. I do my absolute best to buy
higher quality meat as close to pasture raised as I can get... but I don't
make that final leap to source out local farmers and buy directly from them to
ensure that I know exactly how the meat I'm eating is raised.

But at the end of the day, not everyone can afford organic pasture raised eggs
at $7/dozen. And the problem is that we've all gotten so used to eggs at
$0.50/dozen or chicken at $1/pound that I don't think society as a whole could
deal with the cost of meat equalizing to reflect the true cost of non-factory
farmed production.

~~~
hx87
> I don't think society as a whole could deal with the cost of meat

We certainly could if we had to, but so far we haven't had to.

------
YeGoblynQueenne
Oh, the UN is on this? Right, we're screwed.

Seriously though, we can forget about getting 7 billion people to use
antibiotics safely. Really- forget about it. Not even education helps- after
all it's doctors and pharmacists who are primarily responsible for this mess
we're in [1].

Our only chance is to find some other way to deal with bacteria -perhaps that
phage therapy thing- otherwise we may as well just accept that X million
people will die every year because of bacterial infections. Not to mention, of
all the conditions that might be safe to treat given antibiotics, but not
without them (you know, open heart surgery, brain surgery, that sort of
thing).

[1] Here's a childhood memory: my family doctor telling me I have a viral
infection ... and prescribing antibiotics. Almost every year until I was 18
and stopped taking the damn things on my own, for entirely irrelevant reasons
(I thought they were making me worse) (I got better).

------
uptown
The antidote to overprescription of antibiotics is to be able to get accurate
test results to determine what to treat rather than throwing antibiotics at
every problem. This company is working on products which dramatically decrease
testing times to the degree that you can have actionable information before
prescribing antibiotics:

Among some of the advancements:

* Group B Strep results under one hour (traditionally 48-72 hours)

* Salmonella results in 30 minutes (traditionally 24 hours)

* Listeria results in 5 hours (traditionally 18 - 24 hours)

[http://nanologix.com/test_results.html](http://nanologix.com/test_results.html)

------
tombert
There's a pretty good Frontline about this...I didn't see this fact listed in
the article, but another huge problem is that it's generally not profitable
for big medicine corporations to research new antibiotics, which means that
for the time-being, we're stuck with our current regime.

~~~
pdabbadabba
I find this implausible. Surely pharmaceutical companies are as aware as
anyone of the growing antibiotic-resistance problem and know that there will
likely be a return on their investments in new antibiotic research. Sure,
these companies sometimes exhibit a bias towards short-term gains, but they
also aren't run by morons. And if they _are_ run by morons, I see some great
start-up opportunities...

~~~
radus
The reason they are not profitable is because generally antibiotics are only
taken for short time periods. Additionally, it is almost certain that new
antibiotics will be obsoleted by the emergence of resistance. Spending
hundreds of millions of dollars on bringing a drug to market is already a
risky proposition, even more so when your drug will be consumed in low
quantities and may be useless before the patent even expires.

------
naz
Very naive question: won't bacteria lose their resistance after a while? What
if we cycle certain antibiotics on an annual basis? When we reintroduce them,
they'll be more powerful. Right?

~~~
simonbarker87
I was chatting to doctor friend recently who has a masters in this area and he
said that in theory yes but it would likely require the bacteria to have a
reason to loose the mutation that caused the resistance in the first place so
there is no guarantee.

~~~
crimsonalucard
Your doctor friend is incorrect. Unused traits will be lost eventually through
the accumulation of random mutations. In order for a trait to form and be
stable in an organism, selection pressure must not just be applied... it must
be maintained.

This backwards process is actually observable. Many fish living in underground
caves have lost their eyes through evolution. While eyes don't aid a fish in
surviving in the dark, they certainly don't hinder the fish from surviving
either... Yet cave fish have lost their eyes despite the lack of negative
selection pressure.

~~~
cariaso
> Many fish living in underground caves have lost their eyes through
> evolution.

some have, yes. but in order to get the antibiotic benefit we're looking for,
you'd need to have ALL fish having lost their eyes. That's a much higher bar.
(
[https://en.wikipedia.org/wiki/Blind_fish](https://en.wikipedia.org/wiki/Blind_fish)
seems to be a reasonably comprhensive list ). We also need the antibiotics to
be viable again in a reasonable timespan ( a decade or two?), in order to be
useful -- not on the timescale that was involved in cavefish eye degeneration.

~~~
crimsonalucard
Bacteria mutate much quicker than fish. Generations of bacteria form within
minutes. There is significant possibility in the viability of cycling
antibiotics as bacteria lose resistance.

------
merraksh
Related: has videos with bacteria gradually developing resistance to
increasing concentrations of antibiotic.

[http://www.vox.com/2016/9/8/12852924/evolution-bacteria-
time...](http://www.vox.com/2016/9/8/12852924/evolution-bacteria-timelapse-
video-mega-harvard)

------
Nano2rad
Antibiotics are used as growth factor in chicken. Many are growthfactors in
humans also. There could be some way to fight antibiotic resistance
considering this fact.

------
partycoder
Hospitals give a wide range of antibiotics to people once they're admitted.
Since after admitting someone they're legally responsible for their health.

------
mataug
Everytime we consider something to be a silver bullet we end up in a mess such
as this. We are truly victims of our own success.

~~~
roywiggins
Worst case scenario we end up with no working antibiotics. This is no worse
than the pre-penicillin era. We haven't hurt ourselves by developing
antibiotics.

------
lr4444lr
It gives one pause to reconsider the social movement to get more people into
dense "smart" cities.

~~~
jcfrei
"Superbugs" are most prevalent in hospitals.

------
spiegeldom
It's all a lie. Yesterday Mark Zuckerberg told all deceases will be cured till
2100.

~~~
middlef
ssh - if you don't buy the HN optimistic tech-will-cure-all BS they will
downvote you (shaking with terror).

