C-dif, gonnorhea, and life-threatening diarrhea are making a comeback
September 20, 2013 12:24 PM   Subscribe

"Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections. Many more people die from other conditions that were complicated by an antibiotic-resistant infection." This week the Centers for Disease Control and Prevention released Antibiotic resistance threats in the United States, 2013, a first-ever snapshot of the burden and threats posed by the antibiotic-resistant germs having the most impact on human health. "If we’re not careful, the medicine chest will be empty when we go there to look for a life-saving antibiotic,” CDC Director Thomas R. Frieden told reporters. Reports in the Washington Post and New York Times. (Also previously.)

One point of contention has been the extent to which industrial-scale animal farming contributes to the problem of antibiotic-resistant infections in humans. (Previously and more.) According to the report, more than 70% of antibiotics in the United States are given to animals, and much of antibiotic use in animals is unnecessary and inappropriate. But half of antibiotic use in people is inappropriate, too. The Post provides a helpful visualization of how antibiotics are over-prescribed in the US Southeast compared to the rest of the country (as discussed previously), while new antibiotics in the development pipeline are down to the lowest levels since the 1980s.

The good news? Invasive Methicillin-resistant Staphylococcus aureus (MRSA) infections have been declining. The bad news is that other infections are more than making up the gap. Carbapenem-resistant Enterobacteriaceae (CRE, the "nightmare bacteria" that causes life-threatening diarrhea) has shown up in 44 states and has become resistant to nearly all antibiotics on the market.

"We are getting closer and closer to the cliff," said Dr. Michael Bell, a C.D.C. official who presented the data.
posted by RedOrGreen (33 comments total) 20 users marked this as a favorite

 
‘Live’ vaccine kills gonorrhea in mice.
A new treatment based on an anti-cancer therapy successfully eliminates gonorrhea in female mice and prevents it from coming back.

“With this treatment, we have reversed the immunosuppression that gonococcal infection normally causes and allowed an effective immune response to develop,” says Russell.

And because it may circumvent the growing resistance of this bacterium and others to antibiotics, this treatment method also may open up new approaches for the development of non-resistant treatments for other infectious diseases, Russell says.
posted by 1970s Antihero at 12:30 PM on September 20, 2013 [1 favorite]


Because of various life exigencies, it seems like every other conversation around me in social life is about C-dif and fecal transplants and fecal transplant donors.
posted by kalessin at 12:39 PM on September 20, 2013 [2 favorites]


Life-threatening diarrhea?

This might affect my plans of vacationing in Portland this year...
posted by 7segment at 12:46 PM on September 20, 2013


According to the report, more than 70% of antibiotics in the United States are given to animals, and much of antibiotic use in animals is unnecessary and inappropriate.

This paper seems to imply that antibiotics administered preventatively to animals exploit different weaknesses than antibiotics administered to humans. Is that correct, and if so how does that impact this issue?
posted by Jpfed at 1:04 PM on September 20, 2013


This might affect my plans of vacationing in Portland this year...

Only people who move here during the summer, don't have work lined up, and bitch about the gray all winter long are the only ones who catch it.

Tourists who visit, spend lots of money, an promptly leave almost never end up shitting their pants to death.


But seriously, this freaks me out.
posted by furnace.heart at 1:06 PM on September 20, 2013 [2 favorites]


We were involved in the production of a similar report in the UK which was released earlier this year.

One of the biggest problems is the fact that the major drug companies largely stopped R&D of new antibiotics years ago. They're just not profitable enough. It makes much more sense for them to invest in cancer treatments that sell for tens of thousands of dollars, than courses of antibiotics that sell for hundreds.
posted by daveje at 1:06 PM on September 20, 2013 [5 favorites]


Forgive me for being a cynic, but why do I feel that not long after we hit the described "cliff", there will suddenly be a miracle genetically manufactured (and thoroughly patented) virus that eats bad bacteria hitting the market for $150 a pill?

I mean, a lot of these issues we're seeing now with antibiotic resistent diseases were theorized not long after penicillin was discovered, and verified fairly consistently over the last couple decades. They've known it was coming, yet doctors have prescribed me antibiotics minutes after they say "It's definitely something viral."

As for the use of antibiotics in livestock, I recently read that it's primarily the massive conglomerates dishing out a metric ton of meat every hour that are perpetuating the practice of juicing the animals up with antibiotics. Granted, it would dig into their profits to raise the animals in healthier enviornments, and actively monitor their health, instead of buying trimox by the bucketful...

Ah, I think I see the problem here. Wouldn't want something as silly as public health and dodging population liquidating pandemics get in the way of our Capitalism. I even heard China is using more than half of their antibiotic supply on livestock. Glad to hear the socialists know the Good Word.
posted by Bathtub Bobsled at 1:10 PM on September 20, 2013 [3 favorites]


This paper seems to imply that antibiotics administered preventatively to animals exploit different weaknesses than antibiotics administered to humans. Is that correct, and if so how does that impact this issue?

This paper says it makes for worse diseases. The first name (Dr. Alan G Mathew) on the paper you cited works at Purdue University, where most of the Board of Trustees is comprised of both current and former leadership of National Pork Producers Council, US Meat Export Federation, and Cargill, to name a few.

So, yeah, you always gotta look at who's buttering the bread before you come to any sort of conclusion.
posted by Bathtub Bobsled at 1:25 PM on September 20, 2013 [2 favorites]


My mother has lung cancer and has been in and out of the hospital for the last six months and of course she got c. diff. The last hospital stay was last week, and we went in through the ER. As they were triaging her, I said the magic words (c. diff) and they immediately brought us to an isolation room, insisted I wear a gown and gloves, and generally acted all freaked out about it. She was then transferred upstairs to a swanky private room to keep her isolated from other patients and they had a whole gown/glove/handwashing station we had to pass through each time we came in and out of the room. It is extremely likely she contracted it at that same hospital, and it is terrible watching her suffer with it.
posted by crankylex at 1:28 PM on September 20, 2013 [1 favorite]


Having had a horrible case of c. diff about two months ago, and only responding to the second-tier antibiotics (vancomycin) after a couple weeks, I can tell you that one learns really quickly how one's intenstines work, how fast they work, and what options are available to you.

At first the idea of fecal transplants (heh, poop donor) is pretty awful. And then you realize you've been listening to your loved ones' shit for years anyway, and it's really not that bad. I'd go as far to say that using someone else's body to reset my own would be an elegant solution.

But until then.
posted by hanoixan at 1:30 PM on September 20, 2013


Freeze your poop! Freeze your poop before it's too late!
posted by hat_eater at 1:41 PM on September 20, 2013 [2 favorites]


there will suddenly be a miracle genetically manufactured (and thoroughly patented) virus that eats bad bacteria hitting the market

Something like phage therapy?

for $150 a pill?

Oh. Maybe that's why it never caught on.

Well, that and the fact that if the phages get out of control we'll have to use chinese needle snakes to get rid of them.
posted by weston at 1:52 PM on September 20, 2013


7 years ago I had a lump appear on my neck, and ended up getting half my thyroid removed. Post surgery they put me in a bed where the sheets had not been changed (I woke up feeling dried blood and pus at my feet) and I ended up with a Staph. Aureus infection (and in a different hospital for 10 days), and treating that resulted in allowing C. diff to proliferate. This was all within 2 weeks of my daughter being born. What a monumentally shitty time that was, and I never even got an apology from anyone. The only thing I got was a joke from the surgeon ("maybe I should have washed my hands!").
posted by swimming naked when the tide goes out at 1:52 PM on September 20, 2013 [2 favorites]


I think it's more likely that all the people making "going through a phage" jokes are what sent that treatment down a dead end. After the 9th time someone made the joke their friends killed them and the eventual 100% fatality rate confused the clinical trials.
posted by phearlez at 1:55 PM on September 20, 2013 [2 favorites]


Going through a phage? In Soviet Russia, the phage goes through you.
posted by weston at 3:00 PM on September 20, 2013 [1 favorite]


One of the biggest problems is the fact that the major drug companies largely stopped R&D of new antibiotics years ago. They're just not profitable enough. It makes much more sense for them to invest in cancer treatments that sell for tens of thousands of dollars, than courses of antibiotics that sell for hundreds.

It isn't price per pill that is the issue. It is the short duration of the new antibiotics' effectiveness that it is curbing investment.
posted by srboisvert at 4:31 PM on September 20, 2013


"I think it's more likely that all the people making "going through a phage" jokes are what sent that treatment down a dead end."

You know, I am actually a phage biologist and this is the first time I have ever heard this pun, I will be using it constantly from now on of course.
posted by Blasdelb at 4:52 PM on September 20, 2013 [11 favorites]


The best cure is to drink the Louisiana tap water with the brain amoebas. Turns out they cancel each other out.
posted by Renoroc at 5:03 PM on September 20, 2013


One of the biggest problems is the fact that the major drug companies largely stopped R&D of new antibiotics years ago. They're just not profitable enough. It makes much more sense for them to invest in cancer treatments that sell for tens of thousands of dollars, than courses of antibiotics that sell for hundreds.

It isn't price per pill that is the issue. It is the short duration of the new antibiotics' effectiveness that it is curbing investment.


Well, and the fact that a lot the low hanging fruit have mostly been played out. Most antibiotics are just modified forms of molecules found in nature; the penicillin family from mold, vancomycin from a soil bacteria, the cephalosporins from a fungus. Many that weren't isolated from nature were found almost by luck; the sulfa drugs came from dyes, the quinolones (like Cipro) started as byproducts of the synthesis of antimalarial drugs.

But there are only so many soil samples, fungus and molds to look through. Now we are coming to the point where we have to begin to find another way to make drugs rather than looking at nature. You can try to design your own perfect molecule from the ground up, or make a bunch of molecules and try them all in a shotgun approach, but the bottom line is, if you're not using a direct blueprint like nature provided with penicillin, it isn't going to be easy.

This is a big simplification, but this is a common theme in a lot of drugs; it appears to a lot of people that drug discovery isn't making the massive strides that it did over the last 100 years or so for the same reason. How to even overcome this is a big debate in drug discovery.
posted by roquetuen at 6:18 PM on September 20, 2013 [4 favorites]


At first the idea of fecal transplants (heh, poop donor) is pretty awful. And then you realize you've been listening to your loved ones' shit for years anyway, and it's really not that bad. I'd go as far to say that using someone else's body to reset my own would be an elegant solution.

Just don't do it DIY.
posted by Pope Guilty at 6:41 PM on September 20, 2013 [1 favorite]


But there are only so many soil samples, fungus and molds to look through. Now we are coming to the point where we have to begin to find another way to make drugs rather than looking at nature

This is really not true. There remains many, many areas to explore in this arena, and many pharmaceutical companies are doing it.
posted by smoke at 6:56 PM on September 20, 2013 [1 favorite]


This paper seems to imply that antibiotics administered preventatively to animals exploit different weaknesses than antibiotics administered to humans. Is that correct, and if so how does that impact this issue?

My understanding of the concern is that antibiotics that are fed to animals gets into our food supply, and thus we are all (vegans excluded) effectively on a low dose of antibiotics. That causes us to be incubators for these super bugs.
posted by gjc at 3:44 AM on September 21, 2013


Pope Guilty: "Just don't do it DIY."

Self administered home fecal transplants are a thing,
Success of Self-Administered Home Fecal Transplantation for Chronic Clostridium difficile Infection
BACKGROUND & AIMS: Clostridium difficile infection (CDI) can relapse in patients with significant comorbidities. A subset of these patients becomes dependent on oral vancomycin therapy for prolonged periods with only temporary clinical improvement. These patients incur significant morbidity from recurrent diarrhea and financial costs from chronic antibiotic therapy.
METHODS: We sought to investigate whether self- or family-administered fecal transplantation by low volume enema could be used to definitively treat refractory CDI.
RESULTS: We report a case series (n  7) where 100% clinical success was achieved in treating these individuals with up to 14 months of follow-up.
CONCLUSIONS: Fecal transplantation by low volume enema is an effective and safe option for patients with chronic relapsing CDI, refractory to other therapies. Making this approach available in health care settings has the potential to dramatically increase the number of patients who could benefit from this therapy
posted by Blasdelb at 3:17 PM on September 21, 2013 [1 favorite]


But there are only so many soil samples, fungus and molds to look through. Now we are coming to the point where we have to begin to find another way to make drugs rather than looking at nature

This is really not true. There remains many, many areas to explore in this arena, and many pharmaceutical companies are doing it.


Undoubtably, there are many yet to be discovered, as I mentioned that is really a simplification and there is a lot of debate in how to do drug discovery, but there is a debate.

This Science article talks about the debate and mentions that the "the expansion of synthetic medicinal chemistry in the 1990s caused the proportion of new drugs based on natural products to drop to ~50%".

It is hard to make generalization, but even though only a small amount of even bacteria have been screened for drugs, maybe that means that they are difficult to culture, or will not yield anything that is significantly different from what we already have or the natural products we find will be 64 step monsters which may not be worth the effort to synthesize (http://pipeline.corante.com/archives/2012/06/14/organic_synthesis_a_dead_end_for_graduate_students.php).

What I am saying is we got really lucky with penicillin and sulfa drugs, we aren't very likely to get the next generation of antibiotics from a mold growing in a scientist's sink or by observing workers in a dye plant, and it is going to be a tough road to go down.
posted by roquetuen at 10:00 AM on September 22, 2013 [1 favorite]






"A new antibiotic that can defeat anthrax and MRSA"

Whenever you hear these headlines its important to remember that handguns can too. Other things are also important like toxicity (and related therapeutic index), pharmacokenetics and the rest of pharmacodynamics.
posted by Blasdelb at 12:05 PM on September 22, 2013


Coming back late, apologies. I understand that the thing you get when you go official with the fecal transplant is that your donor gets a full workup so you are more assured that thier poop won't be bringing to your GI tract more than you bargained for (like symptom-less parasites, diseases, etc.).

I understand a good fecal transplant donor is quite valuable in this whole arena.
posted by kalessin at 7:45 AM on September 23, 2013


Now we are coming to the point where we have to begin to find another way to make drugs rather than looking at nature.

My understanding is that if we quit destroying the rain forest, we just might luck out on finding various medications there. Maybe even an antibiotic. But whateves.

Self administered home fecal transplants are a thing...

So it's no longer a curse to tell someone to eat shit?
posted by BlueHorse at 5:53 PM on September 23, 2013


You ...ummm ...don't eat it.
posted by Blasdelb at 11:51 PM on September 23, 2013


Precision targeted antibiotics that are inactive (harmless) except when illuminated with a specific wavelength of light could help mitigate antibiotic overuse and side effects. Maybe.
posted by RedOrGreen at 8:10 AM on September 24, 2013


Indeed, Blasdelb, I understand that medical transplants by authorized personnel are performed rectally, but I'm puzzled as to how someone would self-administer?

Of course, many things are done that I can't possibly conceive of...

Thank dog.
posted by BlueHorse at 11:04 AM on September 24, 2013


I think self-administration may be driven by both cost and by some folks (not entirely unfounded) suspicion of the medical industry.

That said, it seems like recurrent need for fecal transplants reveals an underlying problem. And ew.
posted by kalessin at 7:14 AM on September 25, 2013


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