

Deadly 'superbugs' invade U.S. health care facilities - kirillzubovsky
http://www.usatoday.com/story/news/nation/2012/11/29/bacteria-deadly-hospital-infection/1727667

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JunkDNA
I studied antibiotic resistance when I worked in pharma. It's a fiendishly
difficult problem. You have a mix of factors that all conspire to a bad
outcome. First, you have natural selection, so any antibiotic safe for human
consumption is likely to eventually result in drug resistant bacteria. Secon,
you have social practices. In the US you have patients who brow beat their
doctors into giving them antibiotics when they don't need them. In other parts
of the world, you can buy antibiotics over the counter! This is hugely
problematic since the genes for resistance spread globally when they get a
foothold (you can actually watch this over time with DNA sequencing and
careful collection of samples). Finally, on the economic side, most regulators
like the FDA will force any new antibiotic to be held back on the shelf and
used only as a "drug of last resort". This reduces incentives to develop new
antibiotics since the drug patent will expire before you can sell enough to
make back the R&D cost. Much better to throw resources at cancer since your
drug might end up as a front line therapy there, than to waste time on
antibiotics (so the bean counter thinking goes).

I honestly don't know what the answer is. Most likely, there will need to be
some new tech the bugs have a hard time beating. Outside the body we still
have plenty of things that kill bacteria which they can't get around (bleach
comes to mind). The likely outcome is some kind of new delivery mechanism that
is fast, complete, and highly effective.

~~~
seats
I wonder if it would be possible to use natural selection and human behavior
to our advantage?

imagine a compound that causes bacteria to adapt in a way that makes us easier
to control them. like putting fluoride in our water we'd distribute the Trojan
biological 'malware' into the wild and make bacteria more susceptible to very
specific types of treatments.

~~~
JunkDNA
This is a clever idea, but likely to end badly in practice given the way
genetics works. Any neutral trait that doesn't confer increased survivability
will be filtered out rapidly and never spread. So you would need to design
something that gives the bacteria carrying the trait a slight survival
advantage, but at the same time has a hidden "back door" we can exploit.

Furthermore, the back door has to be intimately tied to increased survival and
not just along for the ride. Otherwise, the bacteria will snip the back door
part out and keep the part that gives them increased survival. Now you have
genetically engineered super-bugs. Oops. Even assuming that you have perfectly
designed this new trait to meet the needs of having a back door and increased
survivability that are inseparable, you still fail. Eventually, the bacteria
all drop your fancy new trait and revert to being plain old bacterium because
_that_ state is now the one with the survival advantage that allows them to
duck your new fancy antibiotics.

Probably, the only angle that is likely to work is immune system modification
and enhancement. Something like a vaccine that causes the immune system to go
thermonuclear on the pathogen is likely the best route. The immune system is
highly adaptable and extremely well-honed. We've successfully driven many
viruses to the brink of extinction this way, but the tech we have is not as
good for bacteria (though there are vaccines for some bacterial infections).

~~~
seats
yup, I can see my idea being the start to a sci-fi movie.

Even what you describe though is still just building more arms in an arms
race.

Natural selection itself needs mutations as fuel. Another crack-pot thought -
figure out how to decrease the speed of mutations that bacteria are subjected
to. Something along the lines of biological or synthetic error correction on
DNA.

At some point (have we crossed it?) human evolution has moved from physical
'fitness tests' to non-physical. When we get colder now we just design thicker
clothes and warmer buildings, etc. Heart disease? more pills and surgeries.
I've read people make an interesting case that corn is one of the most
successful organisms as measured by adapting to fit because over time it
became the corner stone of our entire diet as a species. And by that line of
reasoning the genetic modification we do as humans on corn is part of corns
continued adaptation. A little meta perhaps, but eventually I wonder how much
control we'll have over the biology so that the mutations and modifications
would seem artificial and human designed by today standards.

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jacquesm
There is a rather rude joke that if you want to avoid dying you should avoid
hospitals because lots of people die there. What the joke doesn't zero in on
is that people that die in hospitals do not always die of what they had when
they got there.

Hospitals tend to be very tight lipped towards the people they admit when it
comes to admitting mistakes for fear of liability, but in cases like this
there ought to be a maximum of transparency so the people that are about to be
hospitalized can make informed decisions about the additional risks over and
beyond the thing they're going to the hospital for in the first place.

------
rsync
Here's a quote:

"The bacteria made headlines this summer after a CRE strain of Klebsiella
pneumoniae battered the National Institutes of Health Clinical Center outside
Washington, D.C. Seven died, including a 16-year-old boy. (Hospitals don't
reveal victims' names in keeping with medical privacy rules.) But that case
was neither the first nor the worst of the CRE attacks."

I'm curious, were new patients notified before admittance that they had a
resistant outbreak in their hospital ?

Were existing patients notified that this was happening while they were there
?

I'll bet no, and no.

Another quote:

""We were really frustrated; we hadn't seen anything like this in the
literature," says Costi Sifri, the hospital epidemiologist. "The fact that we
had different bacteria told us these cases were not related, but the shoe
leather epidemiology suggested to us that all these (infections) came from the
same patient. ... We realized we might be seeing a mobile genetic event.""

... all the while continuing to admit new patients ...

~~~
cindywu123
this isn't anything new... hospital acquired infections (HAIs) are the 4th
leading cause of death in the U.S.

nearly 1 in 20 hospitalized patients will acquire a HAI killing 270 people/day

hospitals... scary place

~~~
wildranter
Yes, it is scary. But you forgot to add that give or take half the time
doctors don't have the slightest idea of what they're dealing with.

However, the thing gets even hairier when you talk to med students. Most of
the one I've talked told me their main reason to learn the craft was the
money.

Take good care of yourself, exercise, eat healthy, and don't forget to have
sex. Otherwise you're gonna end up in their books as just another entry.

~~~
incision
>However, the thing gets even hairier when you talk to med students. Most of
the one I've talked told me their main reason to learn the craft was the
money.

I lived with a persistent and occasionally debilitating health problem for
nearly a decade while being brushed off by clueless doctors.

Finally, I wound up in the ER (again) being served by a guy who actually took
the time / had the ability to interpret a blood test.

Not long after that I was having a large, old and thankfully benign tumor
removed.

As I understand the issue, a blood test would have revealed this at any point
and likely even before the 10 or so years I'd been having symptoms.

Personally, I'm given to thinking that we tend to give folks in medicine too
much credit.

Sure, I think it reasonable to expect that someone who has made it through
medical school and successfully practices is above average in some regards -
relative to the broad population.

However, within the field, I expect that incompetence / apathy is just as
prevalent as it is in any other profession.

~~~
xyzzyb
I'm currently dealing with similar issues. New symptoms started for me this
summer, my GP and all the tests and specialists I've seen have no ideas.t

When I do my own research my GP brushes it off. I try to take that in stride
-- I do recognize that I am uneducated in the field. But it's disheartening
when a specialist comes up with my researched conclusion as one of their top
possible explanations.

If you don't tick all their boxes on a list of precisely described symptoms --
which you must self-report -- for a condition that they've looked up moments
prior to your appointment you won't get diagnosed correctly unless you are
lucky and have managed to find a competent and caring doctor.

------
stinky613
Every time I hear about hospital acquired infections I cross my fingers for
the narrow band UV lights I remember hearing about. Even if we could just have
those in hospital hallways or elevators... Man, what a difference that could
make.

[http://www.popsci.com/science/article/2010-11/researchers-
us...](http://www.popsci.com/science/article/2010-11/researchers-use-bacteria-
killing-light-destroy-pathogens-flip-switch)

------
tomkinstinch
It's unfortunate that regulatory environment in the US is not more favorable
for advancing phage therapy. It could be a promising alternative to
antibiotics for treating infections caused by multi-drug resistant organisms.

~~~
breakyerself
From what I've read. You're probably right. They're worried that mutations
make it hard to lock down the exact properties of any given phage treatment,
but that would be a risk I'd be willing to take. Especially since they're in
wide use in some countries with no horror stories that I've heard.

------
conanite
Assuming it is correct to say that antibiotic-resistant bacteria evolve in
response to the (over-/ab-)use of antibiotics -

I wonder to what extent opposition to teaching evolution improves the chances
of these kind of bacteria evolving. Disbelief in, and/or ignorance of how a
process works is effectively giving that process a green light.

Conversely, might the appearance of CRE bacteria might sway the evolution
debate?

Or to be more blunt, does a disbelief in evolution increase a nation's chances
of collectively qualifying for a Darwin award?

~~~
slapshot
> Conversely, might the appearance of CRE bacteria might sway the evolution
> debate?

No. It seems like an easy political point, but there's a lot more to the
story.

First, there are far easier and more visible examples of evolution. In UK
schools, possibly because it's a nearby example, it is taught that the color
of moths in London changed dramatically during the Industrial Revolution
because light-colored moths were easy snacks for birds on newly soot-covered
walls. There are more colorful examples closer at hand: most of the
domesticated animals in the world are examples of evolution by artificial
selection: cows today share little with cows 10,000 years ago, and corn today
looks nothing like 10,000 years ago.

Second, thanks to #1, the belief is often that "humans (special) didn't evolve
from apes (animal)" --- not that species never change. The belief is based on
an idea that either evolution started after humans were created, or that even
if evolution has been running for 100 million years, there's no way that
natural selection could cause the leap from animal to human. It doesn't
preclude belief in evolution among animals.

Third, antibiotics are all prescribed by doctors, who are plenty aware of the
work of Sir Charles.

And, last, antibiotic misuse is largely a tragedy of the commons. Rational
patients who are very aware of the risks of antibiotic-resistant phages will
still request antibiotics: they feel the benefit (even if the chance of a
benefit to them is small) but the pain of antibiotic resistance is felt by
other people.

So, no, it's easy political point but it has more to do with enthusiasm than
fact.

~~~
breakyerself
I agree with the tragedy of the commons point, but I think it might be a
smaller piece of the puzzle than industrial farming. Pretty much every chicken
that is raised industrially is given regular doses of antibiotics to "prevent"
rapid spreading of disease through large chicken stocks. Which would happen
easily since the chickens are kept in such close quarters. Just about any non
organic chicken you buy has antibiotic resistant bacteria living on it.

------
fela
I think that what is important to note is that their only evolutionary
advantage, and thus the main reason they spread, is their resistance to
antibiotics, in normal conditions they would have a quite big chance of losing
in competition with other bacteria. As soon as antibiotics are used, the
competition dies and they can proliferate. This means that the best prevention
method is to use antibiotics as rarely as possible. Let's remember that the
same bacteria that cause infections, can ordinarily live on our body quite
harmlessly.

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omegant
It is amazing how this bacteria interchanges genes with ease. Could it be
possible to use this strength as a weakness? Inoculating a modified bacteria
to act as a trojan horse?.

edit: missing letters.

~~~
btbuilder
I believe this approach normally doesn't work because any gene that leads to
weakness with be removed via natural selection.

~~~
lftl
I think the goal might not be to make a bacteria that's easier to kill, but
one that's less likely to kill us. There's generally a strong evolutionary
pressure not to be fatal for your host.

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cindywu123
4 in 10 chance that if you get infected with CRE bacteria you will die...

~~~
ars
People who get sick from CRE usually have lots of other medical issues, and
are weaker.

They don't necessarily die from CRE itself.

Also remember that CRE are not more virulent than non resistant forms of
enterobacteriaceae, and those certainly don't kill 4 in 10 (although that
family seems to have all the really bad bacteria like E. Coli, Salmonella,
Plague and others).

~~~
lgleason
It actually does. Healthy people who get MRSA often end up fighting a long
uphill battle. If you are in a hospital you are going to have a compromised
immune system. When someone gets sepsis it is really nasty.

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adam-f
I've come across some mentions of MDR (Multidrug Resistance) pumps, and MDR
pump inhibitors:

I assume there's a reason we're not mixing in Oregon Grape root into our
antibiotic cocktails? <http://en.wikipedia.org/wiki/Oregon-grape>
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC26451/>
<http://www.ncbi.nlm.nih.gov/pubmed/11321580>

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lgleason
My mother died from a hospital acquired superbug (MRSA) earlier this
year......this is nasty stuff.

