Tag: antibiotic resistance

Worth repeating?

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Worth repeating? Given the lack of action on this issue, despite the repeated warnings from people far more qualified and eminently more important than me, you could be excused for thinking not. However, given the gravity of the situation being described and the impact it will have on our ability to survive as a species – yeah, probably.

We’re back on that old chestnut of antibiotic resistance, I’m afraid. The topic rearing its ugly head on here thanks to this guest editorial in the South African Medical Journal for May 2015, penned by Marc Mendelson of UCT and Malebona Precious Matsoso from the DoH. It’s a local journal, written by local people, about local issues. Just like the Southern Suburbs Tatler. Except sane.
It makes such happy reading:

If our overuse and misuse of antibiotics is not halted now, about 10 million people will die annually from drug-resistant bacterial infections within 35 years. The hammer blow will fall hardest on Africa and Asia, accounting for 4.1 and 4.7 million deaths, respectively, and the world’s economy will lose more than 7% of its gross domestic product (USD210 trillion) by 2050.

If 10 million deaths sounds terrible, it’s because it is terrible. Put in context, annual deaths from HIV worldwide are around 1.5 million. TB accounts for 1.4 million deaths. Heart disease kills about 2.5 million people each year. Three big killers and we’re only just halfway there.

Fortunately, this is all way in the future, isn’t it? Well, no. It’s not:

This is not a futuristic scenario … it is being played out right here, right now, in South Africa and other countries across the globe. Decisions to withhold surgery based purely on the patient being colonised by pan-resistant bacteria are being made, and people are dying of untreatable infections in our hospitals and communities. Quite simply, our abuse of antibiotics is destroying modern medicine as we know it. Unless the international community can alter its path, we will lose the ‘miracle of antibiotics’.

So it’s here, and it’s going to get much worse, so why isn’t something being done about it? We’ve touched on this here before:

Of course, if this problem wasn’t so insidious, we’d all be panicking about it already. If there were a 9/11 or a Hurricane Sandy – a single event – there would be far more awareness. (Not that mere awareness would really help anyway.)
But that’s not the case with the antibiotic resistance problem. It’s sneaking up on us and, for those of us in the know, it’s rather worrying.

And on that note, for me, probably the most significant line in Mendelson’s and Matsoso’s musings:

These numbers should make people sit up, listen and change behaviour. But more often than not, it has to be personal to achieve this.

Yes. Sadly, that’s probably what it will take. And sadly, this will happen to people as well. It’s happened to me already this year.

I was reminded of this satirical piece by Andy Borowitz, penned in reference to climate change, but with a nice, ironic “resistance” twist:

Scientists have discovered a powerful new strain of fact-resistant humans who are threatening the ability of Earth to sustain life, a sobering new study reports…
While reaffirming the gloomy assessments of the study, Logsdon held out hope that the threat of fact-resistant humans could be mitigated in the future. “Our research is very preliminary, but it’s possible that they will become more receptive to facts once they are in an environment without food, water, or oxygen,” he said.

Maybe the same will be true once we find ourselves without antibiotics as well.

We live in hope. Briefly.

H58 is coming

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Well, in fact, H58 is already here. And it’s going to kill you.

Let’s take a step back for just  a moment here though. And let’s consider Ebola, which is something else that kills you a lot. The (probably a little underestimated) figures for the 2014 (but still ongoing) West Africa Ebola epidemic suggest that 11,000 people died. That’s pretty awful. But it pales into some sort of disgraceful insignificance when you compare it with the 200,000 people who die from typhoid each year.

Typhoid is indisputably nasty. That said, it’s different from Ebola in that while it’s much more widespread, the mortality rates are not quite as high. And a lot of that is probably down to the fact that it’s caused by a bacterium (it’s called Salmonella typhi and yes, it’s related to the food poisoning bug that you get from not cooking your chicken enough) and not by a virus. As any fule kno, bacterial diseases can be treated with antibiotics, killing the bugs and making the person remain alive. Good news for typhoid sufferers.

That is, until now.

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Because a new strain of Salmonella typhi is here: Salmonella typhi H58. And H58 is resistant to antibiotics like ciprofloxacin and azithromycin – drugs that people use to treat typhoid. According to the Guardian:

An international team of researchers analysed the DNA of nearly 2000 typhoid pathogens from countries across Asia and Africa and found that a single multiple- drug resistant strain had swept through Asia and crossed into Africa over the past 30 years.
Nearly half of the organisms studied belonged to the resistant strain, called H58, which has steadily pushed out older strains that are susceptible to common antibiotics people buy over the counter or take to protect themselves from the disease.

And H58 is rapidly becoming the dominant strain of S.typhi, easily pushing the other, lesser, more antibiotic-susceptible, more treatable, less deadly strains out of the way:

In some regions, H58 is displacing strains that have been established for hundreds of years: “We were all amazed at what we saw. When you see the data, it’s pretty stark. It’s very convincing that it’s becoming the dominant strain,” said Gordon Dougan, a senior researcher at the Sanger Institute near Cambridge.
“This beast can get into a new area and it’s at an advantage, because a lot of competition is wiped out by antibiotics.”

Hear that? When a senior researcher at the Sanger Institute near Cambridge calls it a beast, you know it’s properly dangerous. Senior researchers at the Sanger Institute near Cambridge aren’t employed to throw words like that around willy-nilly. They’re beige and they’re dull and they’re sensible. The accountants auditors of the microbiological world. Using the word “beast” to describe a strain of bacteria is off-the-fricking-scale to a senior researcher at the Sanger Institute near Cambridge. This is obviously serious stuff.

Serious, and urgent:

The global spread of the strain requires “urgent international attention,” the scientists write in the report. “This is killing 200,000 people a year and no one is really noticing,” said Nick Feasey, a co-author on the study at Liverpool Tropical School of Tropical Diseases.

So – a time for action then? I doubt it. I’ve been telling you all for ages that we’re all going to die horrible deaths at the (metaphorical) hands of drug-resistant bacteria, and no-one has done a damn thing about it.

One of the reasons for this continued lack of decisive action against the spread of antibiotic resistance is that it’s an insidious thing; there’s been no one defining event – no instant train smash – to draw attention to it. Sadly, with the destruction of infrastructure in Nepal – where H58 is prevalent – after the recent earthquakes, we might well see a big spike in the number of cases, which may stick it into the global spotlight until the next plane crash, court case or contentious political statement.

All of which are obviously far more important.

UPDATE: Finally, someone is listening…

Here’s a lovely article on why WE’RE ALL GOING TO DIE HORRIBLE DEATHS SOON

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Herewith the second of the things I saw on The Telegraph website this morning (this being the first), albeit that this one appears to have been around for a short while. It’s all about antibiotic resistance.

The microbiologist in me has been telling you for a long time that we’re about to run out of useful antibiotics and that we’re all doomed buggered. Well, here’s a nice little project from The Telegraph which sums up whole miserable situation up quite nicely. It doesn’t condescendingly spoon-feed the information, but rather, it’s nicely aimed at engaging with an audience which it presumes is interested and intelligent. Yes. I mean you guys.

There are expert quotes:

“We risk going into a post-antibiotic era, and that could start any time in the next 10 or 20 years, when modern medicine becomes impossible. Routine surgical procedures – hip replacements, caesarean sections, modern cancer treatments – all are based on using antibiotics to prevent or treat infections. Without them, people will die.”

…some lovely soundbites:

Sir Alexander Fleming did warn us. During a speech in Stockholm in 1945 after accepting his Nobel Prize, Fleming sounded “one note of warning” over bacteria becoming resistant through inappropriate use of the drug. “The time may come when penicillin can be bought by anyone in the shops.” he said. The idea of his precious discovery being stockpiled by online pharmacies, used to fatten up our fish and livestock, dumped in rivers and sprayed over fields, would have baffled and horrified him in equal measure.

…and a superb interactive graph showing how long it took for our bacterial foes to become resistant to each and every antibiotic from Penicillin (13 years) to Macrolides (a couple of months).

It even mentions Dr Ajit Lalvani, with whom I used to play football every Thursday evening in Oxford (decent, if unenergetic midfield general; good at pointing a lot, in case you were wondering), so it must be good.

If you have a few minutes spare, and you want to read how utterly doomed we all are (because who doesn’t?) and how you can do pretty much nothing about it, go and give it a read.

A different kind of transplant

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When all else fails, (and make no mistake, all else is failing), comes the time to think outside the box. Some might argue that the time to think outside the box should come before all else fails, and they are probably correct in that, but that’s another argument.

We are slowly, surely, insidiously returning to a pre-antibiotic age. The antibiotics that we have are becoming less and less effective against common infections and consequently, those common infections are starting to kill us again. One such infection is Clostidium difficile (so “difficile” in fact, that we microbiologists even disagree on how to pronounce it, so it’s “C.diff” to its friends) – a gastrointestinal bug that gives you horrendous – and now incurable – diarrhoea. This bug kills 14,000 Americans each year, and lengthens the hospital stays of hundreds of thousands of others.

But while supportive therapy might help treat the symptoms, with no antibiotics available to treat the cause, we stay losing.
Until now:

…researchers have discovered an alternative: A donor’s stool can be transplanted in the intestine or colon of a sick patient via an enema,colonoscopy or nasogastric tube. The healthy bacteria fight off C. diff and re-establish a normal community in the gut.

Yep. Poo transplants. Regular (Lolz) readers may recall that we’ve had a quick look at this before, and then yesterday evening, this NYT article arrived from a medically qualified friend on Facebook, complete with smiley face attached.

It’s all about the world’s first “Stool Bank” and it’s beautifully written:

Around noon on a recent Friday, Donor Five, a healthy 31-year-old, walked across M.I.T.’s frigid, wind-swept campus to a third-floor restroom to make a contribution to public health.

Less than two hours later, a technician blended the donor’s stool into preparations that looked like chocolate milk. The material was separated and stored in freezers at an M.I.T. microbiology lab, awaiting shipment to hospitals around the country. Each container was carefully labeled: Fecal Microbiota Preparation.

There are issues though. The FDA are struggling to provide any sort of clarity on licensing of the treatment, meaning that donor poo can’t be sold for profit at the moment. And we know that large pharmaceutical companies are (understandably) reluctant to follow up on these things if there’s no money in them (another argument again).
Until the regulations are established, the research and the treatment can’t gain traction, but that’s not the biggest problem here. Because while there’s no traction in the research and treatment, people are taking matters into their own… er… hands: there exists the danger of an unregulated, unsafe Black… [shurely “Brown”? – Ed.] Market:

“People are doing fecal transplants in their basements and may not be doing any of the right screening or sterile preparation. We need an intermediate solution until there are commercial products on the market.”

What you get up to in your basement is entirely your business. Literally, it would seem in this case. But, even with my limited medical expertise, I would strongly advise against homemade faecal transplants.

Rather get a qualified doctor to fill your colon with someone else’s (screened) poo, should the need arise.