5 ms·

I spoke to an MD/biochemist friend of mine about this issue recently, and was told that this really isn't that big a deal. Specifically that antibiotic resistan

by darawk 10y ago

I spoke to an MD/biochemist friend of mine about this issue recently, and was told that this really isn't that big a deal. Specifically that antibiotic resistance is usually a self-limiting trait, so bacteria that evolve that capability will quickly lose it when no longer in a hostile environment. So these 'superbugs' can be an issue in particular settings, like hospitals, but are unlikely to ever produce major global catastrophes, or spread much beyond those limited environments. Can anyone else with more knowledge of this confirm/refute this perspective? EDIT: I should point out he wasn't saying it was a total non-issue. Just that some of the fear-mongering about global pandemics and such was completely unfounded.

bitwize 10y ago
All of which would be true -- in an environment where antibiotics weren't being pumped into battery-farmed livestock. But we don't live in that world.
imaginenore 10y ago
I think he is wrong. He have all kinds of antibiotic-resistant diseases in the wild, and so we have to introduce new antibiotics all the time.
tedunangst 10y ago
I've seen very little discussion of this. Is antibiotic resistant (proof?) TB in 2016 deadlier than TB without antibiotics in 1916? That seems extremely unlikely, but pop news coverage basically makes it sound like we're all going to die.
- robbiep 10y ago
  You can have TB without having virulent TB. In fact, in western countries, if we discover infection we treat. If you have TB, your risk of becoming symptomatic is only about 1% per year, however you are potentially contagious the entire time. So in the health community we conduct TB screening, and most migrants are required to either show evidence of BCG status, or a series of chest x-rays often combined with the results of a Mantoux test. A friend of mine, an emergency trainee, recently changed hospitals and had to have another Mantoux test. He lived in shanghai as a kid and would have been exposed in some manner, even though his body either cleared it or it is long dormant (his CXRs are clear). NSW health policy is that he needs 6 months of a course of antibiotics to ensure it is not latent in him. The same approach is taken to would be migrants. So you see, with tb the issue is not so much virulence, but our ability to control its spread in the community and prevent a potential pandemic of XDR TB, which all of a sudden would have TB as big of a public health threat as it was 50 years ago
floatrock 10y ago
Not from a medical background, but I spent some time writing hospital infection surveillance software so can share a few anecdotes. What he's saying isn't inaccurate. The idea is antibiotic resistance generally carries some metabolic cost -- the bacteria disable or find some other way around whatever pathway is being targeted by the antibiotic. This means they operate "less efficiently" than their non-resistant peers. When the antibiotic disappears from the environment, the resistance no longer offers an advantage, so they get out-competed by their non-resistant "more-efficient" peers. This is in fact one of the ways hospitals fight outbreaks of resistant bacteria -- they cycle antibiotics. More subtleties of course, but basically the head infection surveillance person says "alright docs, this month we're blacklisting these antibiotics, next month we're blacklisting these." (This is one of the interventions our infection software helped with.) On the other hand, there are places where the widespread use of antibiotics extends far beyond the reaches of a hospital building. Commercial agriculture is infamous for overusing antibiotics (basically mixing them into the lot's feedstock so every cow gets it). Outbreaks like SARS and avian flu weren't antibiotic-resistance outbreaks, but they WERE caused by sizable quantities of people working in close proximity with livestock and then spreading the disease through their normal travel and social interaction vectors. India is known for having antibiotics widely available over-the-counter for people. There are stories of people coming back from India with an infection resistant to literally everything (there's only about 50 antibiotics out there) -- when that happens, it's like the outbreak movies where the CDC comes in with plastic sheets and wearing bunny suits to quarantine the room. So will the lower-metabolic-efficiency attribute of antibiotic resistance be self-limiting enough to prevent it from turning into another 1918 spanish flu global pandemic? Maybe. But as long as there are large city-scale pockets of heavy antibiotic over-use with people traveling in-and-out, there are going to be constant transmission vectors that will still kill people in largely preventable ways.
- Herodotus38 10y ago
  I am in the medical field and can relate an anecdote, I'm sure which happens regularly across the US. Patient visiting from India comes in with sepsis from urinary tract infection, and she has a history of multiple ones. ER doctor calls me to admit her. I come down and review her paper chart that the family brought with her and see where her last E coli UTI was resistant to everything except meropenem, and possibly gentamicin although I don't recall. Until I had looked over this, the patient wasn't in any contact precautions (meaning disposable gloves or gowns for staff) and the ER doctor had given her the usual treatment for a UTI which in her case was going to do nothing.
Bluestrike2 10y ago
The presence of antibiotics creates what's called a selective pressure in favor of bacteria with antibiotic resistance. Removing that selective pressure (i.e. the antibiotics) can potentially lead to the growth of non-resistant bacteria like your friend points out. But that doesn't mean antibiotic resistant bacteria just 'goes away.' There was a recent paper[0] published by the ASM that suggests antibiotic resistant genes can persist even in the absence of selective pressure. While I only skimmed over it, and it's certainly not definitive, it's very much an alarming conclusion. So while I understand his general point, I wouldn't bet the farm on it. Already, we're seeing some pretty scary bugs with CRE (carbapenem-resistant enterobacteriaceae) and XDR-TB (extensively drug-resistant tuberculosis) and others. Festering in hospitals, where patients are at a much higher risk almost by definition, can create a real nightmare scenario that spreads outward from there. Even if that's avoided, antibiotics are almost a fundamental aspect of modern medicine. When they first came out, they were quickly perceived as an almost magical cure-all by the general public. Most people aren't able to imagine a world without them, let alone support the necessary steps to fight such a scenario. Medicine pre-penicillin was a scary thing, and no one really wants to think about the possibility of returning to it. The body count--figuratively, literally, and economically--will likely be higher than a feared superbug as a result of surgical complications, the impact on organ transplants (if they're even feasible at that point), and a host of other problems brought about by common antibiotic resistance under the worst case scenarios. It's not a scary picture, and it's already here with thousands of deaths annually. Unless some of the many ideas already being explored start to pan out, along with the discovery of new antibiotics in the interim, we're looking at a major step backwards to the 1930s. But that's going to require a lot of public funding and support. Personally, my nightmare scenario isn't a pandemic or a drastic decrease in survival rates for routine procedures. It's that we'll wind up having to experience one or both of those before the public starts to understand the problem and change their behavior. Maybe I'm being too pessimistic, but then I look at how antibiotics are treated in foreign countries and in livestock management, and I start to wonder if I'm not being pessimistic enough. 0. https://www.asm.org/index.php/journal-press-releases/94465-antibiotic-resistance-appears-to-persist-in-bacteria-even-absent-selection-pressure-from-antibiotics https://www.asm.org/index.php/journal-press-releases/94465-a...
robbiep 10y ago
It's absolutely a big issue. The main site of antibiotic treatment is hospitals (in the developed world) and if people come to hospital with a treatable or partially treatable infection and then we treat with antibiotics of last resort, and then they aren't treatable anymore because transfection of resistant plasmids happens in hospital, that person dies
Fordrus 10y ago
I work in biomedical informatics, genetics background, and your friend is technically correct and MONSTROUSLY WRONG. Bacterial populations that develop these resistances are certainly self limiting to a small extent - the resistance makes them less fit, less survivable and powerful, than other bacteria that lack the resistance trait - this means that bacteria WITHOUT the resistance out-compete bacteria WITH it - That, in turn, means that when we take away antibiotics from the bacterial growth environment, the population with the resistance dwindles greatly or even disappears - BUT And this is a GIGANTIC BUT! - often the mechanism that causes bacteria to stop expressing the resistance trait doesn't actually remove the genetic material from the individual bacterium, and even more, doesn't remove the trait entirely from the population. The end result of this is that you have a bacterial population that isn't DIRECTLY resistant to a given antibiotic NOW, but that if you introduce an antibiotic, you will almost immediately have a bacterial population resistant to that antibiotic. Through mechanisms like turning resistance genes back 'on' that were previously 'off', genetic material communication (essentially just bacteria passing genes back and forth amongst themselves, many bacteria are frighteningly efficient at this!) - we get the end result that's the functional equivalent of a a town full of regular folk who can go to a bunker in the event of an emergency and immediately transform into the hyper-militia from hell. Like a population full of terrorist sleeper cells, only with far more destructive capability than any terrorist group!
Mz 10y ago
A great many things have changed in recent decades that create a situation that never before existed. We have an unprecedented level of human population. For the first time in the history of the human race, more people live in cities than in rural settings, which means increased density and increased exposure. We use antibiotics on livestock and most humans take them fairly routinely. When antibiotics were introduced, it was heralded as the end of disease. Now, not that many decades later, we are dealing with super bugs. I have read research on how to effectively reverse antibiotic resistance. I think this is a problem we can find solutions for in terms of societal level changes to reduce this issue. But, for the time being, you are screwed if you get one of these and my big concern is that this may be solved by having enough billions of people die so as to serve as a natural means to reduce population densities and interrupt the path we are on currently. This would majorly suck, even if you are one of the lucky survivors, because it would destroy a lot of things we currently take for granted, among other things.

by darawk 10y ago

bitwize 10y ago

All of which would be true -- in an environment where antibiotics weren't being pumped into battery-farmed livestock. But we don't live in that world.

imaginenore 10y ago

I think he is wrong. He have all kinds of antibiotic-resistant diseases in the wild, and so we have to introduce new antibiotics all the time.

tedunangst 10y ago

I've seen very little discussion of this. Is antibiotic resistant (proof?) TB in 2016 deadlier than TB without antibiotics in 1916? That seems extremely unlikely, but pop news coverage basically makes it sound like we're all going to die.

robbiep 10y ago
You can have TB without having virulent TB. In fact, in western countries, if we discover infection we treat. If you have TB, your risk of becoming symptomatic is only about 1% per year, however you are potentially contagious the entire time. So in the health community we conduct TB screening, and most migrants are required to either show evidence of BCG status, or a series of chest x-rays often combined with the results of a Mantoux test. A friend of mine, an emergency trainee, recently changed hospitals and had to have another Mantoux test. He lived in shanghai as a kid and would have been exposed in some manner, even though his body either cleared it or it is long dormant (his CXRs are clear). NSW health policy is that he needs 6 months of a course of antibiotics to ensure it is not latent in him. The same approach is taken to would be migrants. So you see, with tb the issue is not so much virulence, but our ability to control its spread in the community and prevent a potential pandemic of XDR TB, which all of a sudden would have TB as big of a public health threat as it was 50 years ago

floatrock 10y ago

Not from a medical background, but I spent some time writing hospital infection surveillance software so can share a few anecdotes. What he's saying isn't inaccurate. The idea is antibiotic resistance generally carries some metabolic cost -- the bacteria disable or find some other way around whatever pathway is being targeted by the antibiotic. This means they operate "less efficiently" than their non-resistant peers. When the antibiotic disappears from the environment, the resistance no longer offers an advantage, so they get out-competed by their non-resistant "more-efficient" peers. This is in fact one of the ways hospitals fight outbreaks of resistant bacteria -- they cycle antibiotics. More subtleties of course, but basically the head infection surveillance person says "alright docs, this month we're blacklisting these antibiotics, next month we're blacklisting these." (This is one of the interventions our infection software helped with.) On the other hand, there are places where the widespread use of antibiotics extends far beyond the reaches of a hospital building. Commercial agriculture is infamous for overusing antibiotics (basically mixing them into the lot's feedstock so every cow gets it). Outbreaks like SARS and avian flu weren't antibiotic-resistance outbreaks, but they WERE caused by sizable quantities of people working in close proximity with livestock and then spreading the disease through their normal travel and social interaction vectors. India is known for having antibiotics widely available over-the-counter for people. There are stories of people coming back from India with an infection resistant to literally everything (there's only about 50 antibiotics out there) -- when that happens, it's like the outbreak movies where the CDC comes in with plastic sheets and wearing bunny suits to quarantine the room. So will the lower-metabolic-efficiency attribute of antibiotic resistance be self-limiting enough to prevent it from turning into another 1918 spanish flu global pandemic? Maybe. But as long as there are large city-scale pockets of heavy antibiotic over-use with people traveling in-and-out, there are going to be constant transmission vectors that will still kill people in largely preventable ways.

Herodotus38 10y ago
I am in the medical field and can relate an anecdote, I'm sure which happens regularly across the US. Patient visiting from India comes in with sepsis from urinary tract infection, and she has a history of multiple ones. ER doctor calls me to admit her. I come down and review her paper chart that the family brought with her and see where her last E coli UTI was resistant to everything except meropenem, and possibly gentamicin although I don't recall. Until I had looked over this, the patient wasn't in any contact precautions (meaning disposable gloves or gowns for staff) and the ER doctor had given her the usual treatment for a UTI which in her case was going to do nothing.

Bluestrike2 10y ago

The presence of antibiotics creates what's called a selective pressure in favor of bacteria with antibiotic resistance. Removing that selective pressure (i.e. the antibiotics) can potentially lead to the growth of non-resistant bacteria like your friend points out. But that doesn't mean antibiotic resistant bacteria just 'goes away.' There was a recent paper[0] published by the ASM that suggests antibiotic resistant genes can persist even in the absence of selective pressure. While I only skimmed over it, and it's certainly not definitive, it's very much an alarming conclusion. So while I understand his general point, I wouldn't bet the farm on it. Already, we're seeing some pretty scary bugs with CRE (carbapenem-resistant enterobacteriaceae) and XDR-TB (extensively drug-resistant tuberculosis) and others. Festering in hospitals, where patients are at a much higher risk almost by definition, can create a real nightmare scenario that spreads outward from there. Even if that's avoided, antibiotics are almost a fundamental aspect of modern medicine. When they first came out, they were quickly perceived as an almost magical cure-all by the general public. Most people aren't able to imagine a world without them, let alone support the necessary steps to fight such a scenario. Medicine pre-penicillin was a scary thing, and no one really wants to think about the possibility of returning to it. The body count--figuratively, literally, and economically--will likely be higher than a feared superbug as a result of surgical complications, the impact on organ transplants (if they're even feasible at that point), and a host of other problems brought about by common antibiotic resistance under the worst case scenarios. It's not a scary picture, and it's already here with thousands of deaths annually. Unless some of the many ideas already being explored start to pan out, along with the discovery of new antibiotics in the interim, we're looking at a major step backwards to the 1930s. But that's going to require a lot of public funding and support. Personally, my nightmare scenario isn't a pandemic or a drastic decrease in survival rates for routine procedures. It's that we'll wind up having to experience one or both of those before the public starts to understand the problem and change their behavior. Maybe I'm being too pessimistic, but then I look at how antibiotics are treated in foreign countries and in livestock management, and I start to wonder if I'm not being pessimistic enough. 0. https://www.asm.org/index.php/journal-press-releases/94465-antibiotic-resistance-appears-to-persist-in-bacteria-even-absent-selection-pressure-from-antibiotics https://www.asm.org/index.php/journal-press-releases/94465-a...

robbiep 10y ago

It's absolutely a big issue. The main site of antibiotic treatment is hospitals (in the developed world) and if people come to hospital with a treatable or partially treatable infection and then we treat with antibiotics of last resort, and then they aren't treatable anymore because transfection of resistant plasmids happens in hospital, that person dies

Fordrus 10y ago

I work in biomedical informatics, genetics background, and your friend is technically correct and MONSTROUSLY WRONG. Bacterial populations that develop these resistances are certainly self limiting to a small extent - the resistance makes them less fit, less survivable and powerful, than other bacteria that lack the resistance trait - this means that bacteria WITHOUT the resistance out-compete bacteria WITH it - That, in turn, means that when we take away antibiotics from the bacterial growth environment, the population with the resistance dwindles greatly or even disappears - BUT And this is a GIGANTIC BUT! - often the mechanism that causes bacteria to stop expressing the resistance trait doesn't actually remove the genetic material from the individual bacterium, and even more, doesn't remove the trait entirely from the population. The end result of this is that you have a bacterial population that isn't DIRECTLY resistant to a given antibiotic NOW, but that if you introduce an antibiotic, you will almost immediately have a bacterial population resistant to that antibiotic. Through mechanisms like turning resistance genes back 'on' that were previously 'off', genetic material communication (essentially just bacteria passing genes back and forth amongst themselves, many bacteria are frighteningly efficient at this!) - we get the end result that's the functional equivalent of a a town full of regular folk who can go to a bunker in the event of an emergency and immediately transform into the hyper-militia from hell. Like a population full of terrorist sleeper cells, only with far more destructive capability than any terrorist group!

Mz 10y ago

A great many things have changed in recent decades that create a situation that never before existed. We have an unprecedented level of human population. For the first time in the history of the human race, more people live in cities than in rural settings, which means increased density and increased exposure. We use antibiotics on livestock and most humans take them fairly routinely. When antibiotics were introduced, it was heralded as the end of disease. Now, not that many decades later, we are dealing with super bugs. I have read research on how to effectively reverse antibiotic resistance. I think this is a problem we can find solutions for in terms of societal level changes to reduce this issue. But, for the time being, you are screwed if you get one of these and my big concern is that this may be solved by having enough billions of people die so as to serve as a natural means to reduce population densities and interrupt the path we are on currently. This would majorly suck, even if you are one of the lucky survivors, because it would destroy a lot of things we currently take for granted, among other things.