10 ms·

My Husband Became a Poster Child of the Post-Antibiotic Era

139 points by susiecambria 7y ago

HillaryBriss 7y ago
...for most superbugs, health departments and the US Centers for Disease Control and Prevention (CDC) don’t track who acquires them, nor do they know how many recovered or died. The most recent CDC report estimates that 23,000 people die in the U.S. each year from superbug infections, based on data from 2010. But a recent report estimated that at least 153,000 people died from superbug infections the same year, an estimate that is nearly seven-fold higher. We are allowing most superbugs to maintain their invisibility under the radar, where they are spreading quietly. Unreported. Undetected. And, increasingly, untreatable. this isn't really scary at all. i'm not scared. are you scared? why be scared?
- Analemma_ 7y ago
  To me, the really scary thing about antibiotic resistance is not necessarily random infections in the hospital (as bad as that is) but the fact that antibiotics are what made surgery possible, and if they don’t work, all these medical procedures we’ve gotten used to as harmless suddenly carry a very serious risk-reward tradeoff. Imagine C-sections, biopsies, hip replacements, etc. all having a one-in-four chance of death. That’s what we’re heading back to.
  - est31 7y ago
    For operations, sterilizations are carried out with a mixture of means like chemical disinfectants, subjecting instruments to extreme heat (Autoclaving), etc. but they don't rely on antibiotics. Instruments can be put into environments toxic to both human and bacterial cells. The big difference of antibiotics is that they are toxic to bacteria but not to human cells so they can be put directly into the system. Some bacteria are also developing resistance against chemical disinfectants but here we have a much larger choice.
    - wl 7y ago
      It's defense in depth. Yes, sterile technique is used to minimize the occurrence of surgical site infections. Sterile technique, when performed 100% correctly, isn't perfect and prophylactic antibiotics are standard to help mitigate any remaining risk.
      - est31 7y ago
        Oh, TIL. Thanks for the info! It won't throw us back to the pre-semmelweis era though only to the pre-fleming area.
      - Fomite 7y ago
        The field uses "Swiss cheese" as a term for a reason - you can have holes in each layer (and will), but if you have enough layers you'll be okay.
  - HillaryBriss 7y ago
    agree. and my next fear is that all of the medical establishment, suppliers, and practitioners who depend upon surgical procedures for their profitability downplay the additional risks and continue to encourage all of us to undergo surgery
    - Fomite 7y ago
      Surgeons are already the bane of many infection control specialists.
- sithadmin 7y ago
  Extremely scared, especially in light of barriers to drug approval killing off interest in antibiotics development. Just take a look at what happened to Achaogen: http://www.bioworld.com/perspectives/2019/04/24/a-decade-of-incentives-to-promote-antibiotic-development-and-still-no-viable-route-to-commercial-success/ http://www.bioworld.com/perspectives/2019/04/24/a-decade-of-... The FDA granted Fast Track designation for their antibiotic, only later refuse to approve it for use in bloodstream infections due to quibbling over study size (which was admittedly smaller than it could have been, largely in part due to the Fast Track designation). The antibiotic has been relegated to on-label use for complicated UTIs. Though it can still be used off-label, this isn't enough to attract further investment or keep sales strong enough to sustain ongoing operations. Achaogen was forced to lay off nearly all staff, and is now entering bankruptcy. Unfortunately, this sort of thing is hardly unique among early stage pharma companies focusing on antibiotics, and it's steering investors away from such companies. It's also driving pharma professionals away.
  - pkaye 7y ago
    But they could still get approval in other countries.
    - sithadmin 7y ago
      Wouldn't have mattered previously, won't matter going forward. The USA is the most important and lucrative market, whether we like it or not.
    - BurningFrog 7y ago
      As I understand it, other countries are not very profitable as pharmaceutical markets, so they probably won't get developed in the first place there.
- jen_h 7y ago
  The point of her article wasn’t to push despair, but rather to urge the Western medical establishment to get moving on phage research. Bacteriophages as a solution to our antibiotic resistance crisis have been largely ignored in the West due to unpatentability, research mainly performed in Eastern Europe, etc — but her story is that a bacteriophage cocktail saved her husband’s life where antibiotics failed...and the only reason they even were able to go that route was because she’s an epidemiologist who pulled some strings, pulled research teams together, got approvals, and managed the project herself.
  - Mirioron 7y ago
    So, why isn't government funded research being done on it then? I often hear about how the government funds a lot of medical research, so this seems like the perfect thing for them to fund.
    - Fomite 7y ago
      What makes you think they're not?
  - DoreenMichele 7y ago
    From the article: Alternatives to antibiotics are desperately needed. She's not pushing phage research per se, just research into alternatives generally.
    - jen_h 7y ago
      Did you stop reading there, by chance?
      - deleted 7y ago
        [deleted]
      - throwaway5752 7y ago
        Shame on whoever downvoted you. The full last 5 paragraphs are devoted to bacteriophages, which are what ultimately saved the author's husband. The author is "Co-Director of the Center for Innovative Phage Applications and Therapeutics" at UCSD (https://profiles.ucsd.edu/steffanie.strathdee https://profiles.ucsd.edu/steffanie.strathdee) It closes on "The possibility of living in a post-antibiotic era where simple surgeries or scrapes could lead to an infection that requires limb amputation or results in death means we need to improve AMR surveillance, diagnosis and treatment. This includes antibiotics, but should also include phage therapy. We can’t afford to bury a promising alternative to antibiotics for another hundred years." She is absolutely pushing phage research. Not exclusive to any alternatives, but that is basically the point of the article.
- rossenberg79 7y ago
  Not scary at all. This is just life, and we must endure it. Keep in mind at the same time this is happening we also have to deal with climate change and not blowing ourselves up in all out Nuclear War. And even if we avoid all that you could still step outside and be shot or stabbed by a ruffian who leaves you dead all the same.
brohee 7y ago
And people still wonder why civilized countries forbid prophilactic antibiotics usage in livestock....
concerned209 7y ago
Any recommendations on what an individual could do to help? Organizations to donate to? Challenges that could be tackled by a startup? Promising companies to consider investing in? Also, can anybody explain why the CDC doesn’t mandate reporting?
- aaronbrethorst 7y ago
  Call your members of congress and demand that they ask the CDC that question.
- deleted 7y ago
  [deleted]
- DoreenMichele 7y ago
  I'm having trouble figuring out how to reply to the way you are framing the problem space. There are several Einstein quotes along the lines of "A problem cannot be solved using the same thinking that created it." The problem of antibiotic resistance won't be solved with the same mindset that got us here. One thing contributing to the rise of antibiotic resistance is poor santitation in developing countries. Another is poverty. There is also research into how to break up biofilm and thereby reverse antibiotic resistance. It points to issues with body chemistry which can basically be tied to diet. I think there are clearly avenues we can pursue, but most people are extremely dismissive of those avenues. So they simply aren't being pursued in earnest.
  - benj111 7y ago
    "One thing contributing to the rise of antibiotic resistance is poor santitation in developing countries. Another is poverty." I assume this is why you were getting downvotes? I was going to too, but it does actually check out. https://www.omicsonline.org/open-access/antibiotic-abuse-in-developing-countries-2167-7689.1000e106.php?aid=6039 https://www.omicsonline.org/open-access/antibiotic-abuse-in-...
    - DoreenMichele 7y ago
deleted 7y ago
[deleted]
gumby 7y ago
One factor that will return once people start to panic is table manners, many of which seem fussy (separate saving utensils, a butter knife, not putting used utensils onto the table) but actually evolved for hygiene reasons. Sadly of course like any complex behavior it was also hijacked for sumptuary purposes (grape shears, egg spoons, not finishing your plate in some cultures) but I hold out a hope (probably in vail) that those kinds of rules won't be revived.
- saagarjha 7y ago
  > many of which seem fussy (separate saving utensils, a butter knife, not putting used utensils onto the table) Fussy? Aren’t these just common sense? I wouldn’t consider them to even be “table manners”.
  - gumby 7y ago
    Looks like your comment is being downvoted due to lack of clarity in my note. My apologies! Well yes, I agree they are sensible but it seems in the USA they are not only typically unknown but seen as pretentious. E.g. rather than have a butter knife for transferring butter to your plate and then using a regular or smaller but regular style knife for spreading it on your bread, each person (in a typical semi-fancy US restaurant) is issued a butter knife which is used both to retrieve butter and to spread it on your (potentially bitten) bread. And they are learned matters.
    - DanBC 7y ago
      Butter knives are used to prevent crumbs transfering to the butter dish, which can go mouldy. They've got nothing to do with germs in the mouth.
    - saagarjha 7y ago
      > Looks like your comment is being downvoted due to lack of clarity in my note. My apologies! I have more than enough karma to take a hit once in a while. No need to apologize :) > it seems in the USA they are not only typically unknown but seen as pretentious I live in the US, so I'm finding it surprising that you think these are not the norm. Perhaps I'm self-selecting the people I'm around, or don't pay attention to the people who do these things…
deleted 7y ago
[deleted]
spraak 7y ago
It's not just antibiotics, but some types of vaccines are creating evolutionary pressure and new strains of the pathogen. E.g. for pertussis > it is thought that B. pertussis is adapting under acellular vaccine mediated immune selection pressure, towards vaccine escape [1] > an increase in asymptomatic infection with concomitant increases in transmission and increased selection pressure for Bordetellapertussis variants that are better able to evade vaccine-mediated immunity than older isolates [2] [1] https://academic.oup.com/femspd/article/73/8/ftv064/2467598 https://academic.oup.com/femspd/article/73/8/ftv064/2467598 [2] https://www.sciencedirect.com/science/article/pii/S1567134816300636 https://www.sciencedirect.com/science/article/pii/S156713481...
- phkahler 7y ago
  >> some types of vaccines are creating evolutionary pressure... Wouldn't it be nice if we had more eradication programs? Evolution is going to work around every vaccine eventually unless we eradicate the disease. Yes, this is a hard problem but I think long term its worth it. Eventually we might get good at it.
  - spraak 7y ago
    I don't believe that eradication is possible, but I'm curious to hear more what your thoughts are
    - fzeroracer 7y ago
      Eradication is absolutely possible. High enough vaccination rates would help prevent further evolution of viruses, eventually containing them and then removing them provided there aren't alternative vectors like animals or pets. Unfortunately, certain other efforts are compromising this.
      - Fomite 7y ago
        It's not at all clear the pertussis vaccine creates a strong and lasting immunity enough to be an eradication target. Honestly, it's not one of the more promising eradication targets.
mises 7y ago
I think giving the third-world antibiotics was not a wise action for first-world nations to take. They are given out way too often, and there is reason these diseases come from there (also bad hygiene). People will also keep extras and just take them when they don't feel well. It may have helped short-term for the third world, but it will harm us all long-term. The biggest issue is that they were provided at very, very cheap prices (especially relative to prices elsewhere). When they are so cheap and readily available, they are abused. It's like the over-use of corn syrup here.
dgudkov 7y ago
Another article that describes the same story with additional details: https://www.motherjones.com/environment/2018/05/the-best-viral-news-youll-ever-read-antibiotic-resistance-phage-therapy-bacteriophage-virus/ https://www.motherjones.com/environment/2018/05/the-best-vir...
mensetmanusman 7y ago
Why aren’t all hospital surfaces coated with silver?
- emmelaich 7y ago
  https://en.wikipedia.org/wiki/Argyria https://en.wikipedia.org/wiki/Argyria perhaps? And expense. Of course.
- Fomite 7y ago
  There's a lot of work in working antimicrobial sufaces - silver, copper, some interesting structural patterns, etc. The problem is it's not particularly clear they work, and they are very expensive, and often a pain to clean.
- kwhitefoot 7y ago
  Brass will do quite well and is a lot cheaper.
- basetop 7y ago
  Better yet, why don't we have mobile hospital units. Rather than bringing all the sick people and disease into one place, why not go to the place of sickness. Perhaps it's economically not feasible, but I've always it made more sense.
whytaka 7y ago
It’s been a number of years now that I have become aware of MRSA and superbugs. The moment I read on this is also the moment I have come to be aware of phage therapy as a promising path of overcoming this new threat. This article yet again reports on the lack of awareness about bacteriophages in the medical community. I just can’t understand why it is like that. I, an idiot, have heard about it. How do people, who seemingly work with superbugs all the time and understand the threat, not know this thing that is amongst the very first things one is exposed to when one takes a superficial glance at the available literature?
- thayne 7y ago
  > I just can’t understand why it is like that. My guess is because phage treatments are difficult or impossible to patent, and therefore unattractive to pharmaceutical companies. And pharmaceutical companies are incentivized to push their own treatments on doctors and hospitals.
  - whytaka 7y ago
    I can suppose that economic incentives don’t align for its availability in the field but it doesn’t account for the ignorance of the practitioners. Bacteriophages are almost always one of the first things mentioned when the inevitable futility of antibiotics is discussed.
- AllegedAlec 7y ago
  > This article yet again reports on the lack of awareness about bacteriophages in the medical community. A shortlist of answers: - Bacteriophages are evolutionarily close to viruses. Their proteins will resemble viral proteins, so the body will most likely initiate an immune response against it. - Bacteriophages are really quite specific in what they'll infect. This makes them much less useful as an antibacterial. You'd spend a lot of time and money on making one that would infect your mrsa strain, and mrsa would probably just start the arms race, leaving you back at the start. - Bacteriophages are (evolutionarily close to) viruses, and thus also have the immense mutation rate of those. Even if you were to make one that had all the properties you wanted, it'd probably get rid of most of them because they are evolutionarily disadvantages. - Probably a few other fairly good reasons which my coffee-deprived brain can't think off right at this moment.
NyashMyash 7y ago
I'm russian. And for me this article sounds completely idiotic - phage research was always ongoing in SU and literally everyone is aware of the alternative to antibiotics. At the moment there are lab networks available across all the modern russia where you may take a test and find a best phage to your bacterias. One of several mass-produced phages. Moreover, if you dig into soviet medicine, you may find several awesome things. At the moment there are _two_ widely available st.aureus vaccines in russia. For those who work with farm animals. These vaccines may be used for both prevention and treatment. I've used them for myself to treat multiple-antibiotic resistant st.aureus infection and got rid of it. The other interesting thing is a synhetic analogue of thymopoietin - an incredible immune stimulant which may in multiple cases help you to deal with an infection without antibiotics. Unfortunately, russian doctors are idiots and russian medicine is almost dead and noone is interested in any stuff from there. I, personally, regret that we didn't hear any news about epimerox - that only substance would solve 80% of our problems with bacterias, including multi-resistent ones.
- rini17 7y ago
  Is it possible to order some to the EU? I'm having unfortunate combination of staph infection+ ciprofloxacin intolerance.
  - StreamBright 7y ago
    https://www.rbth.com/lifestyle/326184-foreigner-medical-assistance-russia https://www.rbth.com/lifestyle/326184-foreigner-medical-assi...
    - NyashMyash 7y ago
      These things (st. vaccinces) are mostly unknown to usual russian doctors, they are produced for farm workers. A typical therapist wouldn't prescribe you that stuff - they are not aware of their existence. Again - russians doctors are idiots, but there is some amazing soviet legacy you may greatly benefit from. And you don't _really_ need a prescription to buy the stuff.
  - 7y ago
hackerbabz 7y ago
Is it possible to establish a living will with her organization? I would love to have a hotline my next of kin can call to begin treatment whether or not my doctors are aware of its availability.
StreamBright 7y ago
I wish there were a nanotechnology startup that would address MRSA. In theory, you can develop nanobots that attack specific types of bacteria. Not sure if this would work: https://www.youtube.com/watch?v=5bQhGS8V6dQ https://www.youtube.com/watch?v=5bQhGS8V6dQ
- NyashMyash 7y ago
  You don't need nanorobots. You may just pick old soviet vaccines and resolve this particular problem (see my other post in this topic). Also there are a lot of great antibiotics (see epimerox) which still aren't on the market because of many different reasons.
- hairytrog 7y ago
  Startups are not the answer to everything... Capitalism and healthcare do not go well together because you profit from negative health.

139 points by susiecambria 7y ago

...for most superbugs, health departments and the US Centers for Disease Control and Prevention (CDC) don’t track who acquires them, nor do they know how many recovered or died. The most recent CDC report estimates that 23,000 people die in the U.S. each year from superbug infections, based on data from 2010. But a recent report estimated that at least 153,000 people died from superbug infections the same year, an estimate that is nearly seven-fold higher. We are allowing most superbugs to maintain their invisibility under the radar, where they are spreading quietly. Unreported. Undetected. And, increasingly, untreatable. this isn't really scary at all. i'm not scared. are you scared? why be scared?

Analemma_ 7y ago
To me, the really scary thing about antibiotic resistance is not necessarily random infections in the hospital (as bad as that is) but the fact that antibiotics are what made surgery possible, and if they don’t work, all these medical procedures we’ve gotten used to as harmless suddenly carry a very serious risk-reward tradeoff. Imagine C-sections, biopsies, hip replacements, etc. all having a one-in-four chance of death. That’s what we’re heading back to.
- est31 7y ago
  For operations, sterilizations are carried out with a mixture of means like chemical disinfectants, subjecting instruments to extreme heat (Autoclaving), etc. but they don't rely on antibiotics. Instruments can be put into environments toxic to both human and bacterial cells. The big difference of antibiotics is that they are toxic to bacteria but not to human cells so they can be put directly into the system. Some bacteria are also developing resistance against chemical disinfectants but here we have a much larger choice.
  - wl 7y ago
    It's defense in depth. Yes, sterile technique is used to minimize the occurrence of surgical site infections. Sterile technique, when performed 100% correctly, isn't perfect and prophylactic antibiotics are standard to help mitigate any remaining risk.
    - est31 7y ago
      Oh, TIL. Thanks for the info! It won't throw us back to the pre-semmelweis era though only to the pre-fleming area.
    - Fomite 7y ago
      The field uses "Swiss cheese" as a term for a reason - you can have holes in each layer (and will), but if you have enough layers you'll be okay.
- HillaryBriss 7y ago
  agree. and my next fear is that all of the medical establishment, suppliers, and practitioners who depend upon surgical procedures for their profitability downplay the additional risks and continue to encourage all of us to undergo surgery
  - Fomite 7y ago
    Surgeons are already the bane of many infection control specialists.
sithadmin 7y ago
Extremely scared, especially in light of barriers to drug approval killing off interest in antibiotics development. Just take a look at what happened to Achaogen: http://www.bioworld.com/perspectives/2019/04/24/a-decade-of-incentives-to-promote-antibiotic-development-and-still-no-viable-route-to-commercial-success/ http://www.bioworld.com/perspectives/2019/04/24/a-decade-of-... The FDA granted Fast Track designation for their antibiotic, only later refuse to approve it for use in bloodstream infections due to quibbling over study size (which was admittedly smaller than it could have been, largely in part due to the Fast Track designation). The antibiotic has been relegated to on-label use for complicated UTIs. Though it can still be used off-label, this isn't enough to attract further investment or keep sales strong enough to sustain ongoing operations. Achaogen was forced to lay off nearly all staff, and is now entering bankruptcy. Unfortunately, this sort of thing is hardly unique among early stage pharma companies focusing on antibiotics, and it's steering investors away from such companies. It's also driving pharma professionals away.
- pkaye 7y ago
  But they could still get approval in other countries.
  - sithadmin 7y ago
    Wouldn't have mattered previously, won't matter going forward. The USA is the most important and lucrative market, whether we like it or not.
  - BurningFrog 7y ago
    As I understand it, other countries are not very profitable as pharmaceutical markets, so they probably won't get developed in the first place there.
jen_h 7y ago
The point of her article wasn’t to push despair, but rather to urge the Western medical establishment to get moving on phage research. Bacteriophages as a solution to our antibiotic resistance crisis have been largely ignored in the West due to unpatentability, research mainly performed in Eastern Europe, etc — but her story is that a bacteriophage cocktail saved her husband’s life where antibiotics failed...and the only reason they even were able to go that route was because she’s an epidemiologist who pulled some strings, pulled research teams together, got approvals, and managed the project herself.
- Mirioron 7y ago
  So, why isn't government funded research being done on it then? I often hear about how the government funds a lot of medical research, so this seems like the perfect thing for them to fund.
  - Fomite 7y ago
    What makes you think they're not?
- DoreenMichele 7y ago
  From the article: Alternatives to antibiotics are desperately needed. She's not pushing phage research per se, just research into alternatives generally.
  - jen_h 7y ago
    Did you stop reading there, by chance?
    - deleted 7y ago
      [deleted]
    - throwaway5752 7y ago
      Shame on whoever downvoted you. The full last 5 paragraphs are devoted to bacteriophages, which are what ultimately saved the author's husband. The author is "Co-Director of the Center for Innovative Phage Applications and Therapeutics" at UCSD (https://profiles.ucsd.edu/steffanie.strathdee https://profiles.ucsd.edu/steffanie.strathdee) It closes on "The possibility of living in a post-antibiotic era where simple surgeries or scrapes could lead to an infection that requires limb amputation or results in death means we need to improve AMR surveillance, diagnosis and treatment. This includes antibiotics, but should also include phage therapy. We can’t afford to bury a promising alternative to antibiotics for another hundred years." She is absolutely pushing phage research. Not exclusive to any alternatives, but that is basically the point of the article.
rossenberg79 7y ago
Not scary at all. This is just life, and we must endure it. Keep in mind at the same time this is happening we also have to deal with climate change and not blowing ourselves up in all out Nuclear War. And even if we avoid all that you could still step outside and be shot or stabbed by a ruffian who leaves you dead all the same.

brohee 7y ago

And people still wonder why civilized countries forbid prophilactic antibiotics usage in livestock....

concerned209 7y ago

Any recommendations on what an individual could do to help? Organizations to donate to? Challenges that could be tackled by a startup? Promising companies to consider investing in? Also, can anybody explain why the CDC doesn’t mandate reporting?

aaronbrethorst 7y ago
Call your members of congress and demand that they ask the CDC that question.
deleted 7y ago
[deleted]
DoreenMichele 7y ago
I'm having trouble figuring out how to reply to the way you are framing the problem space. There are several Einstein quotes along the lines of "A problem cannot be solved using the same thinking that created it." The problem of antibiotic resistance won't be solved with the same mindset that got us here. One thing contributing to the rise of antibiotic resistance is poor santitation in developing countries. Another is poverty. There is also research into how to break up biofilm and thereby reverse antibiotic resistance. It points to issues with body chemistry which can basically be tied to diet. I think there are clearly avenues we can pursue, but most people are extremely dismissive of those avenues. So they simply aren't being pursued in earnest.
- benj111 7y ago
  "One thing contributing to the rise of antibiotic resistance is poor santitation in developing countries. Another is poverty." I assume this is why you were getting downvotes? I was going to too, but it does actually check out. https://www.omicsonline.org/open-access/antibiotic-abuse-in-developing-countries-2167-7689.1000e106.php?aid=6039 https://www.omicsonline.org/open-access/antibiotic-abuse-in-...
  - DoreenMichele 7y ago

deleted 7y ago

[deleted]

gumby 7y ago

One factor that will return once people start to panic is table manners, many of which seem fussy (separate saving utensils, a butter knife, not putting used utensils onto the table) but actually evolved for hygiene reasons. Sadly of course like any complex behavior it was also hijacked for sumptuary purposes (grape shears, egg spoons, not finishing your plate in some cultures) but I hold out a hope (probably in vail) that those kinds of rules won't be revived.

saagarjha 7y ago
> many of which seem fussy (separate saving utensils, a butter knife, not putting used utensils onto the table) Fussy? Aren’t these just common sense? I wouldn’t consider them to even be “table manners”.
- gumby 7y ago
  Looks like your comment is being downvoted due to lack of clarity in my note. My apologies! Well yes, I agree they are sensible but it seems in the USA they are not only typically unknown but seen as pretentious. E.g. rather than have a butter knife for transferring butter to your plate and then using a regular or smaller but regular style knife for spreading it on your bread, each person (in a typical semi-fancy US restaurant) is issued a butter knife which is used both to retrieve butter and to spread it on your (potentially bitten) bread. And they are learned matters.
  - DanBC 7y ago
    Butter knives are used to prevent crumbs transfering to the butter dish, which can go mouldy. They've got nothing to do with germs in the mouth.
  - saagarjha 7y ago
    > Looks like your comment is being downvoted due to lack of clarity in my note. My apologies! I have more than enough karma to take a hit once in a while. No need to apologize :) > it seems in the USA they are not only typically unknown but seen as pretentious I live in the US, so I'm finding it surprising that you think these are not the norm. Perhaps I'm self-selecting the people I'm around, or don't pay attention to the people who do these things…

deleted 7y ago

[deleted]

spraak 7y ago

It's not just antibiotics, but some types of vaccines are creating evolutionary pressure and new strains of the pathogen. E.g. for pertussis > it is thought that B. pertussis is adapting under acellular vaccine mediated immune selection pressure, towards vaccine escape [1] > an increase in asymptomatic infection with concomitant increases in transmission and increased selection pressure for Bordetellapertussis variants that are better able to evade vaccine-mediated immunity than older isolates [2] [1] https://academic.oup.com/femspd/article/73/8/ftv064/2467598 https://academic.oup.com/femspd/article/73/8/ftv064/2467598 [2] https://www.sciencedirect.com/science/article/pii/S1567134816300636 https://www.sciencedirect.com/science/article/pii/S156713481...

phkahler 7y ago
>> some types of vaccines are creating evolutionary pressure... Wouldn't it be nice if we had more eradication programs? Evolution is going to work around every vaccine eventually unless we eradicate the disease. Yes, this is a hard problem but I think long term its worth it. Eventually we might get good at it.
- spraak 7y ago
  I don't believe that eradication is possible, but I'm curious to hear more what your thoughts are
  - fzeroracer 7y ago
    Eradication is absolutely possible. High enough vaccination rates would help prevent further evolution of viruses, eventually containing them and then removing them provided there aren't alternative vectors like animals or pets. Unfortunately, certain other efforts are compromising this.
    - Fomite 7y ago
      It's not at all clear the pertussis vaccine creates a strong and lasting immunity enough to be an eradication target. Honestly, it's not one of the more promising eradication targets.

mises 7y ago

I think giving the third-world antibiotics was not a wise action for first-world nations to take. They are given out way too often, and there is reason these diseases come from there (also bad hygiene). People will also keep extras and just take them when they don't feel well. It may have helped short-term for the third world, but it will harm us all long-term. The biggest issue is that they were provided at very, very cheap prices (especially relative to prices elsewhere). When they are so cheap and readily available, they are abused. It's like the over-use of corn syrup here.

dgudkov 7y ago

Another article that describes the same story with additional details: https://www.motherjones.com/environment/2018/05/the-best-viral-news-youll-ever-read-antibiotic-resistance-phage-therapy-bacteriophage-virus/ https://www.motherjones.com/environment/2018/05/the-best-vir...

mensetmanusman 7y ago

Why aren’t all hospital surfaces coated with silver?

emmelaich 7y ago
https://en.wikipedia.org/wiki/Argyria https://en.wikipedia.org/wiki/Argyria perhaps? And expense. Of course.
Fomite 7y ago
There's a lot of work in working antimicrobial sufaces - silver, copper, some interesting structural patterns, etc. The problem is it's not particularly clear they work, and they are very expensive, and often a pain to clean.
kwhitefoot 7y ago
Brass will do quite well and is a lot cheaper.
basetop 7y ago
Better yet, why don't we have mobile hospital units. Rather than bringing all the sick people and disease into one place, why not go to the place of sickness. Perhaps it's economically not feasible, but I've always it made more sense.

whytaka 7y ago

It’s been a number of years now that I have become aware of MRSA and superbugs. The moment I read on this is also the moment I have come to be aware of phage therapy as a promising path of overcoming this new threat. This article yet again reports on the lack of awareness about bacteriophages in the medical community. I just can’t understand why it is like that. I, an idiot, have heard about it. How do people, who seemingly work with superbugs all the time and understand the threat, not know this thing that is amongst the very first things one is exposed to when one takes a superficial glance at the available literature?

thayne 7y ago
> I just can’t understand why it is like that. My guess is because phage treatments are difficult or impossible to patent, and therefore unattractive to pharmaceutical companies. And pharmaceutical companies are incentivized to push their own treatments on doctors and hospitals.
- whytaka 7y ago
  I can suppose that economic incentives don’t align for its availability in the field but it doesn’t account for the ignorance of the practitioners. Bacteriophages are almost always one of the first things mentioned when the inevitable futility of antibiotics is discussed.
AllegedAlec 7y ago
> This article yet again reports on the lack of awareness about bacteriophages in the medical community. A shortlist of answers: - Bacteriophages are evolutionarily close to viruses. Their proteins will resemble viral proteins, so the body will most likely initiate an immune response against it. - Bacteriophages are really quite specific in what they'll infect. This makes them much less useful as an antibacterial. You'd spend a lot of time and money on making one that would infect your mrsa strain, and mrsa would probably just start the arms race, leaving you back at the start. - Bacteriophages are (evolutionarily close to) viruses, and thus also have the immense mutation rate of those. Even if you were to make one that had all the properties you wanted, it'd probably get rid of most of them because they are evolutionarily disadvantages. - Probably a few other fairly good reasons which my coffee-deprived brain can't think off right at this moment.

NyashMyash 7y ago

I'm russian. And for me this article sounds completely idiotic - phage research was always ongoing in SU and literally everyone is aware of the alternative to antibiotics. At the moment there are lab networks available across all the modern russia where you may take a test and find a best phage to your bacterias. One of several mass-produced phages. Moreover, if you dig into soviet medicine, you may find several awesome things. At the moment there are _two_ widely available st.aureus vaccines in russia. For those who work with farm animals. These vaccines may be used for both prevention and treatment. I've used them for myself to treat multiple-antibiotic resistant st.aureus infection and got rid of it. The other interesting thing is a synhetic analogue of thymopoietin - an incredible immune stimulant which may in multiple cases help you to deal with an infection without antibiotics. Unfortunately, russian doctors are idiots and russian medicine is almost dead and noone is interested in any stuff from there. I, personally, regret that we didn't hear any news about epimerox - that only substance would solve 80% of our problems with bacterias, including multi-resistent ones.

rini17 7y ago
Is it possible to order some to the EU? I'm having unfortunate combination of staph infection+ ciprofloxacin intolerance.
- StreamBright 7y ago
  https://www.rbth.com/lifestyle/326184-foreigner-medical-assistance-russia https://www.rbth.com/lifestyle/326184-foreigner-medical-assi...
  - NyashMyash 7y ago
    These things (st. vaccinces) are mostly unknown to usual russian doctors, they are produced for farm workers. A typical therapist wouldn't prescribe you that stuff - they are not aware of their existence. Again - russians doctors are idiots, but there is some amazing soviet legacy you may greatly benefit from. And you don't _really_ need a prescription to buy the stuff.
- 7y ago

hackerbabz 7y ago

Is it possible to establish a living will with her organization? I would love to have a hotline my next of kin can call to begin treatment whether or not my doctors are aware of its availability.

StreamBright 7y ago

I wish there were a nanotechnology startup that would address MRSA. In theory, you can develop nanobots that attack specific types of bacteria. Not sure if this would work: https://www.youtube.com/watch?v=5bQhGS8V6dQ https://www.youtube.com/watch?v=5bQhGS8V6dQ

NyashMyash 7y ago
You don't need nanorobots. You may just pick old soviet vaccines and resolve this particular problem (see my other post in this topic). Also there are a lot of great antibiotics (see epimerox) which still aren't on the market because of many different reasons.
hairytrog 7y ago
Startups are not the answer to everything... Capitalism and healthcare do not go well together because you profit from negative health.