Alarming Rise in Antibiotic Resistance

[Trapper John]

From the most recent FierceHealthcare report -

Antibiotic resistance: Global report reveals alarming rates of bacteria resistant to last-resort drugs
By Ilene MacDonald

Fears of a "looming" global crisis of antibiotic resistant superbugs intensified this week as new data reveals alarming rates of bacteria resistant to last resort antibiotics that can lead to life-threatening infections across the world.
The problem is due to overuse and misuse of antibiotics, according to researchers, who also rejected the notion that new antibiotics could help resolve the world-wide crisis. (I published an opinion paper stating exactly that 3 or 4 years ago.)

"No matter how many new drugs come out, if we continue to misuse them, they might as well have never been discovered," Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy (CDDEP) and co-author of the report, "State of the World's Antibiotics, 2015" said in an announcement. Instead, he said the only sustainable solution is to limit overuse and misuse of antibiotics.

One place to start is in the United States, which leads in per capita consumption of antibiotics, according to the report. The nation is also second to China in its consumption of antibiotics in livestock.

And though wealthy countries like the U.S. still use far more antibiotics per capita, the new data reveals high rates of use in low- and middle-income countries. For example, in India, 57 percent of the infections caused by the deadly superbug Klebsiella pneumoniae, were resistant to carbapenem antibiotics, a last-resort drug, in 2014 compared to 29 percent six years earlier. In comparison, these same drugs are still effective against the infections in 90 percent of cases in the U.S. and more than 95 percent of cases in most of Europe.

"Carbapenem antibiotics are for use in the most dire circumstances--when someone's life is in danger and no other drug will cure the infection," said Sumanth Gandra, an infectious diseases physician and CDDEP Resident Scholar in New Delhi, in the announcement. "We're seeing unprecedented resistance to these precious antibiotics globally, and especially in India. If these trends continue, infections that could once be treated in a week or two could become routinely life threatening and endanger millions of lives."

The data also reveals infection rates caused by 12 common and potentially deadly bacteria, including Escherichia coli (E. coli), Salmonella, and methicillin-resistant Staphylococcus aureus (MRSA).

The report outlines six strategies that all countries can follow to halt the spread of resistance:

• Improve water, sanitation and immunization: Better access to clean water and sewerage systems and providing improved coverage for existing and new vaccines will ensure a safe and healthy food supply, reducing the need for antibiotics and thus reducing antibiotic-resistance rates.
• Improve hospital infection control and antibiotic stewardship. The report calls for better hygiene, particularly handwashing between patients, and implementation of antibiotic stewardship programs to reduce infection rates. (We have probably reached the point of diminishing return on this one. But, hell, someone feels good saying this. I'll just bet ya this kind of thinking is exactly how some knucklehead came up with Common Core)
• Eliminate economic incentives that encourage antibiotic misuse and overuse in hospitals, communities and agriculture.
• Reduce and eventually phase out antibiotic use for growth promotion in agriculture. (Doh!)
• Educate health professionals, policymakers, and the public on antibiotic use and promote conservation. (More feel good BS!)
• Work with politicians to gain their support for policies to address the threat of antibiotic resistance. (Give me a F'N break will ya?)

Meanwhile, the U.S. has recently taken action to address the growing threat. This week the U.S. Department of Health and Human Services announced the establishment of a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria to provide advice, information and recommendations to the HHS regarding programs and policies related to combating antibiotic-resistant bacteria. (Typical response, we don't have a f'n clue so let's form a commission to study it some more. Yeah, that's the ticket!)

HHS also announced a strategic alliance with a global biopharmaceutical company to accelerate the development of new drugs to treat multi-drug resistant bacterial infections. (Brilliant, just f'n brilliant! Let's make more antibiotics only do it faster! I really want to meet the chucklehead that came up with that one!) Although the CDDEP report said only 20 percent of efforts should focus on new drug development, (Yeah the other 80% is to do what? Oh, stuff ya know important stuff) HHS said in the announcement that lack of investment in new drugs has helped create a "perfect storm" with the rise of antibiotic-resistant infections. (Now that's some insight rat there, Cap'n Obvious)

The Joint Commission has also launched a Speak Up on Antibiotics campaign to help educate the public on the appropriate and safe use of antibiotics, as well as the risks associated with antibiotic overuse. The campaign includes complete package of free resources, including an infographic, podcast and video. (And I wonder what other "free" stuff might be in that feel good program).

I don't know about yous guys, but I am going to sleep much better tonight Knowing these guys have this under control.

[Flagg]

Is it true that Cipro is the one and only broad spectrum/general antibiotic magic bullet left in infection control?

Is there much in the antibiotic development pipeline?

The last I remember reading several years ago was that the product development pipeline is anywhere from 7-10 years long and there wasn't much in the way of promise coming thru(antibiotic r&d gap).

I know down here on the civvie side there's been a major shift in recent years to protect antibiotic efficacy. When our kids were born starting 10'years ago, antibiotics were dished out like candy to placate worried parents.

Not anymore thankfully.

[Trapper John]

Originally Posted by Flagg

Is it true that Cipro is the one and only broad spectrum/general antibiotic magic bullet left in infection control? Yes)

Is there much in the antibiotic development pipeline? (No)

The last I remember reading several years ago was that the product development pipeline is anywhere from 7-10 years long and there wasn't much in the way of promise coming thru(antibiotic r&d gap).

I know down here on the civvie side there's been a major shift in recent years to protect antibiotic efficacy. When our kids were born starting 10'years ago, antibiotics were dished out like candy to placate worried parents.

Not anymore thankfully.

The basic problem is the strategic approach we have been taking over the past 75 years. Antibiotic resistance began being noticed within a year or two of the widespread use of penicillin and sulfa drugs.

Think in terms of a UW strategy vs a DA strategy. We have been conducting DA centric actions against insurgent pathogens for 75 years and the insurgents are adapting defenses faster than we can develop weapons (antibiotics).

On the other hand nature has mechanisms to clear the insurgents that just gets overwhelmed at times and the infection leads to disease (note that most infections do not lead to disease otherwise we humans would not survive).

Think UW, i.e. working by, through, and with the indigenous population of cells and force multiplication via an auxillary to enhance the natural defense mechanisms.

We have shown that the UW strategy works very well and it doesn't matter what the insurgent population is.

The hurdle has been educatiing the DA centric folks. I would expect this different strategy to begin appearing in clinical usage in the next 3-4 years.

[SouthernDZ]

I remember a statement like it was yesterday. I went through the 18D30 course in 1984-85 and the physician that covered ATB Therapy stated, "When Staph A overtakes Vancomycin, we have entered the post-antibiotic era."

That was 30 years ago.....

[Trapper John]

Originally Posted by SouthernDZ

I remember a statement like it was yesterday. I went through the 18D30 course in 1984-85 and the physician that covered ATB Therapy stated, "When Staph A overtakes Vancomycin, we have entered the post-antibiotic era."

That was 30 years ago.....

Exactly, and look how far we have advanced infectious disease therapies.

FYI- See the Opinion I wrote and posted (10/27/13) in the "Drug Resistant Infections" thread in this Forum

[JJ_BPK]

Trapper,
Thanks for posting,
Will re-post to my kids..

DOL

[Flagg]

Originally Posted by Trapper John

The basic problem is the strategic approach we have been taking over the past 75 years. Antibiotic resistance began being noticed within a year or two of the widespread use of penicillin and sulfa drugs.

Think in terms of a UW strategy vs a DA strategy. We have been conducting DA centric actions against insurgent pathogens for 75 years and the insurgents are adapting defenses faster than we can develop weapons (antibiotics).

On the other hand nature has mechanisms to clear the insurgents that just gets overwhelmed at times and the infection leads to disease (note that most infections do not lead to disease otherwise we humans would not survive).

Think UW, i.e. working by, through, and with the indigenous population of cells and force multiplication via an auxillary to enhance the natural defense mechanisms.

We have shown that the UW strategy works very well and it doesn't matter what the insurgent population is.

The hurdle has been educatiing the DA centric folks. I would expect this different strategy to begin appearing in clinical usage in the next 3-4 years.

Great analogy.

I get the sense(at least down here) of a change in doctrine more towards what you are suggesting, but still with room for improvement.

[Patriot007]

Originally Posted by Flagg

Is it true that Cipro is the one and only broad spectrum/general antibiotic magic bullet left in infection control?

While cipro is still generally effective for its purposes we are seeing an alarming rate of even simple urinary tract infections or kidney infections that are cipro resistant. The rate of E.coli ( the most common UTI bacteria) cipro resistance in my area is as high as 20% which makes it no longer first line for pyelonephritis (kidney infection) in my area.

Just 2 weeks ago I had a young healthy female without a history of UTI or antibiotic treatment present with pyelonephritis with a multidrug resistant E. Coli only sensitive to gentamicin,meropenem, and imipenem.