
Antibiotic resistance 'a time-bomb' - clicks
http://www.belfasttelegraph.co.uk/news/local-national/uk/antibiotic-resistance-a-timebomb-29121193.html
======
DanBC
([http://v6.tinypic.com/player.swf?file=24goih4&s=6](http://v6.tinypic.com/player.swf?file=24goih4&s=6))

Here's a short snippet from a BBC Television programme (Horizon - 'defeating
the superbugs').

It shows E.Coli developing anti-biotic resistance. There's a tray of nutrient
jelly. The jelly is divided into sections. It starts with no antibiotic. Then
there's a normal dose. Then there's a 10x dose, followed by 100x dose,
followed by 1000x dose. They reach the limits of solubility. They cannot
dissolve any more antibiotic into the jelly.

Then they drop E.Coli onto the normal jelly, and use a time lapse camera to
show the growth.

After just two weeks the bacteria is able to live on the 1000x dosed jelly.

It's pretty impressive demonstration.

(Apologies for the suboptimal hosting site. YouTube's contentID blocks this
video worldwide.)

~~~
jacquesm
That's scarier than any horror movie that I've ever seen. It also makes
perfect sense. You're providing nature with an evolutionary pressure and it
adopts by breeding the most resistant strains until they are undefeatable.

~~~
sbirchall
Exactly why industrial scale monoculture is the single greatest threat to
humanity. We rely almost entirely on a few dozen animals, vegetable plants,
grasses and a handful of other organisms that have all have their comfort
zones artificially inflated and their genetic variance severely compromised by
human intervention.

We've essentially created vast plateaus within the evolutionary landscape and
these are beginning to be occupied by pioneer species that will quickly take
the advantage to adapt.

Scary stuff indeed.

------
lgleason
A year ago my mother went in for back surgery, a week after she had a sharp
pain, and ended up with MRSA which had turned into sepsis. It damaged her
heart and in the end, after a two month fight led the ARDS and took her life.
The hell this put her through was extremely real.

Between the lack of solid contact precautions, doctors who think they are
above them, the over-use of antibiotics which lead to this etc. this is a huge
problem. The number of instances of MRSA are growing every year which is the
scariest part of this. I can vividly remember my mother reading and
recommending a book about the coming superbugs back in the 90's when MRSA was
rare. It was quite ironic that this ended up killing her.

~~~
harshreality
My condolences.

Can someone explain, even if there are resistant pathogenic bacterial strains
floating around, where the entrypoint for infection is? Operating rooms are
cleanrooms, and after that, with good dressings on the wounds, bacteria should
be prevented from entering.

"Flesh eating bacteria" due to scratching is one thing; bacteria that gain a
foothold through the GI tract is another; I understand how those infections
get started.

However, internal infections caused somehow by surgical wounds? Are surgical
suite clean rooms not a low enough class and therefore not sterile enough? Is
wound aftercare not good enough? Are surgical tools getting contaminated after
sterilization but before the surgery?

Maybe hospitals should be turned into high-class[1] (lower-effectiveness)
cleanrooms. I realize laminar flow in such a chaotic environment is
impossible, and of limited effectiveness if people are not gowned and so shed
contamination all the time, but there could at least be an attempt to push
some of the contamination to vents on the floor. How much would that increase
costs? It wouldn't have to be entire hospitals, only the recovery wards.

Other than that, a major initiative to clean up hospitals could be undertaken.
Surfaces and floors and everything else commonly touched should be sterilized
more often, to start with. Any area that sees a lot of patient turn-over is
going to be heavily contaminated. Anyone who goes from room to room (doctors,
nurses) should wear gloves before entering a room to avoid cross-
contamination. Donning new gloves once in a room is not good enough;
doorknobs, clipboards, light switches, etc. are all still subject to cross-
contamination.

Recent studies on hotel rooms made me never want to check into one again:

[http://www.cbc.ca/news/canada/story/2012/11/07/marketplace-d...](http://www.cbc.ca/news/canada/story/2012/11/07/marketplace-
dirty-hotels.html)

[http://www.scientificamerican.com/podcast/episode.cfm?id=hot...](http://www.scientificamerican.com/podcast/episode.cfm?id=hotel-
rooms-house-bountiful-bacteri-12-06-19)

[1]
[http://en.wikipedia.org/wiki/Cleanroom#Cleanroom_classificat...](http://en.wikipedia.org/wiki/Cleanroom#Cleanroom_classifications)

~~~
aplusbi
Hospitals really can be that bad. People get sloppy if they aren't constantly
reminded that they need to be vigilant. I have personally witnessed doctors
open doors with bloody gloves and then interact with patients.

[http://thechart.blogs.cnn.com/2011/04/08/hospital-
checklist-...](http://thechart.blogs.cnn.com/2011/04/08/hospital-checklist-
cut-infections-saved-lives/)

~~~
scarmig
The funny thing is (if by funny you mean absolutely horrific), some doctors
and hospitals really dislike the idea of checklists. For a variety of reasons,
but one suspects that the motivating concern is that it assumes it's possible
for doctors to be utterly incompetent.

------
AaronBBrown
I had a "minor" bought with MRSA a few years back that put me in the hospital
for 2 days. Several weeks after getting a tiny little scratch near my elbow my
entire forearm swelled up a couple inches. I went through several oral
antibiotic treatments before they had to stick me in the hospital to give me
the crazy IV stuff. The one that ended up solving the infection was
vancomycin, which has been historically the "drug of last resort." During that
little incident, I developed an allergy to two different antibiotics, so on
top of bacterial resistance, now I have to be concerned with my own body's
inability to deal with particular antibiotics.

Also, let me tell you, IV Benadryl is some good shit...

------
boas
I've worked in a US hospital for a few years, and I've never seen a bacteria
that was resistant to all antibiotics, but I have seen people die from
bacterial infections. So I think the media focus on drug-resistant bacteria is
oversimplified. Why would someone die from a bacterial infection while
receiving appropriate antibiotics? One reason is that the antibiotics can't
reach the bacteria -- for example if the bacteria are organized into an
abscess or biofilm. Another reason is that the body can overreact to the
infection, and the patient can die from their immune response rather than the
infection itself -- this is called sepsis. Other problems with antibiotics:
culture results (which tell you which antibiotic to use) can take a few days,
antibiotics frequently have side effects, and it's frequently unclear when the
infection is fully treated and the antibiotics can be stopped. I felt a need
to respond because a politician reading articles in the popular media will get
a distorted view of what is actually needed in hospitals, potentially leading
to inappropriate research funding priorities.

~~~
ZoFreX
> So I think the media focus on drug-resistant bacteria is oversimplified.

This article is from the UK. Our media's focus on drug-resistant bacteria
isn't oversimplified, it's FUD. The whole nation is scared stiff of MRSA
because the papers all used "the lab that gets results" - aka some dude in his
shed who had no idea what he was doing. They used this lab because it
repeatedly confirmed that large numbers of journalists samples (taken from
various areas in hospitals) did indeed contain MRSA.

Not that there isn't a problem, and it merits attention, but the hysteria they
whipped up was unwarranted.

I'd be less angry, but despite all this antibiotic fear, people still keep
taking them for colds. Grr.

------
ams6110
A bit of a tangent, but... from the posted link: _Routine operations such as
hip replacements could become deadly in just 20 years time if we lose the
ability to fight infection_

I would never encourage anyone to think of a hip replacement as "routine." It
is majorly invasive surgery, and any number of things can go wrong. Post op
infections are not uncommon. And just being under deep anasthesia for that
long is not without suspected long-term side effects.

~~~
to3m
Better yet, the daily mail quotes the uk chief medical adviser describing
_organ transplants_ in the same terms!

[http://www.dailymail.co.uk/health/article-2291314/Superbugs-...](http://www.dailymail.co.uk/health/article-2291314/Superbugs-
send-health-service-19th-century-Even-routine-surgery-deadly-warns-medical-
adviser.html?ito=feeds-newsxml)

------
alvarosm
Yeah, well, good luck convincing, say, chinese farmers not to give tons of
antibiotics to their livestock. Nobody is interested reducing pharmaceuticals'
revenue either. On a side note, take into account we didn't have antibiotics
centuries ago, and people just lived. Endure whatever comes, just live. And
don't look so shocked, we have democracy and we're surrounded by morons, the
shocking thing is that there's still any prosperity at all.

~~~
andor
_Yeah, well, good luck convincing, say, chinese farmers not to give tons of
antibiotics to their livestock_

This is also a problem in North America. Try buying a simple disinfectant
(e.g. for small cuts) that doesn't contain antibiotics.

~~~
jrmg
I think you're thinking of antiseptics or disinfectants, not antibiotics.
Resistance to these is not such a problem, and many work on a level that it
would be very hard for a microorganism to develop resistance to (for example,
by physically destroy the organism).

<http://en.wikipedia.org/wiki/Antiseptic>
<http://en.wikipedia.org/wiki/Disinfectant>

~~~
tsotha
Sadly, he's probably _not_ thinking of antiseptics or disinfectants.
Manufacturers have started putting antibiotics in consumer products
(especially soaps) because there are a lot of consumers who don't know any
better.

~~~
maxerickson
Or ggp is talking about Neosporin (and other triple antibiotic ointments).

But peroxide and iodine and rubbing alcohol are all also available, and plain
petroleum jelly is available. And then most small cuts should probably just be
washed with soapy water and left open to the air.

(also, the Wikipedia roundup on triclosan suggests it isn't a problem yet:
<http://en.wikipedia.org/wiki/Triclosan#Resistance_concerns>

Not that it is particularly useful to put it in soap)

~~~
jrmg
Wow, I didn't actually realtors that's what Neosporin was. I'm from he UK,
where antibiotics are heavily controlled and, though I lived for a fair amount
of time in the USA, I guess my bias made me not even consider that could be
the case. Crazy.

Having said that, even with what ie now learned, I think it's still the case
that _most_ disinfectants and antiseptics, even in the USA, are not
antibiotics.

Thanks for the correction, I certainly learned something.

------
jsherry
The ROI on antibiotics is much lower than that of a "lifetime drug" such as an
anti-depressant that a patient will take for years and years. Pharmaceuticals
are mostly privatized and that's not changing, so the government is going to
have to find some ways to incentivize innovation in the antibiotics market.
Counting on government isn't a popular option these days, but this is the
perfect role for them actually.

------
stephengillie
Antibiotic resistance, giant mosquitos [1], mutant rats [2]. Pests are
evolving to continue living despite our pesticides. We aren't going to make
the Earth too hot to live on, or block out the sun with pollution. We're going
to be forced off of the planet by evolved pests and predators.

Like species which were forced out of the water, onto dry land, because they
were out-competed -- one of our evolutionary advantages is that we can survive
in space.

[1]
[http://www.gainesville.com/article/20130305/ARTICLES/1303098...](http://www.gainesville.com/article/20130305/ARTICLES/130309802/-1/news?Title=State-
prone-for-mosquito-season-ripe-with-painful-behemoth&tc=ar)

[2] [http://www.thenational.ae/news/world/middle-east/iran-
deploy...](http://www.thenational.ae/news/world/middle-east/iran-deploys-
sniper-teams-in-tehran-to-battle-mutant-rats)

~~~
crusso
_We're going to be forced off of the planet by evolved pests and predators._

Doubtful. They may impact our growth or even trim back our numbers, but we're
numerous and have lots of mutations too. If technology doesn't save us, it's
likely that we'll experience some sort of evolution that allows us to adapt.
Even back before modern medicine, the Plague only managed to wipe out 2/3 of
the population.

 _one of our evolutionary advantages is that we can survive in space_

I doubt we'll be getting many humans out into space any time before some sort
of Singularity beyond which we're all just guessing anyway.

------
nathan_long
To help, spread this message: _you often don't want an antibiotic_.

If you have a viral infection, taking an antibiotic is like setting mousetraps
to kill mosquitos.

Meanwhile, your unnecessary antibiotic 1) has side effects, 2) costs money, 3)
helps breed superbugs.

Many patients feel that "if I waited 2 hours to see the doctor, he/she had
better give me _something_." Many doctors cave to these demands. We need to
stop both.

~~~
tomjen3
What we really need is something that can do to viruses what penicillin did to
bacteria.

And we need some serious work on bacteriophages. Those little buggers are
_awesome_ and have a faster evolution than bacteria.

~~~
tsotha
That evolution part is the problem. There's a chance we'll breed superviruses
in our effort to stop supergerms.

As a practical matter, it's nearly impossible to breed therapeutic quantities
of a virus without having a wide range of mutations present. We'll probably
end up using phages because we won't have any other choice. But they won't be
as safe as antibiotics.

------
btipling
The comments here are a little over the top "antibiotic resistance is worse
than terrorism!" Drug resistance is a problem, but check a reasonable source:
<http://www.cdc.gov/drugresistance/about.html> and don't gravitate toward
panic and fear. Fear is the path to the dark side.

~~~
carbocation
People shouldn't be _afraid_ of antibiotic resistance so much as they should
be _outraged_ , _diligent_ , and _cautious_.

According to the World Health Organization, tuberculosis antibiotic resistance
kills 150,000 people per year [1], so I believe your statements on this topic
are much too sanguine.

[1] <http://www.who.int/mediacentre/factsheets/fs194/en/>

~~~
btipling
There is no shortage of outrage on Hacker News, there seems to be an infinite
supply every other day so you've tapped a good market.

------
jbhernan
What about how most of the soap you can buy in stores these days is
antibacterial soap? I would think the huge use of antibacterial soap might
play a part as well. Antibacterial soap probably is not necessary for most
people yet it has become the default soap for most, and you have to go out of
your way to buy non antibacterial soap.

------
jballanc
I think this Wikipedia page does the best job of succinctly summarizing the
severity of the issue:

<http://en.wikipedia.org/wiki/Timeline_of_antibiotics>

------
michaelochurch
Antibiotic resistance is _scarier_ than terrorism. A once-in-a-century
terrorist attack killed 3000 people. TB still carries off more than a million
people per year, and used to be incurable.

Drug-resistant bacteria sounds like a paranoid tinfoil fear, but hospitals
already deal with the problem. Doctors do not want to hear the words "drug-
resistant MRSA", ever.

Probably the worst culprit is the abuse of antibiotics in factory farming. The
animals live in disgusting conditions that require antibiotics to keep them
viable. (As a side effect, the drugs also make them fatter, producing more
meat per head.) This is a huge contributor to the problem.

~~~
DanBC
MRSA is already drug resistant. That's what the MR bit is - methicillin
resistant.

> Probably the worst culprit is the abuse of antibiotics in factory farming.

That's certainly a problem, but misuse of antibiotics in humans is still a big
big problem.

Antibiotics were routinely used for illnesses where they shouldn't have been -
ear infections, viral coughs and colds.

In developing nations people often use antibiotics in the worst way - a short
course until they feel better, not a long course until the bacteria are all
killed. This is partly because they don't know any better and partly because
they buy what they can afford.

~~~
pm90
> _Antibiotics were routinely used for illnesses where they shouldn't have
> been - ear infections, viral coughs and colds.

In developing nations people often use antibiotics in the worst way - a short
course until they feel better, not a long course until the bacteria are all
killed. This is partly because they don't know any better and partly because
they buy what they can afford._

On the contrary, I would like to point out that its not limited to developing
nations. When I first arrived in the US, one of the advice that my US settled
relatives gave me was that American doctors routinely prescribe antibiotics
even for the simplest illness. This fact was confirmed when I took my Mum to a
doctor when she felt unwell when visiting me: light fever, and the
prescription was some very potent antibiotics. My mother refused to take them
and got better on her own after a few days. There seems to be a reluctance to
take antibiotics in my family.

~~~
DanBC
Yes, I worded my post poorly.

What I meant to say was something like "Another misuse of antibiotics is
caused by poor people not being able to afford a complete course".

