3 ms·

When very bad outbreaks start to occur because antibiotics' effectiveness starts dropping precipitously, I think there will be progress. It will take a few yea

When very bad outbreaks start to occur because antibiotics' effectiveness starts dropping precipitously, I think there will be progress. It will take a few years to get ramped up, but given modern technology I think there will be some interesting partial solutions fairly soon after that. The Russians were particularly interested in this sort of thing during the latter part of the Cold War, as I'm sure the West was, and still is. They were looking at enhancing the immune system as an alternative to antibiotics or vaccines for agents that could not necessarily be fought with antibiotics or vaccines (i.e. biological terrorism). They also looked at using immune response as a bioterror target (e.g. something like the reaction to TGN1412 but using a transmissible bioagent instead of a non-biological agent.) They were keenly aware that the two problems were linked. Obviously, immune response is bad at all times when there's no active threatening infection to fight, but needs to be maximized at least along certain paths when there's a threatening infection. That was a difficult problem with 1980's technology. I'm optimistic that it's not quite so intractable a problem, at least in cases of common bacterial infections typically treated with antibiotics today. More narrowly targeted immune system boosting seems plausible now that there's a somewhat better understanding of immune system interactions...

DanBC 13y ago
> When very bad outbreaks start to occur because antibiotics' effectiveness starts dropping precipitously, I think there will be progress. Hospital acquired infection is a significant cause of death. > In the United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined, cause or contribute to 99,000 deaths each year. > In Europe, where hospital surveys have been conducted, the category of Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year. (http://en.wikipedia.org/wiki/Hospital-acquired_infection http://en.wikipedia.org/wiki/Hospital-acquired_infection) These are just nosocomial (hospital acquired) and not necessarily antibiotic resistant.
- harshreality 13y ago
  Resistant infections in hospitals must not yet be a significant enough problem to get lots of smart people working on the problem. Or, rather, they're working on trying to contain infections and reduce transmissions rather than on how to treat the infections, right? The other shoe has to drop before other half of the problem gets serious attention.
hga 13y ago
"enhancing the immune system" Note that one possible flip side of this is auto-immune diseases. "immune response is bad at all times when there's no active threatening infection to fight" I don't think that's at all true. Our immune systems tend to work wonderfully most of the time given that we're constantly bathed in potentially pathogenic bacteria. In this discussion scythe says of "the ESKAPE pathogens, which are the primary superbugs" that "in every case except S aureus, infection is basically unheard of when an individual has a functioning immune system; they are all opportunistic pathogens". I take that to mean that for a lot people, temporary immune system dysfunction, e.g. due to other insults to the body, are a big factor. I noticed on Wikipedia that one of the ESKAPE bacteria, Acinetobacter baumannii (http://en.wikipedia.org/wiki/Acinetobacter_baumannii http://en.wikipedia.org/wiki/Acinetobacter_baumannii), "Colloquially, A. baumannii is referred to as 'Iraqibacter' due to its seemingly sudden emergence in military treatment facilities during the Iraq War. It has continued to be an issue for veterans and soldiers who serve in Iraq and Afghanistan. Multidrug resistant (MDR) A. baumannii has spread to civilian hospitals in part due to the transport of infected soldiers through multiple medical facilities." That I assume is largely due to gross trauma (and lots more soldiers surviving because of much better body armor (even helps in non-comat accidents I've read) and ever better treatment) ... and e.g. car crashes in the US tell us we're not soon going to be rid of that problem....
- harshreality 13y ago
  I realize that auto-immune disease is a consequence of overactive immune system, and I thought I alluded to that in the last paragraph. I guess I don't believe that the only way to enhance the immune system is to make it more active in general or in ways that would necessarily lead to increased instances of autoimmune disease. I should have said wherever rather than at all times when. I don't try to discuss this a lot so I guess I'm not as precise at organizing my thoughts as I'd like to be. Thanks. Yeah, "superbugs" are disproportionately at hospitals, and garden variety bacterial species; they cause problems because patients tend to have wounds or compromised immune systems, and because the frequency of antibiotic use at hospitals encourages thriving populations of resistant strains.
  - 13y ago

DanBC 13y ago

> When very bad outbreaks start to occur because antibiotics' effectiveness starts dropping precipitously, I think there will be progress. Hospital acquired infection is a significant cause of death. > In the United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined, cause or contribute to 99,000 deaths each year. > In Europe, where hospital surveys have been conducted, the category of Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year. (http://en.wikipedia.org/wiki/Hospital-acquired_infection http://en.wikipedia.org/wiki/Hospital-acquired_infection) These are just nosocomial (hospital acquired) and not necessarily antibiotic resistant.

harshreality 13y ago
Resistant infections in hospitals must not yet be a significant enough problem to get lots of smart people working on the problem. Or, rather, they're working on trying to contain infections and reduce transmissions rather than on how to treat the infections, right? The other shoe has to drop before other half of the problem gets serious attention.

hga 13y ago

"enhancing the immune system" Note that one possible flip side of this is auto-immune diseases. "immune response is bad at all times when there's no active threatening infection to fight" I don't think that's at all true. Our immune systems tend to work wonderfully most of the time given that we're constantly bathed in potentially pathogenic bacteria. In this discussion scythe says of "the ESKAPE pathogens, which are the primary superbugs" that "in every case except S aureus, infection is basically unheard of when an individual has a functioning immune system; they are all opportunistic pathogens". I take that to mean that for a lot people, temporary immune system dysfunction, e.g. due to other insults to the body, are a big factor. I noticed on Wikipedia that one of the ESKAPE bacteria, Acinetobacter baumannii (http://en.wikipedia.org/wiki/Acinetobacter_baumannii http://en.wikipedia.org/wiki/Acinetobacter_baumannii), "Colloquially, A. baumannii is referred to as 'Iraqibacter' due to its seemingly sudden emergence in military treatment facilities during the Iraq War. It has continued to be an issue for veterans and soldiers who serve in Iraq and Afghanistan. Multidrug resistant (MDR) A. baumannii has spread to civilian hospitals in part due to the transport of infected soldiers through multiple medical facilities." That I assume is largely due to gross trauma (and lots more soldiers surviving because of much better body armor (even helps in non-comat accidents I've read) and ever better treatment) ... and e.g. car crashes in the US tell us we're not soon going to be rid of that problem....

harshreality 13y ago
I realize that auto-immune disease is a consequence of overactive immune system, and I thought I alluded to that in the last paragraph. I guess I don't believe that the only way to enhance the immune system is to make it more active in general or in ways that would necessarily lead to increased instances of autoimmune disease. I should have said wherever rather than at all times when. I don't try to discuss this a lot so I guess I'm not as precise at organizing my thoughts as I'd like to be. Thanks. Yeah, "superbugs" are disproportionately at hospitals, and garden variety bacterial species; they cause problems because patients tend to have wounds or compromised immune systems, and because the frequency of antibiotic use at hospitals encourages thriving populations of resistant strains.
- 13y ago