The CDC has worked with hospitals to successfully apply these measures. The CDC worked with Florida to stop a year-long CRE outbreak in a long-term acute care hospital. With the improved use of CDC recommendations (such as educating staff; dedicating staff, rooms, and equipment to patients with CRE; and improving use of gloves and gowns) the percentage of patients who got CRE at the facility dropped from 44% to 0.

One travesty has been how poorly health care professionals have been about prescribe antibiotics wisely We need to improve and follow CDC antibiotics guidelines (stop the overuse of antibiotics) and use culture results (for patients undergoing treatment) to modify prescriptions, if needed. Antibiotic overuse contributes to the growing problems of Clostridium difficile (c-diff) infection and antibiotic resistance in healthcare facilities. Studies indicate that nearly 50% of antimicrobial use in hospitals is unnecessary or inappropriate (per CDC web site).

Israel decreased CRE infection rates in all 27 of its hospitals by more than 70% in one year with a coordinated prevention program. The USA is at a critical time in which CRE infections could be controlled if addressed in a rapid, coordinated, and consistent effort by doctors, nurses, lab staff, medical facility leadership, health departments/states, policy makers, and the federal government.

As I have been saying for years the damage we are creating due to our actions around the use and abuse of antibiotics is likely to kill tens of thousands, or more people. Because the deaths are delayed and often not dramatic we have continued dangerous practices for years when we know better. It is a shame we are condemning so many to increased risks. The CDC, and others, are doing good work, unfortunately too much bad work is continuing in the face of evidence of how dangerous that is.

Related: CDC Urges Increased Effort to Reduce Drug-Resistant Infections (2006) – Key scientific articles on Healthcare Associated Infections via CDC – Our Dangerous Antibiotic Practices Carry Great Risks – Dangerous Drug-Resistant Strains of TB are a Growing Threat

The damage done by our indiscriminate use of antibiotics is not just the long term resistance that we create in bacteria (making the future more dangerous for people) that I have written about numerous times but it also endangers the person taking the anti-biotics in the short term. Sometimes the other damage is a tradeoff that should be accepted. But far too often we ignore the damage taking antibiotics too often does.

When You Swallow A Grenade

The human body contains trillions of microorganisms — outnumbering human cells by 10 to 1. Because of their small size, however, microorganisms make up only about 1% to 3% of the body’s mass, but play a vital role in human health.

Where doctors had previously isolated only a few hundred bacterial species from the body, Human Microbiome Project (HMP) researchers now calculate that more than 10,000 microbial species occupy the human ecosystem. Moreover, researchers calculate that they have identified between 81% and 99% of all microorganismal genera in healthy adults.

“Humans don’t have all the enzymes we need to digest our own diet,” said Lita Proctor, Ph.D., NHGRI’s HMP program manager. “Microbes in the gut break down many of the proteins, lipids and carbohydrates in our diet into nutrients that we can then absorb. Moreover, the microbes produce beneficial compounds, like vitamins and anti-inflammatories that our genome cannot produce.” Anti-inflammatories are compounds that regulate some of the immune system’s response to disease, such as swelling.

“Enabling disease-specific studies is the whole point of the Human Microbiome Project,” said Barbara Methé, Ph.D., of the J. Craig Venter Institute, Rockville, MD, and lead co-author of the Nature paper on the framework for current and future human microbiome research. “Now that we understand what the normal human microbiome looks like, we should be able to understand how changes in the microbiome are associated with, or even cause, illnesses.”

Read the full NIH press release on the normal bacterial makeup of the body

Related: Tracking the Ecosystem Within Us – What Happens If the Overuse of Antibiotics Leads to Them No Longer Working? – Antibacterial Products May Do More Harm Than Good – Antibiotics Too Often Prescribed for Sinus Woes

I continue to believe we are far to quick to medicate. We tremendously overuse anti-biotis and those costs are huge. They often are delays and systemic and given our current behavior we tend to ignore delayed and systemic problems.

The link between the extremely rapid rise in obesity and the overuse of anti-biotics is in need of much more study. It seems a possible contributing factor but there is much more data needed to confirm such a link. And other factors still seem dominant to me: increase in caloric intake and decrease in physical activity.

Related: Science Continues to Explore Causes of Weight Gain – Waste from Gut Bacteria Helps Host Control Weight – Healthy Diet, Healthy Living, Healthy Weight – Raising Our Food Without Antibiotics

Resistance to antibiotics is becoming a crisis

Seeking new antibiotics is wise but the commentary completely ignores our bad practices that are causing the problem to be much worse than it would be if we acted as though bad practices that will lead to many deaths should be avoided.

Previous posts about practices we taking that create great risk for increased deaths: Antibiotics Too Often Prescribed for Sinus Woes (2007) – Meat Raised Without Antibiotics is Sadly Rare Today (2007) – Overuse of Antibiotics (2005) – CDC Urges Increased Effort to Reduce Drug-Resistant Infections (2006) – FDA May Make Decision That Will Speed Antibiotic Drug Resistance (2007) – Antibacterial Soaps are Bad (2007) – Waste Treatment Plants Result in Super Bacteria (2009) – Antibiotics Breed Superbugs Faster Than Expected (2010) – Antibiotics Use in Farming Can Create Superbugs (2010) – What Happens If the Overuse of Antibiotics Leads to Them No Longer Working? (2011) – Dangerous Drug-Resistant Strains of TB are a Growing Threat (2012)

Obviously bacteria evolve to survive the counter measures we currently have. The foolish practices of promoting ignorance of evolution leads to a society where the consequences of actions, and the presence of evolution, lead to bad consequences. We find ourselves in that society.

The dangerous risks we are taking are known by those that understand science, health care and evolution. We are choosing not to take these risks seriously enough to stop the foolish actions As the consequences of those decisions causing ever increasing harm it would be nice if we could learn from that and improve our ability to apply scientific knowledge to public policy. However most of the evidence I see is we are decreasing our interest in using science to understand our choices. Choosing to ignore science when it would help understand the consequences of choices is an extremely damaging decision for a society to make.

It is possible we find some super drugs that help us treat bacterial infections. Hopefully we do. But whether we do or not the practices we continue to engage in are foolish. We are risking millions of deaths on the hope that either evolution doesn’t happen (it does) or that find some super drugs that save us. The decision that the value of cheaper factory farm meat and giving patients drugs that won’t help them because otherwise they will make a bother of themselves (since they don’t understand that anti-biotics don’t treat viral infections and they just want a magic pill) compared to risking millions of lives are the tradeoffs that are political in nature.

Science just helps us understand the options and consequences; the decision on what we do is political. The current decisions (to mostly ignore the problems) are based more on ignorance than science, I believe. If we clearly stated, “we understand the risk of millions of lives to continue x, y and z policy and we figure new super drugs are likely to be found so we choose to follow the current policies”, I would disagree, but at least feel we made a decision based on knowledge instead of ignorance.

Related: How Bleach Kills Bacteria – Tuberculosis Risk – New Drug Targets May Fight Tuberculosis in Novel Way – New Family of Antibacterial Agents Discovered – Are you ready for a world without antibiotics? – Biologists Identified a New Way in Which Bacteria Hijack Healthy Cells – Potential Antibiotic Alternative to Treat Infection Without Resistance

The lead researcher on this study, Gerry Wright, previously published on antibiotic properties of bacteria found in soil.

Abstract of Antibiotic Resistance Is Prevalent in an Isolated Cave Microbiome

Antibiotic resistance is a global challenge that impacts all pharmaceutically used antibiotics. The origin of the genes associated with this resistance is of significant importance to our understanding of the evolution and dissemination of antibiotic resistance in pathogens. A growing body of evidence implicates environmental organisms as reservoirs of these resistance genes; however, the role of anthropogenic use of antibiotics in the emergence of these genes is controversial.

We report a screen of a sample of the culturable microbiome of Lechuguilla Cave, New Mexico, in a region of the cave that has been isolated for over 4 million years. We report that, like surface microbes, these bacteria were highly resistant to antibiotics; some strains were resistant to 14 different commercially available antibiotics. Resistance was detected to a wide range of structurally different antibiotics including daptomycin, an antibiotic of last resort in the treatment of drug resistant Gram-positive pathogens.

Enzyme-mediated mechanisms of resistance were also discovered for natural and semi-synthetic macrolide antibiotics via glycosylation and through a kinase-mediated phosphorylation mechanism. Sequencing of the genome of one of the resistant bacteria identified a macrolide kinase encoding gene and characterization of its product revealed it to be related to a known family of kinases circulating in modern drug resistant pathogens. The implications of this study are significant to our understanding of the prevalence of resistance, even in microbiomes isolated from human use of antibiotics. This supports a growing understanding that antibiotic resistance is natural, ancient, and hard wired in the microbial pangenome.

Related: Alligator Blood Provides Strong Resistance to Bacteria and Viruses – Bacteria Survive On All Antibiotic Diet – Clay Versus MRSA Superbug

We tend to do a poor job of dealing with systemic effects of poorly functioning systems. Direct present threats get out attention. And we are decent at directing brain power and resources to find solutions. We are not very good at dealing with failures that put us in much worse shape in the long term. For small threats we can wait until it becomes a present threat and then deal with it. There are costs to doing this (economic and personal) but it can be done.

Some problems though become enormously complicated to deal with once they become obvious. Global climate change, for example. And often, even once they are obvious, we won’t act until the costs (economic and in human lives) are very large. It is possible that once we decide to get serious about dealing with some of these issues that the costs (economic and in human lives) will be catastrophic.

The failure to use anti-biotics medicine properly is a very serious threat to become one of these catastrophic societal failures. While tuberculosis failures may be larger in poorer countries, rich countries are failing probably much more critically in the misuse of anti-biotics (I would guess, without having much evidence at my fingertips to back up my opinion. I believe the evidence exists I am just not an expert). These failures have huge costs for all of humanity but we are risking many premature deaths because we systemically fail to deal with issues until the consequences are immediate.

Related: Extensively Drug-resistant Tuberculosis (XDR TB) (2007) – What Happens If the Overuse of Antibiotics Leads to Them No Longer Working? – Antibiotics Too Often Prescribed for Sinus Woes – Overuse of Antibiotics (post from 2005) – CDC Urges Increased Effort to Reduce Drug-Resistant Infections (2006)

By using high-throughput screening of a library of small molecules, the team identified a class of compounds that significantly reduced the spread and severity of group A Streptococcus (GAS) bacteria in mice. Their work suggests that the compounds might have therapeutic value in the treatment of strep and similar infections in humans.

“The widespread occurrence of antibiotic resistance among human pathogens is a major public health problem,” said David Ginsburg, a faculty member at LSI, a professor of internal medicine, human genetics, and pediatrics at the U-M Medical School and a Howard Hughes Medical Institute investigator.

Ginsburg led a team that included Scott Larsen, research professor of medicinal chemistry and co-director of the Vahlteich Medicinal Chemistry Core at U-M’s College of Pharmacy, and Hongmin Sun, assistant professor of medicine at the University of Missouri School of Medicine.

Work on this project is continuing at U-M and the University of Missouri, including the preparation of new compounds with improved potency and the filing of patents, Larsen said. Large research schools are also very interested in patents. That is ok, though seems to cloud the pursuit of knowledge too often when too large a focus is on dollars at many schools. But, it seems to put the schools primary focus on dollars; education seems to start to be a minor activity at some of these large schools.

Current antibiotics interfere with critical biological processes in the pathogen to kill it or stop its growth. But at the same time, stronger strains of the harmful bacteria can sometimes resist the treatment and flourish.

An alternate approach is to suppress the virulence of the infection but still allow the bacteria to grow, which means there is no strong selection for strains that are resistant to antibiotics. In a similar experiment at Harvard University, an anti-virulence strategy was successful in protecting mice from cholera.

About 700 million people have symptomatic group A Streptococcus infections around the world each year, and the infection can be fatal. Most doctors prescribe penicillin. The newly identified compounds could work with conventional antibiotics and result in more effective treatment.

Related: full press release – What Happens If the Overuse of Antibiotics Leads to Them No Longer Working? – Norway Reduces Infections by Reducing Antibiotic Use – New Family of Antibacterial Agents Discovered – Many Antibacterial Products May Do More Harm Than Good – Anti-microbial Paint

In a recent clinical study, 12 subjects who rinsed just one time with the experimental mouthwash experienced a nearly complete elimination of the S. mutans bacteria over the entire four-day testing period.

Dental caries, commonly known as tooth decay or cavities, is one of the most common and costly infectious diseases in the United States, affecting more than 50 percent of children and the vast majority of adults aged 18 and older. Americans spend more than $70 billion each year on dental services, with the majority of that amount going toward the treatment of dental caries.

This new mouthwash is the product of nearly a decade of research conducted by Wenyuan Shi, chair of the oral biology section at the UCLA School of Dentistry. Shi developed a new antimicrobial technology called STAMP (specifically targeted anti-microbial peptides) with support from Colgate-Palmolive and from C3-Jian Inc., a company he founded around patent rights he developed at UCLA; the patents were exclusively licensed by UCLA to C3-Jian.

The human body is home to millions of different bacteria, some of which cause diseases such as dental caries but many of which are vital for optimum health. Most common broad-spectrum antibiotics, like conventional mouthwash, indiscriminately kill both benign and harmful pathogenic organisms and only do so for a 12-hour time period.

The overuse of broad-spectrum antibiotics can seriously disrupt the body’s normal ecological balance, rendering humans more susceptible to bacterial, yeast and parasitic infections.

Shi’s Sm STAMP C16G2 investigational drug, tested in the clinical study, acts as a sort of “smart bomb,” eliminating only the harmful bacteria and remaining effective for an extended period.

“With this new antimicrobial technology, we have the prospect of actually wiping out tooth decay in our lifetime,” said Shi, who noted that this work may lay the foundation for developing additional target-specific “smart bomb” antimicrobials to combat other diseases.

Related: full press release – False Teeth For Cats – Cavity-Fighting Lollipop – Biologists Identified a New Way in Which Bacteria Hijack Healthy Cells

The health system in the USA is broken in a huge way in which it is broken is the failure to address creating systemic behavior that promotes human health and instead just treating illness. It is much better to avoid a situation where we breed super bugs and then try to treat those super bugs that have evolved to be immune to the antibiotics we have to use.

When antibiotics no longer work

Related: Antibiotics Too Often Prescribed for Sinus Woes – Overuse of Antibiotics (2005) – FDA May Make Decision That Will Speed Antibiotic Drug Resistance (2007)

The end of the era of antibiotics

The Potential Role of Concentrated Animal Feeding Operations in Infectious Disease Epidemics and Antibiotic Resistance

Antibiotic Resistance in Livestock: More at Risk Than Steak

Throwing away the miracle of antibiotics because we are too lazy, too shortsighted, too greedy or too uncaring is going to bring misery to millions of people. That is why I have written about this problem for years. We have had warning. We have largely ignored those warnings. If we bring about a massive decline in the usefulness of antibiotics it will be due to our decision to not take care and at wisely. That is going to be a very high cost. I hope we will avoid it, but I fear we will not. The best I realistically hope for is we can reduce the suffering we cause those that follow us due to our refusal to seriously address the problem we are creating with our actions and inaction.

Related: Raised Without Antibiotics – Harm to Others: The Social Cost of Antibiotics in Agriculture – Antibacterial Products May Do More Harm Than Good