Watcher – Page 5 – Antibiotic Fail

WHO Study – Resistance is Worse Than AIDS

[Nothing new here – unless governments act]
Deaths from cuts and grazes, diarrhoea and flu will soon be common as antibiotics lose their power to fight minor infections, experts have warned.

The World Health Organisation says the problem has been caused by antibiotics being so widely prescribed that bacteria have begun to evolve and develop resistance.

It claims the crisis is worse than the Aids epidemic – which has caused 25 million deaths worldwide – and threatens to turn the clock back on modern medicine.

The WHO warns that the public should ‘anticipate many more deaths’ as it may become routine for children to develop lethal infections from minor grazes, while hospital operations become deadly as patients are at risk of developing infections that were previously treatable.

Doctors are increasingly finding that antibiotics no longer work against urinary and skin infections, tuberculosis and gonorrhoea.

Dr Keiji Fukuda, the WHO’s assistant director for health security, said: ‘Without urgent, co-ordinated action, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.

In the largest study of its kind, the WHO looked at data from 114 countries on seven major types of bacteria. Experts are particularly concerned about bacteria responsible for pneumonia, urinary tract infections, skin infections, diarrhoea and gonorrhoea

Back To Square One / Short LifeSpans

The History of Medicine:

2000 B.C.—Here, eat this root.
1000 A.D.—That root is heathen. Here, say this prayer.
1850 A.D.—That prayer is superstition. Here, drink this potion.
1920 A.D.—That potion is snake oil. Here, swallow this pill.
1945 A.D.—That pill is ineffective. Here, take this penicillin.
1955 A.D.—Oops … bugs mutated. Here, take this tetracycline.
1960–1999 A.D.—39 more “oops.”… Here, take this more powerful antibiotic.
2000 A.D.—The bugs have won! Here, eat this root.

—Anonymous, as cited by the World Health Organization (WHO, 2000a)

Kills 99.9% of Germs?

Have you noticed that virtually every antibacterial product claims to kill 99.9% or even 99.99% of germs? It sounds impressive – but that’s advertising for you. With every claim you need to ask how does it compare to other products. In this instance, how would it compare to warm water and soap?

First of all, the study that proves such an extraordinary effectiveness might not be all it seems to be. Consider:

the studies are conducted in lab conditions – the most optimal situation possible.
are the germs not killed the ones we need to avoid the most?

This is from the Wall Street Journal 5 years ago:

They often don’t include all pesky germs, and are based on laboratory tests that don’t represent the imperfections of real-world use. Human subjects, or countertops, in labs are cleaned first, then covered on the surface with a target bug. That is a far cry from a typical kitchen or a pair of grimy hands.

…”It’s the optimal environment for the hand sanitizer to work,” says Jason Tetro, a microbiologist at the University of Ottawa. “This differs greatly from the real-world setting.”

Mr. Tetro showed the difference by testing three hand-sanitizer products for CBC News last month among eighth graders in Hamilton, Ontario. Three popular sanitizers killed between 46% and 60% of microbes on the students’ hands, far short of 99.99%.

To cite a 99.9% fatality rate, manufacturers don’t have to kill 99.9% of all known bugs. Regulations don’t require them to disclose which bugs they exterminate, just that the products are effective against a representative sample of microbes. For instance, many products can’t kill clostridium difficile, a gastrointestinal scourge, or the hepatitis A virus, which inflames the liver. Yet by killing other, more common bugs, they can claim 99.9% effectiveness.

…some products need to sit on surfaces for 10 minutes to attain desired kill rates, yet many home cleaners are likely to wipe them off long before that.

With a banning of triclosan by the FDA looking likely, I have noticed a massive increase in promoting such products in Australia. It looks like they want to sell as much as they can, while they can.

The FDA’s current policy is already pretty negative on antibacterial soaps, stating that there’s no evidence that antibacterial soaps and washes provide “any benefit over washing with regular soap and water.”

I wrote to Dettol to inquire about the study behind their claims of 99.9% germ kill. The reply came from their legal department, stating that the study is private and not publicised due to commercial sensitivity, although the appropriate advertising authorities are able to view it.

If I could read the study, I would have grounds for complaining that the 99.9% was achieved in an environment very different to typical use. Such a complaint could lead to small print being added to their ads. Unfortunately that avenue isn’t available to me. It is a shame that when such studies are not commercially sensitive – they all use triclosan anyway – they can hide them.

So yeah, just use soap and water. It is safer and just as effective.

Do Antibiotics Making Us Fat?

I came across this article in Mother Jones – it is not available online.

Researchers looked at the demographics of the states within the USA, looking for increased antibiotic use in states like Florida (higher percentage of elderly folk). Race, education, health care coverage and income didn’t correlate with increased usage either. Only one demographic did – obesity. Fat people use more antibiotics.

Now it could be because fat people get sicker more – but so do the elderly, so do the poor. Or could it be that antibiotics add to your weight. It sounds crazy but that is why they are fed to cattle.

Key snippets:

Hicks was surprised to find that states with higher rates of antibiotic use also were very likely to have significantly more obese people. The research team can’t yet explain the connection, and they suspect a chicken-and egg effect might be at work: “There might be reasons that more obese people need antibiotics,” she says. “But it also could be that antibiotic use is promoting weight gain.”

Meat producers have long dosed livestock with low levels of antibiotics to bulk up their animals, and recent studies suggest that the antibiotics your doc prescribes may have similar effects. A 2012 New York University study found that use of the drugs in the first six months of life correlates with obesity later in childhood. Another 2012 study from the same lab found that mice given antibiotics gained more weight than their drug free counterparts. No one knows exactly how antibiotics help animals-and perhaps humans-pack on the pounds, but some researchers think that it has to do with their effect on the gut microbiome, the intestinal community of microorganisms that scientists and doctors are just beginning to understand.

Dirty stethoscopes need constant cleaning

Presence of bacteria on a surface doesn’t prove that it is a cause of infection, but better to be clean than sorry.

One of the instruments was found to be more contaminated with bacteria than the palm of a doctor’s hand after being used to examine 71 patients.

Among the microbes spreading from patients was the potentially deadly superbug MRSA (methicillin-resistant Staphylococcus aureus).

“From infection control and patient safety perspectives, the stethoscope should be regarded as an extension of the physician’s hands and be disinfected after every patient contact.”

Source: News.com.au

A different study found that nozzle triggers at gas stations were another place where you can find a lot of bacteria.

Post-Antibiotic Might Look Like Pre-Antibiotic

An article at Matter looks into what we could reasonably expect when antibiotics fail en masse. It begins with the death of a fireman, less than 80 years ago:

I had always heard Joe had been injured at work: not burned, but bruised and cut when a heavy brass hose nozzle fell on him. The article revealed what happened next. Through one of the scrapes, an infection set in. After a few days, he developed an ache in one shoulder; two days later, a fever. His wife and the neighborhood doctor struggled for two weeks to take care of him, then flagged down a taxi and drove him fifteen miles to the hospital in my grandparents’ town. He was there one more week, shaking with chills and muttering through hallucinations, and then sinking into a coma as his organs failed. Desperate to save his life, the men from his firehouse lined up to give blood. Nothing worked. He was thirty when he died, in March 1938.

Penicillin-resistant staph emerged in 1940, while the drug was still being given to only a few patients. Tetracycline was introduced in 1950, and tetracycline-resistant Shigellaemerged in 1959; erythromycin came on the market in 1953, and erythromycin-resistant strep appeared in 1968. As antibiotics became more affordable and their use increased, bacteria developed defenses more quickly. Methicillin arrived in 1960 and methicillin resistance in 1962; levofloxacin in 1996 and the first resistant cases the same year; linezolid in 2000 and resistance to it in 2001; daptomycin in 2003 and the first signs of resistance in 2004.

Without the protection offered by antibiotics, entire categories of medical practice would be rethought:

transplants
the use of ventilators, catheters, and ports
kidney dialysis
Caesarean sections
surgery on intestines and the urinary tract
bone marrow transplant
implantable devices
hip replacements
botox injections
liposuction
prostate biopsies
open-heart surgery

British health economists with similar concerns recently calculated the costs of antibiotic resistance. To examine how it would affect surgery, they picked hip replacements, a common procedure in once-athletic Baby Boomers. They estimated that without antibiotics, one out of every six recipients of new hip joints would die.

Antibiotics are administered prophylactically before operations as major as open-heart surgery and as routine as Caesarean sections and prostate biopsies. Without the drugs, the risks posed by those operations, and the likelihood that physicians would perform them, will change.

Medical procedures may involve a high risk of infections, but our everyday lives are pretty risky too. One of the first people to receive penicillin experimentally was a British policeman, Albert Alexander. He was so riddled with infection that his scalp oozed pus and one eye had to be removed. The source of his illness: scratching his face on a rosebush. (There was so little penicillin available that, though Alexander rallied at first, the drug ran out, and he died.)

Before antibiotics, five women died out of every 1,000 who gave birth. One out of nine people who got a skin infection died, even from something as simple as a scrape or an insect bite. Three out of ten people who contracted pneumonia died from it. Ear infections caused deafness; sore throats were followed by heart failure.

AntiBacterial Crackdown in USA

An estimated 75% of the anti-bacterial liquid soaps and body washes sold in the United States contain triclosan, a germ-killing ingredient. The only problem is, the Food and Drug Administration has no idea whether it actually works — and there’s some evidence it may pose health risks. [USA Today]

Consequently the FDA has “proposed rule requiring manufacturers to prove that their antibacterial cleaners are safe and more effective than plain soap and water”. That’s because when a product is promoted as killing 99.9% of germs, that’s the same result you get from soap and water. However, Antibacterial products can increase resistance in antibiotics.

The advertising used for these products makes consumers think if they wash with them they won’t get sick, said Kweder. “You’ll see pictures of people sneezing and coughing and looking pretty ill.”

But many of those images “look like people who have viral illnesses” such as the common cold, she said. Viruses are the most common cause of infections in the United States and antibacterial agents have no effect on them.

In Australia Dettol, presumably to counter the backlash they see coming, has been heavily promoting their hand wash product via Sophie’s story:

Tuberculosis – still a major threat

I just came across a thoroughly interesting article from last year about a journalist who, whilst reporting on tuberculosis in Papua New Guinea, ended up catching the disease herself:

We spent some days poking around overflowing wards and diseased shanties for The Age, investigating the insidious reach of deadly, drug-resistant tuberculosis across Papua New Guinea. More than 60 per cent of the global burden of TB occurs in the Asia-Pacific region, and PNG bears some of the worst of it.

…Tuberculosis retains the distinction of being the greatest infectious killer in human history, claiming an estimated billion lives in the past 200 years. Its toll today is still second only to HIV (and it is the major killer of people with HIV). In 2011, 8.7 million people fell sick with TB.

…many are poorly nourished and dozens might share a room at night. TB thrives in such conditions.

…Some of the other children’s limbs are shrivelled, their heads misshapen and eyes vacant in a way I have come to recognise. They are survivors of TB meningitis, the infection having found its way into their brains, rotting away physical and intellectual capacity.

…TB is invisible because the people who suffer it are already on the margins, says Hewison. “They are the poor, the prisoners, alcoholics, refugees, Aboriginals, drug users, old people. And the drug companies forgot it because there is no money to be made there,”

…“Rising rates of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB threaten global control efforts in both developing and developed countries,” The Lancet authors – Ben Marais among them – warned. The rise of drug-resistant TB and the ease of international travel means “the threat and range and spread of untreatable TB is very real …

…A chest tube is installed to drain fluid and I’m pumped with antibiotics that burn like fury as they flow through the cannulas in my wrists …I move to the Royal Melbourne Hospital where I’m put into the care of an infectious disease team and isolated… at least two years of aggressive drug treatment, including four months of intravenous drips.

———

Extensively drug-resistant tuberculosis (XDR-TB) is a form of tuberculosis caused by bacteria that are resistant to some of the most effective anti-TB drugs. XDR-TB strains have arisen after the mismanagement of individuals with multidrug-resistant TB (MDR-TB).

One in three people in the world is infected with TB bacteria. Only when the bacteria become active do people become ill with TB. Bacteria become active as a result of anything that can reduce the person’s immunity, such as HIV, advancing age, or some medical conditions. TB can usually be treated with a course of four standard, or first-line, anti-TB drugs. If these drugs are misused or mismanaged, multidrug-resistant TB (MDR-TB) can develop. MDR-TB takes longer to treat with second-line drugs, which are more expensive and have more side-effects. XDR-TB can develop when these second-line drugs are also misused or mismanaged and therefore also become ineffective.

XDR-TB raises concerns of a future TB epidemic with restricted treatment options, and jeopardizes the major gains made in TB control and progress on reducing TB deaths among people living with HIV/AIDS. It is therefore vital that TB control be managed properly and new tools developed to prevent, treat and diagnose the disease.

The true scale of XDR-TB is unknown as many countries lack the necessary equipment and capacity to accurately diagnose it. It is estimated however that there are around 40,000 cases per year. As of June 2008, 49 countries had confirmed cases of XDR-TB. By 2013, that number had risen to 84. [Wikipedia]

Klebsiella pneumoniae: warning sign

How’s this for a warning sign?

Doctors are warning Australians to stop travelling overseas for elective surgery, after a New Zealand man contracted a superbug that no antibiotic could treat.

Brian Pool, a 68-year-old teacher, is believed to be New Zealand’s first victim of an aggressive bacterium that experts believe he caught in Asia.

”It’s the first time I’ve ever seen a totally resistant bacterium,” said Dr Mark Jones, a clinical microbiologist at Wellington Hospital. ”Nothing would touch it.”

…Tests showed he contracted Klebsiella pneumoniae, a strain of bacteria that produce enzymes that are completely drug-resistant. ”It is likely he caught it while in India,” said Dr Jones. ”The bacterium probably became infectious after he had surgery for a hernia.”

Read more: http://www.theage.com.au/national/doctors-warn-on-overseas-surgery-after-teacher-brian-pool-catches-superbug-20131120-2xvvu.html#ixzz2lHrVC6MF

Antibiotic Failure Makes Newsweek Cover Story

The article starts off with the tragic story of a young girl who survives a staph infection – but only just and she will always need medical help. Ten years ago she would have survived without a scratch… but today there is only one product left that can treat this infection, and it has nasty side-effects.

As recently as a decade ago, Addie’s story would have been a shocking anomaly, the kind of case that comes along once in any doctor’s life.

But after years of futile warnings from scientists that overuse of antibiotics was causing bacteria to evolve into strains resistant to drugs, experts in the field say we have reached a tipping point, and some deadly pathogens are becoming incurable. “We are confronting one of the gravest threats to public health that we have ever faced,” said Dr. Lance Price, a professor at the George Washington University School of Public Health and Health Services who specializes in studying resistant bacteria. “We are entering a place we don’t want to be, with people dying of infections that could have treated in the past.”

There are many anecdotes shared, all about people who would have been successfully treated until recently:

A few months ago, she consulted on a case of a woman suffering from a resistant bacterial infection of her gall bladder. There were no antibiotics that could treat her; with no options, the patient was sent to hospice so she could die comfortably. A plastic surgeon she knows also had a horrifying case: A knee replacement implant in a patient had collected untreatable bacteria. Doctors were forced to amputate the leg to prevent the infection from spreading any further.

It isn’t just when infections are the primary problem. Some medical procedures will become to difficult unless antibiotics can be trusted to work. It is looking like heart transplants will no longer be tenable. And worse, no more chemotherapy.