infinite hope

In full from Ezra Klein:

I don’t feel like talking about the election today. So let’s talk about something else. On Wednesday, the FDA finalized a plan to ask drug companies to “voluntarily” limit the use of certain antibiotics in animal feed.

This might not seem like a huge deal to you. But it is. And it gets to one of my favorite scary statistics: 70 percent of the antibiotics used in this country — 70 percent! — go into livestock production. And that’s before you even get to the antibiotics that are used on animals who actually fall ill.

The reason is simple enough: If we didn’t pump our livestock full of antibiotics, they would get sick. They are, after all, packed into dim and dirty enclosures. They’re stacked on top of one another. And they’re being fed food they didn’t evolve to eat. All of this makes animals sick. But rather than raise them in a way that doesn’t make them sick, but costs somewhat more, we just keep them on constant does of antibiotics.

And then we eat them. Which means we get constant, low-grade doses of these antibiotics. Which means common bacteria get constant, low-grade doses of these antibiotics. And there’s mounting evidence that this background exposure to antibiotics is contributing to the startling rise in antibiotic-resistant bacteria.

Everything from staph to strep to salmonella is exhibiting uncommon resilience in the face of our latest drugs. A 2003 World Health Organization study (PDF) put it pretty starkly: “There is clear evidence of the human health consequences [from agricultural use of antibiotics, including] infections that would not have otherwise occurred, increased frequency of treatment failures (in some cases death) and increased severity of infections.” Even stronger was the title of a 2001 New England Journal of Medicine editorial: “Antimicrobial Use in Animal Feed — Time to Stop.” (Full disclosure: I’m partially quoting from a column I wrote on this subject in 2009.)

As my colleague Dina ElBoghdady notes, these concerns aren’t new. The FDA proposed banning penicillin and two forms of tetracycline for use on livestock in 1977. But industry opposition led to congressional oppositions, and the FDA backed down. Last year, the National Resources Defense Council, alongside a few other health and consumer-advocacy groups, sued to get those regulations back on track. Last month, a federal plaintiff court in Manhattan ruled that the FDA had to restart those proceeding. “The scientific evidence of the risks to human health from the widespread use of antibiotics in livestock has grown, and there is no evidence that the FDA has changed its position that such uses are not shown to be safe,” Judge Theodore H. Katz wrote.

The FDA would prefer a voluntary approach. They’re asking drug makers to reserve 200 antibiotics for humans because it’s the right thing to do. If they fail to comply, they have to say, on their labels, that these drugs are also used for animals. But if you’ve ever read the label on an antibiotic, you know it’s rather long. That’s not much of a sanction.

Congresswoman Louise Slaughter, a former microbiologist, has introduced The Preservation of Antibiotics for Medical Treatment Act, which takes a more aggressive approach: It simple reserves seven full classes of antibiotics for human use. If her legislation passed, those antibiotics simply couldn’t be used for livestock.

A 2005 study out of Tufts University estimated that antibiotic-resistant infections add $50 billion to the annual cost of American health care. On the other side of the coin, a National Academy of Sciences study found that eliminating non-therapeutic antibiotics from animals would cost about $5 to $10 per person per year. I’d pay that for a lower risk of super-staphylococcus.

This is the sort of issue that doesn’t tend to get much attention in Washington. But it matters. To put it in the simplest terms, a drug-resistant superbug might kill me, or kill you. The budget deficit probably won’t.

“Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry,” said Chan. “A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.”

Aggressive infections in hospitals are an increasing health problem worldwide. The development of bacterial resistance is alarming. Now a young Danish scientist has found a natural substance in a Chilean rainforest plant that effectively supports the effect of traditional treatment with antibiotics. Read more…

“Historically, in Western countries, classical strains of Klebsiella pneumoniae have caused infections mostly in sick, hospitalized patients whose host defense systems are compromised,” says Thomas Russo, MD, professor in the Department of Medicine at the UB School of Medicine and Biomedical Sciences and head of its Infectious Disease Division.

“But in the last 10 to 15 years, a new variant of it has begun causing community-acquired infection in young, healthy individuals,” he says. “This variant causes serious, life-threatening, invasive infections and is able to spread to other organs from the initial site of infection.”

Perhaps most important, says Russo, these hypervirulent strains of Klebsiella pneumoniae have the potential to become highly resistant to antibiotics, similar to Escherichia coli and classical Klebsiella pneumoniae.

“These hypervirulent strains are the next ‘superbugs’ -in-waiting,” he says. “If they become resistant to antibiotics, they will become difficult, if not impossible to treat.”

With recent funding from the National Institutes of Health under a program to fund high-risk, high-reward research, Russo and his UB colleagues are studying the microbiology of the new variant of Klebsiella pneumoniae in an effort to identify the genes that make it hypervirulent so they can figure out how to stop it in its tracks.

“Infections due to highly resistant bacteria are becoming increasingly problematic,” says Russo. “We are continually threatened by a ‘post-antibiotic’ era. The combination of a bacterium that is both highly virulent and resistant to antimicrobials is double-trouble.”

Read more…

North Carolina State University chemists have created a compound that makes existing antibiotics 16 times more effective against recently discovered antibiotic-resistant “superbugs.”

In at least 37 states, Washington, D.C., and Puerto Rico, doctors have identified bacteria, including E. coli, that produce Klebsiella pneumoniae carbapenemase, or KPC—an enzyme that makes bacteria resistant to most known treatments. It’s much more prevalent in America than bacteria that produce NDM-1, the enzyme that has Indian doctors ”hell scared,” and, according to Alexander Kallen, a medical officer at the Centers for Disease Control in Atlanta, the final outcome isn’t much different: superbacteria that are hard to kill.