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The Age of the Superbug Is Here

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Re: The Age of the Superbug Is Here

#131

Post by [deleted] »

rufius wrote: post #77
rm2889 wrote: post #68

I live in India and despite some improvements, the level of antibiotic abuse here is shocking. They're available over the counter and people self-medicate with antibiotics all the time. The attitude is, "if my sore throat doesn't go away in a couple of days, its time to take antibiotics. No point in going to the doc coz they'll prescribe antibiotics too and this way I save money." People self-medicating on antibiotic…

I'd imagine it's not much different in Central and South America based on my travels. You can walk into any pharmacy and show them the word "amoxicillin" and they'll give you a 2 week course. Edit: a word

[deleted]

Re: The Age of the Superbug Is Here

#132

Post by robbiep »

darawk wrote: post #97

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 globa…

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

Re: The Age of the Superbug Is Here

#133

Post by robbiep »

tedunangst wrote: post #107
darawk wrote: post #97

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 globa…

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.

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

Re: The Age of the Superbug Is Here

#134

Post by robbiep »

biesnecker wrote: post #52
lossolo wrote: post #6

This is an amazing video[1] from Harvard Medical School released couple of days ago showing evolution of bacteria that evolve in 10 days to become resistant to antibiotics. [1] https://youtu.be/plVk4NVIUh8

Amazing video. Question that comes to mind is how easy would it be to take the bacteria that make it to the center, and put them on a new plate with a different antibiotic in the same configuration, and then repeat until you've gone through all available antibiotics, then scoop that last batch up and do something really nasty with it? It must be harder than it seems, because otherwise why do terrorists and the like e…

Resistance does not equal virulence

Re: The Age of the Superbug Is Here

#135

Post by alkonaut »

rm2889 wrote: post #68

I live in India and despite some improvements, the level of antibiotic abuse here is shocking. They're available over the counter and people self-medicate with antibiotics all the time. The attitude is, "if my sore throat doesn't go away in a couple of days, its time to take antibiotics. No point in going to the doc coz they'll prescribe antibiotics too and this way I save money." People self-medicating on antibiotic…

A country that allows humans to buy antibiotics over the counter OR allows antibiotic use in healthy livestock needs to be heavily sanctioned very quickly. Sanctions from the international community can include ceasing aid, adding visa requirements or other travel restrictions, food import bans, or whatever.

I don't understand why other countries (and the international community as a whole) still accept this behavior.

Re: The Age of the Superbug Is Here

#136

Post by TeMPOraL »

DonaldFisk wrote: post #75
slv77 wrote: post #69

Earlier quoted context omitted.

Each bacteriophage typically targets just one or at most few types of bacteria. The targeted treatment in many ways is an advantage because a phage treatment to target a pathogen wouldn't also wipe out the symbiotic bacteria that we are increasing finding act as part of our natural defense mechanism against pathogens. The challenge for drug companies is that they would need to isolate and get regulatory approval for…

Other than the last paragraph, the problems you mention are a market failure, which can be dealt with by having all aspects of phage therapy carried out within a government-owned health service, rather than by privately owned pharmaceutical companies. It's worth noting that phage therapy was successfully used in the Soviet Union, and is still used in Georgia where the phage was "farmed", and that attempts to commerci…

I wonder if the economic reasons isn't exactly why phage research seems (AFAIR) to be coming mostly out of Russia.

Re: The Age of the Superbug Is Here

#137

Post by Fordrus »

darawk wrote: post #97

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 globa…

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!

Re: The Age of the Superbug Is Here

#138

Post by TeMPOraL »

msandford wrote: post #117
magicalist wrote: post #112

Earlier quoted context omitted.

> As a former boss used to say, there is no "fairly sterile" just as there is no "fairly pregnant". This (and mrob's post) is definitely incorrect. It's the opposite, in fact, there is no "sterile" in the absolute sense. You'll never kill everything. This is measured in multiple ways, depending on field: sterility assurance level[0] is one, similar to the way the USDA specifies cooking temperatures to hit 6- or 7-log…

> This (and mrob's post) is definitely incorrect. It's the opposite, in fact, there is no "sterile" in the absolute sense. You'll never kill everything. I suspect that there's some level of heat at which you've done exactly that. What organic molecule is going to survive a bath in liquid tungsten? ~6100F

"It's life Jim, but not as we know it" ;).

Re: The Age of the Superbug Is Here

#139

Post by Mz »

darawk wrote: post #97

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 globa…

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.

Re: The Age of the Superbug Is Here

#140

Post by magicalist »

msandford wrote: post #117
magicalist wrote: post #112

Earlier quoted context omitted.

> As a former boss used to say, there is no "fairly sterile" just as there is no "fairly pregnant". This (and mrob's post) is definitely incorrect. It's the opposite, in fact, there is no "sterile" in the absolute sense. You'll never kill everything. This is measured in multiple ways, depending on field: sterility assurance level[0] is one, similar to the way the USDA specifies cooking temperatures to hit 6- or 7-log…

> This (and mrob's post) is definitely incorrect. It's the opposite, in fact, there is no "sterile" in the absolute sense. You'll never kill everything. I suspect that there's some level of heat at which you've done exactly that. What organic molecule is going to survive a bath in liquid tungsten? ~6100F

Sure, but usually the problem is the thing you're trying to sterilize won't survive either :)

There's also flaws in procedure -- was it at the required temperature long enough -- and, of course, the real world that your target is going to be exposed to when it leaves the tungsten bath -- clean rooms aren't all that clean.

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