7 ms·

Deadly 'superbugs' invade U.S. health care facilities

45 points by kirillzubovsky 14y ago

cindywu123 14y ago
4 in 10 chance that if you get infected with CRE bacteria you will die...
- kirillzubovsky 14y ago
  That's one nasty bacteria. According to the article, the worst part is that it contains a resistant strain that started migrated to other types of bacteria. So far, contained mostly at hospitals, might get outside and merge with more common bacterias. The plague is near?
  - jacquesm 14y ago
    The plague has never really left us. It's just being held at bay (barely) by anti-biotics and basic hygiene. On a long term scale bacteria have won over every other kind of life, there is little reason to assume that this will change in the future. This holds whether you look at them by mass, by number or by just about any other metric.
- rincebrain 14y ago
  Not precisely. 4 in 10 chance that if they notice you're infected, you'll die - doesn't count all the countless people who are infected but not immunocompromised, so their bodies keep the infections in check or actively destroy them.
- daeken 14y ago
  What's the sample size behind that? Because it doesn't seem like there have been that many CRE cases yet, and we don't know the condition of patients before CRE infection.
- ars 14y ago
  People who get sick from CRE usually have lots of other medical issues, and are weaker. They don't necessarily die from CRE itself. Also remember that CRE are not more virulent than non resistant forms of enterobacteriaceae, and those certainly don't kill 4 in 10 (although that family seems to have all the really bad bacteria like E. Coli, Salmonella, Plague and others).
  - lgleason 14y ago
    It actually does. Healthy people who get MRSA often end up fighting a long uphill battle. If you are in a hospital you are going to have a compromised immune system. When someone gets sepsis it is really nasty.
- shasta 14y ago
  10 in 10, the way you've phrased it
rsync 14y ago
Here's a quote: "The bacteria made headlines this summer after a CRE strain of Klebsiella pneumoniae battered the National Institutes of Health Clinical Center outside Washington, D.C. Seven died, including a 16-year-old boy. (Hospitals don't reveal victims' names in keeping with medical privacy rules.) But that case was neither the first nor the worst of the CRE attacks." I'm curious, were new patients notified before admittance that they had a resistant outbreak in their hospital ? Were existing patients notified that this was happening while they were there ? I'll bet no, and no. Another quote: ""We were really frustrated; we hadn't seen anything like this in the literature," says Costi Sifri, the hospital epidemiologist. "The fact that we had different bacteria told us these cases were not related, but the shoe leather epidemiology suggested to us that all these (infections) came from the same patient. ... We realized we might be seeing a mobile genetic event."" ... all the while continuing to admit new patients ...
- cindywu123 14y ago
  this isn't anything new... hospital acquired infections (HAIs) are the 4th leading cause of death in the U.S. nearly 1 in 20 hospitalized patients will acquire a HAI killing 270 people/day hospitals... scary place
  - wildranter 14y ago
    Yes, it is scary. But you forgot to add that give or take half the time doctors don't have the slightest idea of what they're dealing with. However, the thing gets even hairier when you talk to med students. Most of the one I've talked told me their main reason to learn the craft was the money. Take good care of yourself, exercise, eat healthy, and don't forget to have sex. Otherwise you're gonna end up in their books as just another entry.
    - gregsq 14y ago
      Good advise. If you can at all stay out of a hospital, the better your chances of avoiding these highly selected bugs. It makes sense that feeders are nursing homes or establishments that have some palliative care, as many patients there have somewhat weakened immune systems, whether from age related illnesses or otherwise, and the prescription of antibiotics is, as it is in many other scenarios, excessive. [1] Stay as strong and as healthy as you can, and condition your immune system as best you can is good advise. http://www.sciencedaily.com/releases/2008/02/080226092810.htm http://www.sciencedaily.com/releases/2008/02/080226092810.ht...
omegant 14y ago
It is amazing how this bacteria interchanges genes with ease. Could it be possible to use this strength as a weakness? Inoculating a modified bacteria to act as a trojan horse?. edit: missing letters.
- btbuilder 14y ago
  I believe this approach normally doesn't work because any gene that leads to weakness with be removed via natural selection.
  - lftl 14y ago
    I think the goal might not be to make a bacteria that's easier to kill, but one that's less likely to kill us. There's generally a strong evolutionary pressure not to be fatal for your host.
tomkinstinch 14y ago
It's unfortunate that regulatory environment in the US is not more favorable for advancing phage therapy. It could be a promising alternative to antibiotics for treating infections caused by multi-drug resistant organisms.
- breakyerself 14y ago
  From what I've read. You're probably right. They're worried that mutations make it hard to lock down the exact properties of any given phage treatment, but that would be a risk I'd be willing to take. Especially since they're in wide use in some countries with no horror stories that I've heard.
conanite 14y ago
Assuming it is correct to say that antibiotic-resistant bacteria evolve in response to the (over-/ab-)use of antibiotics - I wonder to what extent opposition to teaching evolution improves the chances of these kind of bacteria evolving. Disbelief in, and/or ignorance of how a process works is effectively giving that process a green light. Conversely, might the appearance of CRE bacteria might sway the evolution debate? Or to be more blunt, does a disbelief in evolution increase a nation's chances of collectively qualifying for a Darwin award?
- meaty 14y ago
  If bacteria can modify the host's behaviour (this is proven), perhaps your hypothesis is a certain type of bacteria's survival vector?
- slapshot 14y ago
  > Conversely, might the appearance of CRE bacteria might sway the evolution debate? No. It seems like an easy political point, but there's a lot more to the story. First, there are far easier and more visible examples of evolution. In UK schools, possibly because it's a nearby example, it is taught that the color of moths in London changed dramatically during the Industrial Revolution because light-colored moths were easy snacks for birds on newly soot-covered walls. There are more colorful examples closer at hand: most of the domesticated animals in the world are examples of evolution by artificial selection: cows today share little with cows 10,000 years ago, and corn today looks nothing like 10,000 years ago. Second, thanks to #1, the belief is often that "humans (special) didn't evolve from apes (animal)" --- not that species never change. The belief is based on an idea that either evolution started after humans were created, or that even if evolution has been running for 100 million years, there's no way that natural selection could cause the leap from animal to human. It doesn't preclude belief in evolution among animals. Third, antibiotics are all prescribed by doctors, who are plenty aware of the work of Sir Charles. And, last, antibiotic misuse is largely a tragedy of the commons. Rational patients who are very aware of the risks of antibiotic-resistant phages will still request antibiotics: they feel the benefit (even if the chance of a benefit to them is small) but the pain of antibiotic resistance is felt by other people. So, no, it's easy political point but it has more to do with enthusiasm than fact.
fela 14y ago
I think that what is important to note is that their only evolutionary advantage, and thus the main reason they spread, is their resistance to antibiotics, in normal conditions they would have a quite big chance of losing in competition with other bacteria. As soon as antibiotics are used, the competition dies and they can proliferate. This means that the best prevention method is to use antibiotics as rarely as possible. Let's remember that the same bacteria that cause infections, can ordinarily live on our body quite harmlessly.
jacquesm 14y ago
There is a rather rude joke that if you want to avoid dying you should avoid hospitals because lots of people die there. What the joke doesn't zero in on is that people that die in hospitals do not always die of what they had when they got there. Hospitals tend to be very tight lipped towards the people they admit when it comes to admitting mistakes for fear of liability, but in cases like this there ought to be a maximum of transparency so the people that are about to be hospitalized can make informed decisions about the additional risks over and beyond the thing they're going to the hospital for in the first place.
JunkDNA 14y ago
I studied antibiotic resistance when I worked in pharma. It's a fiendishly difficult problem. You have a mix of factors that all conspire to a bad outcome. First, you have natural selection, so any antibiotic safe for human consumption is likely to eventually result in drug resistant bacteria. Secon, you have social practices. In the US you have patients who brow beat their doctors into giving them antibiotics when they don't need them. In other parts of the world, you can buy antibiotics over the counter! This is hugely problematic since the genes for resistance spread globally when they get a foothold (you can actually watch this over time with DNA sequencing and careful collection of samples). Finally, on the economic side, most regulators like the FDA will force any new antibiotic to be held back on the shelf and used only as a "drug of last resort". This reduces incentives to develop new antibiotics since the drug patent will expire before you can sell enough to make back the R&D cost. Much better to throw resources at cancer since your drug might end up as a front line therapy there, than to waste time on antibiotics (so the bean counter thinking goes). I honestly don't know what the answer is. Most likely, there will need to be some new tech the bugs have a hard time beating. Outside the body we still have plenty of things that kill bacteria which they can't get around (bleach comes to mind). The likely outcome is some kind of new delivery mechanism that is fast, complete, and highly effective.
- seats 14y ago
  I wonder if it would be possible to use natural selection and human behavior to our advantage? imagine a compound that causes bacteria to adapt in a way that makes us easier to control them. like putting fluoride in our water we'd distribute the Trojan biological 'malware' into the wild and make bacteria more susceptible to very specific types of treatments.
  - JunkDNA 14y ago
    This is a clever idea, but likely to end badly in practice given the way genetics works. Any neutral trait that doesn't confer increased survivability will be filtered out rapidly and never spread. So you would need to design something that gives the bacteria carrying the trait a slight survival advantage, but at the same time has a hidden "back door" we can exploit. Furthermore, the back door has to be intimately tied to increased survival and not just along for the ride. Otherwise, the bacteria will snip the back door part out and keep the part that gives them increased survival. Now you have genetically engineered super-bugs. Oops. Even assuming that you have perfectly designed this new trait to meet the needs of having a back door and increased survivability that are inseparable, you still fail. Eventually, the bacteria all drop your fancy new trait and revert to being plain old bacterium because that state is now the one with the survival advantage that allows them to duck your new fancy antibiotics. Probably, the only angle that is likely to work is immune system modification and enhancement. Something like a vaccine that causes the immune system to go thermonuclear on the pathogen is likely the best route. The immune system is highly adaptable and extremely well-honed. We've successfully driven many viruses to the brink of extinction this way, but the tech we have is not as good for bacteria (though there are vaccines for some bacterial infections).
stinky613 14y ago
Every time I hear about hospital acquired infections I cross my fingers for the narrow band UV lights I remember hearing about. Even if we could just have those in hospital hallways or elevators... Man, what a difference that could make. http://www.popsci.com/science/article/2010-11/researchers-use-bacteria-killing-light-destroy-pathogens-flip-switch http://www.popsci.com/science/article/2010-11/researchers-us...
adam-f 14y ago
I've come across some mentions of MDR (Multidrug Resistance) pumps, and MDR pump inhibitors: I assume there's a reason we're not mixing in Oregon Grape root into our antibiotic cocktails? http://en.wikipedia.org/wiki/Oregon-grape http://en.wikipedia.org/wiki/Oregon-grape http://www.ncbi.nlm.nih.gov/pmc/articles/PMC26451/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC26451/ http://www.ncbi.nlm.nih.gov/pubmed/11321580 http://www.ncbi.nlm.nih.gov/pubmed/11321580
lgleason 14y ago
My mother died from a hospital acquired superbug (MRSA) earlier this year......this is nasty stuff.

4 in 10 chance that if you get infected with CRE bacteria you will die...

kirillzubovsky 14y ago
That's one nasty bacteria. According to the article, the worst part is that it contains a resistant strain that started migrated to other types of bacteria. So far, contained mostly at hospitals, might get outside and merge with more common bacterias. The plague is near?
- jacquesm 14y ago
  The plague has never really left us. It's just being held at bay (barely) by anti-biotics and basic hygiene. On a long term scale bacteria have won over every other kind of life, there is little reason to assume that this will change in the future. This holds whether you look at them by mass, by number or by just about any other metric.
rincebrain 14y ago
Not precisely. 4 in 10 chance that if they notice you're infected, you'll die - doesn't count all the countless people who are infected but not immunocompromised, so their bodies keep the infections in check or actively destroy them.
daeken 14y ago
What's the sample size behind that? Because it doesn't seem like there have been that many CRE cases yet, and we don't know the condition of patients before CRE infection.
ars 14y ago
People who get sick from CRE usually have lots of other medical issues, and are weaker. They don't necessarily die from CRE itself. Also remember that CRE are not more virulent than non resistant forms of enterobacteriaceae, and those certainly don't kill 4 in 10 (although that family seems to have all the really bad bacteria like E. Coli, Salmonella, Plague and others).
- lgleason 14y ago
  It actually does. Healthy people who get MRSA often end up fighting a long uphill battle. If you are in a hospital you are going to have a compromised immune system. When someone gets sepsis it is really nasty.
shasta 14y ago
10 in 10, the way you've phrased it

rsync 14y ago

Here's a quote: "The bacteria made headlines this summer after a CRE strain of Klebsiella pneumoniae battered the National Institutes of Health Clinical Center outside Washington, D.C. Seven died, including a 16-year-old boy. (Hospitals don't reveal victims' names in keeping with medical privacy rules.) But that case was neither the first nor the worst of the CRE attacks." I'm curious, were new patients notified before admittance that they had a resistant outbreak in their hospital ? Were existing patients notified that this was happening while they were there ? I'll bet no, and no. Another quote: ""We were really frustrated; we hadn't seen anything like this in the literature," says Costi Sifri, the hospital epidemiologist. "The fact that we had different bacteria told us these cases were not related, but the shoe leather epidemiology suggested to us that all these (infections) came from the same patient. ... We realized we might be seeing a mobile genetic event."" ... all the while continuing to admit new patients ...

cindywu123 14y ago
this isn't anything new... hospital acquired infections (HAIs) are the 4th leading cause of death in the U.S. nearly 1 in 20 hospitalized patients will acquire a HAI killing 270 people/day hospitals... scary place
- wildranter 14y ago
  Yes, it is scary. But you forgot to add that give or take half the time doctors don't have the slightest idea of what they're dealing with. However, the thing gets even hairier when you talk to med students. Most of the one I've talked told me their main reason to learn the craft was the money. Take good care of yourself, exercise, eat healthy, and don't forget to have sex. Otherwise you're gonna end up in their books as just another entry.
  - gregsq 14y ago
    Good advise. If you can at all stay out of a hospital, the better your chances of avoiding these highly selected bugs. It makes sense that feeders are nursing homes or establishments that have some palliative care, as many patients there have somewhat weakened immune systems, whether from age related illnesses or otherwise, and the prescription of antibiotics is, as it is in many other scenarios, excessive. [1] Stay as strong and as healthy as you can, and condition your immune system as best you can is good advise. http://www.sciencedaily.com/releases/2008/02/080226092810.htm http://www.sciencedaily.com/releases/2008/02/080226092810.ht...

omegant 14y ago

It is amazing how this bacteria interchanges genes with ease. Could it be possible to use this strength as a weakness? Inoculating a modified bacteria to act as a trojan horse?. edit: missing letters.

btbuilder 14y ago
I believe this approach normally doesn't work because any gene that leads to weakness with be removed via natural selection.
- lftl 14y ago
  I think the goal might not be to make a bacteria that's easier to kill, but one that's less likely to kill us. There's generally a strong evolutionary pressure not to be fatal for your host.

tomkinstinch 14y ago

It's unfortunate that regulatory environment in the US is not more favorable for advancing phage therapy. It could be a promising alternative to antibiotics for treating infections caused by multi-drug resistant organisms.

breakyerself 14y ago
From what I've read. You're probably right. They're worried that mutations make it hard to lock down the exact properties of any given phage treatment, but that would be a risk I'd be willing to take. Especially since they're in wide use in some countries with no horror stories that I've heard.

conanite 14y ago

Assuming it is correct to say that antibiotic-resistant bacteria evolve in response to the (over-/ab-)use of antibiotics - I wonder to what extent opposition to teaching evolution improves the chances of these kind of bacteria evolving. Disbelief in, and/or ignorance of how a process works is effectively giving that process a green light. Conversely, might the appearance of CRE bacteria might sway the evolution debate? Or to be more blunt, does a disbelief in evolution increase a nation's chances of collectively qualifying for a Darwin award?

meaty 14y ago
If bacteria can modify the host's behaviour (this is proven), perhaps your hypothesis is a certain type of bacteria's survival vector?
slapshot 14y ago
> Conversely, might the appearance of CRE bacteria might sway the evolution debate? No. It seems like an easy political point, but there's a lot more to the story. First, there are far easier and more visible examples of evolution. In UK schools, possibly because it's a nearby example, it is taught that the color of moths in London changed dramatically during the Industrial Revolution because light-colored moths were easy snacks for birds on newly soot-covered walls. There are more colorful examples closer at hand: most of the domesticated animals in the world are examples of evolution by artificial selection: cows today share little with cows 10,000 years ago, and corn today looks nothing like 10,000 years ago. Second, thanks to #1, the belief is often that "humans (special) didn't evolve from apes (animal)" --- not that species never change. The belief is based on an idea that either evolution started after humans were created, or that even if evolution has been running for 100 million years, there's no way that natural selection could cause the leap from animal to human. It doesn't preclude belief in evolution among animals. Third, antibiotics are all prescribed by doctors, who are plenty aware of the work of Sir Charles. And, last, antibiotic misuse is largely a tragedy of the commons. Rational patients who are very aware of the risks of antibiotic-resistant phages will still request antibiotics: they feel the benefit (even if the chance of a benefit to them is small) but the pain of antibiotic resistance is felt by other people. So, no, it's easy political point but it has more to do with enthusiasm than fact.

fela 14y ago

I think that what is important to note is that their only evolutionary advantage, and thus the main reason they spread, is their resistance to antibiotics, in normal conditions they would have a quite big chance of losing in competition with other bacteria. As soon as antibiotics are used, the competition dies and they can proliferate. This means that the best prevention method is to use antibiotics as rarely as possible. Let's remember that the same bacteria that cause infections, can ordinarily live on our body quite harmlessly.

jacquesm 14y ago

There is a rather rude joke that if you want to avoid dying you should avoid hospitals because lots of people die there. What the joke doesn't zero in on is that people that die in hospitals do not always die of what they had when they got there. Hospitals tend to be very tight lipped towards the people they admit when it comes to admitting mistakes for fear of liability, but in cases like this there ought to be a maximum of transparency so the people that are about to be hospitalized can make informed decisions about the additional risks over and beyond the thing they're going to the hospital for in the first place.

JunkDNA 14y ago

I studied antibiotic resistance when I worked in pharma. It's a fiendishly difficult problem. You have a mix of factors that all conspire to a bad outcome. First, you have natural selection, so any antibiotic safe for human consumption is likely to eventually result in drug resistant bacteria. Secon, you have social practices. In the US you have patients who brow beat their doctors into giving them antibiotics when they don't need them. In other parts of the world, you can buy antibiotics over the counter! This is hugely problematic since the genes for resistance spread globally when they get a foothold (you can actually watch this over time with DNA sequencing and careful collection of samples). Finally, on the economic side, most regulators like the FDA will force any new antibiotic to be held back on the shelf and used only as a "drug of last resort". This reduces incentives to develop new antibiotics since the drug patent will expire before you can sell enough to make back the R&D cost. Much better to throw resources at cancer since your drug might end up as a front line therapy there, than to waste time on antibiotics (so the bean counter thinking goes). I honestly don't know what the answer is. Most likely, there will need to be some new tech the bugs have a hard time beating. Outside the body we still have plenty of things that kill bacteria which they can't get around (bleach comes to mind). The likely outcome is some kind of new delivery mechanism that is fast, complete, and highly effective.

seats 14y ago
I wonder if it would be possible to use natural selection and human behavior to our advantage? imagine a compound that causes bacteria to adapt in a way that makes us easier to control them. like putting fluoride in our water we'd distribute the Trojan biological 'malware' into the wild and make bacteria more susceptible to very specific types of treatments.
- JunkDNA 14y ago
  This is a clever idea, but likely to end badly in practice given the way genetics works. Any neutral trait that doesn't confer increased survivability will be filtered out rapidly and never spread. So you would need to design something that gives the bacteria carrying the trait a slight survival advantage, but at the same time has a hidden "back door" we can exploit. Furthermore, the back door has to be intimately tied to increased survival and not just along for the ride. Otherwise, the bacteria will snip the back door part out and keep the part that gives them increased survival. Now you have genetically engineered super-bugs. Oops. Even assuming that you have perfectly designed this new trait to meet the needs of having a back door and increased survivability that are inseparable, you still fail. Eventually, the bacteria all drop your fancy new trait and revert to being plain old bacterium because that state is now the one with the survival advantage that allows them to duck your new fancy antibiotics. Probably, the only angle that is likely to work is immune system modification and enhancement. Something like a vaccine that causes the immune system to go thermonuclear on the pathogen is likely the best route. The immune system is highly adaptable and extremely well-honed. We've successfully driven many viruses to the brink of extinction this way, but the tech we have is not as good for bacteria (though there are vaccines for some bacterial infections).

stinky613 14y ago

Every time I hear about hospital acquired infections I cross my fingers for the narrow band UV lights I remember hearing about. Even if we could just have those in hospital hallways or elevators... Man, what a difference that could make. http://www.popsci.com/science/article/2010-11/researchers-use-bacteria-killing-light-destroy-pathogens-flip-switch http://www.popsci.com/science/article/2010-11/researchers-us...

adam-f 14y ago

I've come across some mentions of MDR (Multidrug Resistance) pumps, and MDR pump inhibitors: I assume there's a reason we're not mixing in Oregon Grape root into our antibiotic cocktails? http://en.wikipedia.org/wiki/Oregon-grape http://en.wikipedia.org/wiki/Oregon-grape http://www.ncbi.nlm.nih.gov/pmc/articles/PMC26451/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC26451/ http://www.ncbi.nlm.nih.gov/pubmed/11321580 http://www.ncbi.nlm.nih.gov/pubmed/11321580

lgleason 14y ago

My mother died from a hospital acquired superbug (MRSA) earlier this year......this is nasty stuff.