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.
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.
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).
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.
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.
"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.
""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 ...
nearly 1 in 20 hospitalized patients will acquire a HAI killing 270 people/day
hospitals... scary place
I think there are some advocacy groups that overestimate the role of hospital-acquired infections (nosocomial infections) as a cause of death. The ranking I find in one source that is readily looked up
is lower. A general ranking of causes of death in the United States by the standard WHO definitions
gives a different picture of which causes of death rank highest, and which have declined the most in recent decades. Life expectancy is up at all ages in the United States, even though most people have a hospital visit at some time in life.
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.
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.
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.
Stay as strong and as healthy as you can, and condition your immune system as best you can is good advise.
So the question then becomes: How do I, as a consumer of healthcare, tell them apart? Well, patient survival rate and causes of death are never published (hospitals hide behind HIPAA to avoid revealing this info, even in aggregate). But one way we found (empirical & anecdotal evidence, so treat accordingly) is to look down the ward and see if the nurse-call lights flashing for more than a few minutes. If the patients are pushing the bedside button and not getting attention from the care-givers, find yourself another hospital.
Another good way is to see if the staff are frequently washing their hands and cleaning the equipment that can be moved from room to room (the plastics used typically have silver ions in them, but that's only partially effective at killing the wee beasties).
Family involvement is also critical. If you're wonked out on drugs, you really need someone in the room watching the staff to ensure they do things correctly, and that the bill doesn't get padded with goods & services that weren't used in your care.
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?
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.
Keep in mind that this class of antibiotic is always administered by IV, so if there is overuse or abuse, it is by doctors who likely already believe in evolution.
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).
On a long term scale bacteria have won over every other kind of life, there is little reason to assume that this will change in the future. This holds whether you look at them by mass, by number or by just about any other metric.
edit: missing letters.
I assume there's a reason we're not mixing in Oregon Grape root into our antibiotic cocktails?