Superbugs

August 9, 2008 10:16 PM

Superbugs."The new generation of resistant infections is almost impossible to treat."
posted by homunculus (55 comments total)

Lighten up, Francis.
posted by Fupped Duck at 10:33 PM on August 9, 2008 [1 favorite]

I usually wait until the magazine arrives and then it's too late to get in on the snarking...but in this case, I'd like to make the generic comment that the inability of conventional medical procedures to cure what used to be fairly routine infectious diseases has been disturbing for a decade or two. It's getting worse. Calling Dr. Shyalmalan.
posted by kozad at 10:33 PM on August 9, 2008

Good link, thanks for posting. One longer term possibility I was surprised not to see mentioned in this article is bacteriophage ("phage") therapy, which might be an option with Gram-negative bacteria.
posted by Blazecock Pileon at 10:35 PM on August 9, 2008 [1 favorite]

...disturbing for a decade or two.

It was disturbing to me in November 2001, when I got a SEMI-resistant staph infection in my left arm, swelling it up to the size of the turkey on Thanksgiving weekend, and requiring 'the second-most powerful antibiotics available' in the Hospital and some massively painful 'scraping out of the bad stuff'. Ten days in hospital, a month of twice-daily wound-cleaning after the hospital, plus I was the only one at my pharmacy with a prescription for Cipro that wasn't taking it 'cause I was scared of Terrorist Anthrax. (And during a time I lacked access to the Web and MetaFilter)

Thank you New Yorker and homunculus for bringing back those wonderful memories. We're all gonna die. I'm right in the front of the line.
posted by wendell at 10:45 PM on August 9, 2008

I'm sorry if I've caused you any distress by posting this, wendell. That's the last thing I want. But I thought it was a good article on an important subject.
posted by homunculus at 10:54 PM on August 9, 2008

This is an excellent article that deserves a wide readership and an FPP. But I must point out that Dr. Groopman, who I much admire, made a significant error when talking about the cases of Acinetobacter among troops returning from Iraq and Afghanistan. He writes, "Now microbes are appearing far outside their environmental niches. Acinetobacter thrives in warm, humid climates, like Honduras, as well as in parts of Iraq, and is normally found in soil."

While Acinetobacter as a broad class of bacteria is indeed found in soil, the particular species causing the epidemic among the troops, A. baumannii -- which has spread to and killed civilians in American and European military hospitals -- is not native to Iraqi soil, as the Pentagon has claimed and the press has repeated many times. In fact, A. baumannii is found most often in hospitals, particularly in ICUs. Last year in Wired, I wrote the most in-depth investigation of this epidemic that has appeared in the media to date: The Invisible Enemy [previously FPP'd]. Drawing on the Defense Department's own internal investigations, which were never made public, I discovered that while Pentagon spokesmen were still blaming the epidemic on organisms in the Iraqi soil -- or even on insurgents intentionally "dosing" IEDs with animal feces -- the DoD's own investigators had found that the bacteria was only present in our combat-support hospitals, where infection control was lax and antibiotics were overprescribed in the early days of the war. In other words, Iraqis didn't give us this bug -- we gave it to them, by creating conditions (i.e., massive amounts of wounded, unsterile conditions, and antibiotic overuse) in which the bacteria thrived and spread.

Other than that minor but significant point, great piece by Groopman, and this whole subject deserves much more (unhysterical) attention.
posted by digaman at 11:06 PM on August 9, 2008 [23 favorites]

I was also surprised when I read this article other night (for some light reading before bed!) that there was no discussion of phage therapy. I have this vague sense that it's not being studied or developed extensively in the West, even now, because of its initial development in the Soviet Union (after all, we BEAT THEM IN THE COLD WAR, therefore their science must be bunk)....but maybe that's an unfair assumption.
posted by scody at 11:07 PM on August 9, 2008

aww wendell. That must have been massively scary. wendell 1, Superbug 0. YAY, you won! Glad you're alive.

digaman: In other words, Iraqis didn't give us this bug -- we gave it to them, by creating conditions (i.e., massive amounts of wounded, unsterile conditions, and antibiotic overuse) in which the bacteria thrived and spread.

Holy shit. Amazing.

And that's an awesome article you wrote.

Surviving the new killer bug. Time mag article.

Oh man, that Klebsiella pneumoniae does nasty damage. *Warning. Not for the squeamish. Image. And mrsa.

Rapid Spread of Carbapenem-Resistant Klebsiella pneumoniae in New York City

Oil from the common herb oregano may be an effective treatment against dangerous, and sometimes drug-resistant bacteria...and thymol.

We are having problems finding this funding because essential oils cannot be patented as they are naturally occurring, so few drug companies are interested in our work as they do not see it as commercially viable. Obviously, we find this very frustrating as we believe our findings could help to stamp out MRSA and save lives,' added Peter, who is based at Hope Hospital.
posted by nickyskye at 11:12 PM on August 9, 2008

Thanks, nickyskye. And nice to see you again!
posted by digaman at 11:20 PM on August 9, 2008

Thanks digaman. :)
posted by nickyskye at 11:23 PM on August 9, 2008

I have this vague sense that it's not being studied or developed extensively in the West, even now, because of its initial development in the Soviet Union (after all, we BEAT THEM IN THE COLD WAR, therefore their science must be bunk)....but maybe that's an unfair assumption.

Because of the age of the technology involved, it may be more difficult to patent and monetize phage therapies. It'll be up to governments to pick up the slack, where private industry has so far failed.
posted by Blazecock Pileon at 11:25 PM on August 9, 2008

it may be more difficult to patent and monetize phage therapies.

Ah, of course. And antibiotic research/development isn't profitable to begin with, either... gah!!
posted by scody at 11:30 PM on August 9, 2008 [1 favorite]

It is once again time for me to beg anyone who will listen to stop using "antibacterial" soaps, cleaning products, cutting boards, socks - whatever. No more orange hand/dish soap, ok? No more "antibacterial" anything.

Don't take antibiotics for a cold - a cold is a virus, not a bacterial infection. Don't take antibiotics at random. Don't ask your doctor for them unless you actually have a bacterial infection that can't be controlled using your immune system and some proper rest.

All of these things are just making the bacteria stronger and stronger.

I know, they're tiny little things. I know, you can't even see them. But they've been here evolving for much, much longer than we have. Look, they've been here since before the dinosaurs - and they've survived many mass extinction events. We have yet to actually meet a mass extinction event.

How old are bacteria? How does over 3000 million years sound? You think some sulfa drugs, some penicillin or some fancy orange soap is going to keep the bacteria off, or do anything other than cause them to adapt rapidly to our crude, silly little toxins?

No. Comparing the human time-scale from, say, the Stone Age until now - bacteria haven't even really noticed that we're here yet. The last 50 years is a nearly unmeasurable picosecond to the long history of bacteria. They're probably still arguing and trying to decide if we're intelligent life or not. They just think we taste good because we eat so much fat and sugar.

Now if you'll excuse me I'm going to eat a whole bunch of garlic and wash it down with handfuls of dirt. My immune system isn't evolving fast enough. I think I'm going to start licking the walls in public restrooms or something.

Note to self: Avoid hospitals and extremely clean homes. The cleaner the home, the more likely they always wipe everything down with bleach and antibiotics - and the more likely it will be a fertile breeding ground for superbacteria all over everything, because everything else is dead.
posted by loquacious at 12:08 AM on August 10, 2008 [10 favorites]

Can someone who isn't a shrill, sanctimonious fuck (such as myself) please rewrite and/or reaffirm what I just wrote in my last comment so more people will read and understand how these things are problems for all of us? *gnashes teeth, goes back to reading the article despite creeping skin-crawlies*
posted by loquacious at 12:17 AM on August 10, 2008

I thought all soap was 'antibacterial' by nature. Is that an incorrect perception? Why?
posted by Kikkoman at 12:18 AM on August 10, 2008

Thanks for that clarification, digaman.
posted by homunculus at 12:29 AM on August 10, 2008

Basic soap + hot water is by nature antibacterial, Kikkoman. As far as I recall, surfecants not only make water "more wet", but the small bubbles (and hot water) help naturally kill bacteria.

I'm talking about the (usually orange) antibacterial soap (or other cleaning products) that most commonly use triclosan as an antibacterial agent. (See wikipedia on antibacterial soap.) The stuff has become very, very popular over the past few years.

There are also many products (such as cutting boards or even clothes like socks or workout clothes) that have been marketed with embedded triclosan or other antibiotic agents.

To understate things, this is unwise.
posted by loquacious at 12:33 AM on August 10, 2008

Antibacterial soaps that kill 99.9% of bacteria leave the nastiest 0.1% around.

Sanitation may have been the greatest single development in the history of humanity, but the level to which we take it today is ridiculous. Perhaps we should all employ the 3 second rule intentionally, just to keep our immune systems on their toes.
posted by clearly at 12:51 AM on August 10, 2008

Continuation from nickyskye's post above. This is an interesting point in that the large drug companies , driven by the market have little incentive to get involved with products that cannot be patented. A call for open source medicine.
posted by adamvasco at 1:46 AM on August 10, 2008

I'm hoping triclosan will be banned as an aquatic pollutant. East Bay MUD was looking into it last year.
posted by ryanrs at 4:21 AM on August 10, 2008 [1 favorite]

Wow, the New Yorker echo took almost a week!

Seriously, though, this is one of the most important, and simultaneously least discussed, public health concerns in the states.

I like to think of myself as anti-nanny state, but I really think that allowing Dow and Clorox to convince people that they need the products that are making this so much worse so quickly would be a chance to do some useful public safety legislation.
posted by paisley henosis at 5:31 AM on August 10, 2008 [2 favorites]

Yeah, not to make wendell feel even worse, but loquacious has it: We are not going to win this thing. It may take awhile, but the bacteria will outlast our species.
posted by odinsdream at 5:32 AM on August 10, 2008

loquacious, it's my understanding that as horrible as triclosan is, bleach (as in bleach-water solutions used to wipe countertops that may have had raw meat juices on them) and the alcohol in commercial hand sanitizers, don't increase bacterial resistance.

Antibacterials kill bacteria. Those such as alcohol, bleach and peroxide evaporate after killing the bacteria, but provide no lasting antibacterial action. Other antibacterials, such as the commonly used triclosan, leave a residue, which manufacturers say continues to kill bacteria. While that is the chemical's greatest selling point, it's also its greatest potential drawback, because that residue has the potential to create resistant bacteria or so-called super bugs, some researchers say. ...

Alcohol-based sanitizers are not believed to promote bacterial resistance because they don't leave a residue that allows bacteria time to evolve a resistant strain.

"(Resistance is) not going to occur with alcohol, peroxide or bleach. It's not there long enough (for the bacteria) to select a mutant," Levy says.

posted by maudlin at 6:51 AM on August 10, 2008 [2 favorites]

Let's not lump bleach with the antibiotics and antibacterials. Antibiotics must be relatively non-toxic to be useful as medicines. Antibacterials must at least be safe for external use. Bleach, on the other hand, is a destructive inorganic agent more comparable to fire or the autoclave. Bacteria are unlikely to develop resistance to bleach.*

* Offer void in low concentrations. Cryptosporidium cysts seem to be resistant to chlorine levels commonly found in swimming pools.
posted by ryanrs at 7:01 AM on August 10, 2008 [1 favorite]

or what maudlin said
posted by ryanrs at 7:04 AM on August 10, 2008

Laurie Garrett wrote about this over a dozen years ago, and i imagine she wasn't the first. Still a good read.
posted by CheeseDigestsAll at 7:27 AM on August 10, 2008

If antibiotics are outlawed then only outlaws will have antibiotics.
posted by Mr.Encyclopedia at 7:50 AM on August 10, 2008 [1 favorite]

Back in '96, I managed to get a massive staph infection in the incision for my lumbar disc surgery. 5 days in the hospital with pencil-thick needles/drains in my back, then a month with a shunt going in my shoulder, leading to my jugular vein, for daily doses of a drug that, I was told (though I can't remember the name) there was nothing after that had gotten out of testing. My family kind of kept me in the dark about this whole thing, but evidently I came pretty close to dying.

This stuff is scary. It's approaching The Sheep Look Up scary, if not Oryx and Crake outright terrifying. Take care of those little cuts on your hands. Just, y'know, because.
posted by Ghidorah at 9:35 AM on August 10, 2008

loquacious, I don't think it's so clear-cut: At least seven peer-reviewed and published studies have been conducted demonstrating that triclosan is not significantly associated with bacterial resistance over the short term
posted by wastelands at 10:02 AM on August 10, 2008

Bleach, on the other hand, is a destructive inorganic agent more comparable to fire or the autoclave. Bacteria are unlikely to develop resistance to bleach.

Probably not, but this doesn't address the problem of the potential negative side-effects of reduced population sizes. Even if the so-called superbugs never develop a resistance to chemicals like bleach, the mere fact that competing bacteria have been wiped out of a treated area could lead to a boom in the "superbug" population density.
posted by Civil_Disobedient at 10:12 AM on August 10, 2008

It doesn't help that there has been a huge decline in new antibiotics...
posted by plinth at 10:22 AM on August 10, 2008

In my article linked above, I cite the chilling anecdote of a Norwegian researcher who discovered that a container of disinfectant being used by a gynecologist to sterilize catheters had become "a veritable culture" of Acinetobacter baumannii. They're quite versatile bugs.
posted by digaman at 10:25 AM on August 10, 2008

the short term being an important qualifier. These superbugs did not develop in the short term.
posted by pointilist at 10:37 AM on August 10, 2008

It is now nearly impossible, at my local grocery stores, to buy a cheap liquid hand soap that doesn't have triclosan in it. To get to the non-triclosan ones, you have to pay a premium for other fancy stuff. And yet it's useless. Less than useless, if you count in the fact that as well as having shown to be no more effective than regular soap, there's the resistance question to deal with.
posted by subbes at 12:51 PM on August 10, 2008

Even if the so-called superbugs never develop a resistance to chemicals like bleach, the mere fact that competing bacteria have been wiped out of a treated area could lead to a boom in the "superbug" population density.

If "superbugs" have no resistance to bleach, then they won't be favored in a bleached environment. Selective pressure may favor bleach resistance, but (1) good luck with that, and (2) that's not related to drug resistance anyway.
posted by ryanrs at 12:53 PM on August 10, 2008

Antibacterial soap has nothing to do with this problem. The problem is that bacteria are evolving resistance to things that can be safely ingested or infused into human beings, like penicillin and other pharmaceutical antibiotics. Triclosan and chlorhexidine do not meet this criterion. Neither do thymol or oregano extracts, for that matter; they may be useful as antibacterial topicals but we are not in need of new antibacterial topicals, the ones we have work fine. You cannot hang a bag of thymol and run it into the IV of someone dying of Klebsiella pneumonia.
posted by ikkyu2 at 1:14 PM on August 10, 2008 [1 favorite]

Ah, so the pizza with extra oregano I just ordered won't actually do anything for my sinus infection.
posted by subbes at 1:16 PM on August 10, 2008

It is once again time for me to beg anyone who will listen to stop using "antibacterial" soaps, cleaning products, cutting boards, socks - whatever. No more orange hand/dish soap, ok? No more "antibacterial" anything.

I'm right there with you. I've been on a one-woman mission teaching my partner that no, we do not need to put BLEACH all over the house every single time we clean it. That we do not need to STERILIZE the sink. No one is performing surgery here, soap will do just fine. (And since I am a card carrying tree-hugger, it's Simple Green. Good stuff.)

Two anecdotes:
#1) I took a short trip to the ER when I was in Iceland for a condition that I have. Nothing contagious. No infections. I was quarantined as soon as I got there for having been in contact with an American hospital within the past six months. MRSA doesn't exist in Iceland and the possibility of my unknowingly spreading it to patients with weakened immune systems and/or open wounds was distressing enough to require me to be in an isolated room with a huge sign on it saying "DO NOT ENTER" and instructing the staff to wash their hands with alcohol before AND after visiting my room. And wearing masks. And gloves. And orange jackets. It was bizarre to say the least, but hey, small island nation - I can definitely appreciate doing everything possible to avoid an MRSA outbreak.

They swabbed me for it, so that if I was a carrier, I would be treated with antibiotics as a prophylactic measure meant to protect the people of Iceland. I wasn't, so I was set free and humans were allowed to touch me again.

#2) I was in an ER in the US (being semi-seriously ill is kind of a hobby of mine) and there was a nickel on the floor. A kid stooped over and picked it up and his mother started screeching "NO! Don't touch it! There are super-germs all over the place!" So, the kid put the nickel down (Uh, kid, damage already done - you should have just kept it.) and his mother dragged him over to the nurse's station and pumped some of the hand-sanitizer that NURSES use all over this kid's hands. For touching a nickel.

I wanted to start yelling "GERM PREVENTION: YOU'RE DOING IT WRONG."

(Also this article simultaneously enlightened and terrified me.)
posted by grapefruitmoon at 1:17 PM on August 10, 2008

On second thought:


Antibacterial soap has nothing to do with this problem.

Thanks for that, ikkyu2! I'll stop freaking out whenever I see moms with hand-sanitizer chasing their children through the playground. Though I myself will stick to just wiping the kid down with baby wipes, I will not fear that the sanitized children have become breeding grounds for super-bacteria.

(I keep picturing Super Bacteria as having capes and masks, like anti-super heroes.)
posted by grapefruitmoon at 1:19 PM on August 10, 2008

Antibacterial soap has nothing to do with this problem.

This is incorrect.

"When a bacterial population is placed under a stressor-- such as an antibacterial chemical--a small subpopulation armed with special defense mechanisms can develop. These lineages survive and reproduce as their weaker relatives perish. 'What doesn't kill you makes you stronger' is the governing maxim here, as antibacterial chemicals select for bacteria that endure their presence.

As bacteria develop a tolerance for these compounds there is potential for also developing a tolerance for certain antibiotics. This phenomenon, called cross-resistance, has already been demonstrated in several laboratory studies using triclosan, one of the most common chemicals found in antibacterial hand cleaners, dishwashing liquids and other wash products. "Triclosan has a specific inhibitory target in bacteria similar to some antibiotics," says epidemiologist Allison Aiello at the University of Michigan School of Public Health.
posted by digaman at 2:20 PM on August 10, 2008

from the Alliance for the Prudent Use of Antibiotics:

Do antibacterials create resistant bacteria?

Because of their rapid killing effect, the non-residue producing antibacterial agents are not believed to create resistant bacteria. Resistance results from long-term use at low-level concentrations, a condition that occurs when consumer use residue-producing agents such as triclosan and triclocarban. Until recently, it was accepted that these agents did not affect a specific process in bacteria, and because of this, it was unlikely that resistant bacteria could emerge. However, recent laboratory evidence indicates that triclosan inhibits a specific step in the formation of bacterial lipids involved in the cell wall structure. Additional experiments found that some bacteria can combat triclosan and other biocides with export systems that could also pump out antibiotics. It was demonstrated that these triclosan-resistant mutants were also resistant to several antibiotics, specifically chloramphenicol, ampicillin, tetracycline and ciprofloxacin.

Resistance to antibacterials has been found where these agents are used continuously (as in the hospital and food industry); however, at the present time, this modest increase in resistance has not yet created a clinical problem.

Can the widespread use of antibacterial agents lead to more resistant bacteria?

Many scientists feel that this is a potential danger, but others argue that the laboratory conditions used in the research studies do not represent the "real world." So far, studies of antibacterial use in home products such as soap, deodorant and toothpaste have not shown any detectable development of resistance. However, such products have only been in use for a relatively short period of time and studies of their effects are still extremely limited.
posted by digaman at 2:28 PM on August 10, 2008

I was going to clean the house today, but now I'm not! Thanks for posting this!
posted by desjardins at 3:35 PM on August 10, 2008 [1 favorite]

You cannot hang a bag of thymol and run it into the IV of someone dying of Klebsiella pneumonia.

Well, you can, it's just that nice people with guns and badges will want to talk to you about it after.
posted by ROU_Xenophobe at 3:45 PM on August 10, 2008

Well, it's not like that. But as the child of a woman, bless her heart, who ran to the doctor to get antibiotics every time she had a sniffle, and advised that her kids did the same... and then simply popped a few until her symptoms went away, ignoring the instructions on the bottle to always finish the cycle... and kept bottles of Cipro around the house, just in case... and used antibiotic soaps at home, just in case... I now realize that my mother was a little superbug evolution-acceleration machine. Every little bit helps, from the bugs' perspective.
posted by digaman at 3:45 PM on August 10, 2008

Oh my god, digaman... did we have the same mother?
posted by scody at 3:49 PM on August 10, 2008

I daren't ask if you're Jewish. :)
posted by digaman at 3:57 PM on August 10, 2008

If you need major invasive surgery, and have the leisure to choose where you want it done, it might be a good idea to choose an university teaching hospital in a relatively underpopulated area. Not a big-city public hospital.
posted by bad grammar at 4:23 PM on August 10, 2008

Superbugs are a problem.

Washing your hands or using Purell on your kids is not making the problem worse.

Unless you have severely depressed immune system people living in your house, bleaching everything is not necessary, but also not making the problem worse.

This is a problem in Big Buildings With Lots of Sick People (TM). This is not a problem caused by sanitizing your cutting board at home.

Most people badly overreact to "germs" and how careful you should be of them.

Fewer germs, by and large, is a good thing. I don't think anyone would want to have their spleen cut out by a surgeon who didn't wash their hands.

But, just because someone somewhere is spraying Lysol every 20 minutes in their bathroom is not going to cause you to die of flesh-eating bacteria.

The superbug problem has 3 main components:

1. Overuse of powerful antibiotic medicines, which accounts for probably 50% of the problem

2. Improper cleaning techniques and disinfecting methodologies at Big Buildings With Lots of Sick People (TM), which accounts for probably 49.9% of the problem

3. Everything else, which accounts for the remaining 0.1% of the problem

Don't take antibiotics for every little sniffle. Do wash your hands.

Don't panic.
posted by Ynoxas at 9:28 PM on August 10, 2008

As a healthy person, I would far rather be infected with a strain of bacteria that was wasting a lot of its resources making multidrug-resistance transporters, instead of multiplying and dividing with every single bit of energy from every free carbon it metabolized. My immune system would beat the living crap out of that bug before it even knew what hit it, without assistance from any antibiotics.

It is the very young, the elderly, and the already-ill-from-other-causes who get in trouble with these resistant bugs. And the hypochondriacs, who are out in force in this thread. Good prescribing practices are necessary to safeguard the first three; there is no help for the latter.
posted by ikkyu2 at 4:27 AM on August 11, 2008

Well, as long as you can ensure your perpetual health and youth, you clearly have nothing to be concerned about.
posted by digaman at 10:57 AM on August 11, 2008 [1 favorite]

It is the very young, the elderly, and the already-ill-from-other-causes who get in trouble with these resistant bugs.

This will be a consolation to a friend of a colleague (in her 30s, ran marathons, no chronic illnesses, etc.) who nearly had to have her leg amputated when she got a drug-resistant infection after some muddy water splashed into a scratch on her knee during a day of gardening. They did manage to save her leg, but her running days are over, and she's now got permanent kidney damage from the medications. It's perhaps not the typical scenario, but it's not an unknown one, either.
posted by scody at 12:43 PM on August 11, 2008

My ex-husband had a pilonidal cyst removed and got MRSA, horrible horrible mind numbing quantities of it. Then I got MRSA and then the dog got MRSA and we were so very overly careful and quarantined (I even slept in a separate room and we used separate bathrooms and laundered cloths and UH), battling it took over a year....I truely believe that MRSA was the straw that broke our marriage's back...and now I even get a zit and freak out. Bad stuff.
posted by Jenny is Crafty at 12:50 PM on August 11, 2008

Ynoxas, what about the (over)use of antibiotics in the meat industry?
posted by theora55 at 6:42 AM on August 12, 2008

theora55: I'm not aware of definitive links between antibiotic use in food animals and increased resistance in human borne illnesses, but I'm no expert in agriculture, and more than willing to augment my list above. But I think at this time it is suspicion, not fact. But again, I will defer to the literature, which I admit some ignorance to.

The talk in healthcare (my field) is what I said above. This is really a prescription and disinfecting problem at its core, and why you (typically) see these resistant strains in medical care facilities, not at home or the workplace.

It's scary to think you could be like Jenny's husband, and go to the hospital for a minor procedure and leave with something much nastier. We know this, and it is a HUGE topic of conversation in the halls of facilities across the country. It is not being ignored.

From my understanding, the bigger problem with the meat industry is the hormones they use, and how that could potentially be harming adolescents.
posted by Ynoxas at 7:59 AM on August 12, 2008

I'm late to the party, but let me try to help, locquacious!

Can someone who isn't a shrill, sanctimonious fuck (such as myself) please rewrite and/or reaffirm what I just wrote in my last comment

Locaquacious: Eat shit and don't die.
posted by davemee at 2:08 PM on August 15, 2008