Short Answers to Hard Questions About Antibiotic Resistance

May 30, 2016

By Sabrina Tavernise, Erica Goode, and Denise Grady

The idea of people dying from infections that were once easily cured may seem outlandish. But it is happening already — taking about 23,000 lives in the United States a year — and experts warn that things will get worse because bacteria are becoming resistant to antibiotics faster than we can make new drugs to fight back.

We have ourselves to blame, for overusing the drugs in people and squandering them on livestock. Now, a dangerous form of drug resistance has reached the United States, leaving us just one step away from infections that are completely untreatable.

What is antibiotic resistance?

It used to be that infectious diseases were the biggest killers of Americans — illnesses like tuberculosis and pneumonia. The invention of antibiotics, which were developed for medical use in the 1940s, changed all that. But they became overused, and the bugs they were invented to fight started to develop ways of resisting them. For some years now, infectious disease doctors have been warning that unless we rein in use of antibiotics in both people and livestock, there will come a day when they will be powerless against the most ferocious bugs, turning the clock back to the early years of the 20th century.

What is CRE?

CRE, which stands for carbapenem-resistant Enterobacteriaceae, is the most fearsome family of germs because it is resistant even to last-resort antibiotics.

The only drug that reliably treats CRE is colistin, an old and inexpensive drug that came on the market more than 50 years ago. This week researchers reported that they had discovered a gene in a bacteria that makes bugs resistant to colistin. It was found in a strain of E. coli in the urine of a patient in Pennsylvania. The patient was successfully treated, but if that gene makes its way into a strain of CRE, the bug would be unstoppable.

“We depend on colistin for the worst of the worst,” said Dr. James Johnson, a professor of medicine and an infectious disease expert at the University of Minnesota. “If it is knocked out, in most cases we really have nothing.”

Should I be scared?

Not yet. The discovery does not mean that an otherwise healthy person with a urinary tract infection is in danger of dying from it. (The Pennsylvania woman eventually recovered because her infection was treatable with antibiotics.) But the gene is mobile and can be picked up by other bugs — in sewer systems, in animal feed lots, in people’s guts or urinary tracts. That can make more bugs more resistant. The biggest worry is that a strain of CRE will pick up the gene. That could be devastating for anyone who is suffering from a CRE infection. “That is the combination we are all afraid of,” said Dr. Lance Price, a researcher at George Washington University.

For now, CRE is rare. The CRE germs cause about 600 deaths a year, usually strike people receiving medical care in hospitals or nursing homes, including patients on breathing machines or dependent on catheters. Healthy people are rarely affected.

How has antibiotic resistance changed medicine?

Dr. Johnson from Minnesota says the spread of resistant bugs means doctors are having to blast patients’ infections with increasingly stronger antibiotics. That has led to more patients coming in with infections caused by the C. difficile, a gut germ that flourishes when the patient has taken a lot of antibiotics. (The germ was estimated to cause almost half a million infections in the United States in 2011, and 29,000 people died within 30 days of the initial diagnosis.) Doctors now frequently send patients home with setups for intravenous antibiotics because pills no longer do the trick. Sometimes the specter of resistant infections can delay or cancel surgeries.

Why aren’t there more new antibiotics?

Most drug companies are not eager to make them. Compared with other drugs, antibiotics are not big moneymakers, and some manufacturers have gotten out of the business. Most people take antibiotics just once in a while, for a short time — unlike drugs for blood pressure, high cholesterol or diabetes, which most patients will take every day for the rest of their lives. When a new antibiotic comes out, doctors may hesitate to prescribe it, wanting to keep it in reserve for tough infections that older drugs cannot cure. Once the drug gets more widespread use, germs may become resistant to it, and doctors will quit prescribing it. So an antibiotic that required lots of time and money to develop may have a short life on the market. Infectious disease experts are working with Congress and the Food and Drug Administration to try to find ways to create financial incentives for drug companies to invest in making new antibiotics.

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4 comments on “Short Answers to Hard Questions About Antibiotic Resistance

  • There’s so much that’s ironic in this article. Antibiotic resistant bacteria are a product of evolution by natural selection. The drug companies won’t develop new antibiotics becauses there’s little money in it. The religious right, aka the Republican party, don’t believe in evolution. They also see no problem in a health care system run for profit, have tried to repeal Obamacare 50 times and think that a National Health Service system as in the UK and most other civilised countries is barely one step removed from communism. The free market always knows best apparently, which is their second religion. Of course it’s also the free market which is feeding all these unnecessary antibiotics to animals which is a large part of the problem.

    I wonder what sort of numbers people are going to have to start dying in to make them admit their first religion was wrong about evolution and their second religion wasn’t the solution?

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  • It’s not so hopeless as this article suggests though. There are alternatives to antibiotics. Bacteriophage research is really promising. When it works out it’s so much better than antibiotics, because it doesn’t kill off all your normal flora. Has anyone had experience with these kinds of treatments personally?

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  • I do not believe the ” free market always knows best ” any more. because the “free market” assumes that majority humans knows the best. but they don’t. Majorities of us are ill-informed, ignorant in most fields, and can not decide the best for the long-term future of both human species as well as all other things, including life and non-life on planet earth.

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