Image: Photograph by Darren Braun
In Brief
- A new pattern of resistance has emerged among a particularly challenging group of bacteria called the gram-negatives; it threatens to make many common infections untreatable.
- The bacterial genes responsible confer resistance to the carbapenems, a group of so-called last-resort antibiotics. Two of the most important resistance genes are dubbed NDM-1 and KPC.
- Carbapenem resistance in gram-negative bacteria is especially worrisome because these germs are ubiquitous and share genes easily. Plus, no new drugs for these bugs are being developed.
- This confluence of factors means many people in hospitals and in the wider community could die of newly untreatable infections of the urinary tract, blood and other tissues.
More In This Article
In early summer 2008 Timothy Walsh of Cardiff University in Wales got an e-mail from Christian Giske, an acquaintance who is a physician on the faculty of Sweden’s Karolinska Institute. Giske had been treating a 59-year-old man hospitalized that past January in Örebro, a small city about 100 miles from Stockholm. The man had lived with diabetes for many years, suffered several strokes and had lately developed deep bedsores. But those were not the subject of Giske’s message. Instead he was worried about a bacterium that a routine culture had unexpectedly revealed in the man’s urine. Would Walsh, who runs a lab that unravels the genetics of antibacterial resistance, be willing to take a look at the bug?
Walsh agreed and put the isolate through more than a dozen assays. It was Klebsiella pneumoniae, a bacterium that in hospitalized patients is one of the most frequent causes of pneumonia and bloodstream infection. This strain, though, contained something new, a gene that Walsh had never seen before. It rendered the Klebsiella, which was already resistant to many antibiotics used in critical care medicine, insensitive to the only remaining group that worked reliably and safely—the carbapenems, the so-called drugs of last resort. The one medication the investigators found that had any effect on the resistant strain was colistin, a drug that had been out of general use for years because of its toxic effects on the kidneys. Walsh named the enzyme that this gene produced New Delhi metallo-beta-lactamase, or NDM-1, for the city where the man acquired the infection just before he returned home to Sweden.
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12 Comments
Add CommentWe keep wringing our hands over the appearance of new strains of antibiotic-resistant bacteria while doing nothing about the cause: antibiotics constantly being pumped into livestock and poultry. If we wanted to deliberately destroy the efficacy of all our antibiotics, this would be the way to do it. The hold that Food Inc. has on our governments must be broken and our laws changed to stop this constant abuse of antibiotics. Some governments have laws in place but they are of little use while most countries continue this practice.
Reply | Report Abuse | Link to thisWhat this really means is that the days of using anti-biotics are coming to an end.
Reply | Report Abuse | Link to thisThere are already much simpler methods of treating many sicknesses and diseases. I quote high dosage Vitamin C as one example. Just last week I personally had a severe attack of cellulitis. The first anti-biotic was totally ineffective, the second produced a strong allergic reaction, and the third was again ineffective, as well as continuing the allergic reaction.
Three (3) iv treatments of 25 grams of vitamin C have completely cleared the infection.
I would suggest that conventional medicine look outside the very small box in which it has tried to hide itself.
Yes, I can provide copies of the treatment regimes if requested.
Reply | Report Abuse | Link to thisThere are downsides to high doses of vitamin C. Digestive difficulty is one. Certain cancers proliferate when large amounts of vitamin C are consumed. As with any treatment, the entire patient must be considered before the treatment is prescribed.
Reply | Report Abuse | Link to thisIn the future I hope that a patients medical profile will be much more accurate and will include patient specific risks and susceptibilities based on genetics and environments exposures.
Alter one part of the KPC gene, grow it in e-coli, let it conjugate with the gram-negative bacteria, let it propagate, and see what happens.
Reply | Report Abuse | Link to thisThis article is screaming to tell us about a lot more than bacterial resistance. For me, the primary message is about the irresponsibility of both government and scientists.
Reply | Report Abuse | Link to thisBecause of the explosion of technology over the last 100 years, the complexity of life has moved far beyond the ability of simple “human intuition” to control. The scientific community has repeatedly made this known to the governments of the world. But due to the inability of our current form of democracy to elect wise leaders, because it is structured on the greed, ignorance and predatory competition inherent in human psychology, leadership across the world is no longer up to the challenge. To be sure, there are “system” methods that can deal with the complexity. But, the refusal of society to face up to how deeply greed, ignorance, and competitiveness are built into our culture completely suppresses system thinking. I also fault the scientific community in this process. Their personal greed, a focus on self interest above world needs, leads them to hide and play the game to maintain their positions and funding, rather than storming the government with protest.
The point is, the world has now reached multiple catastrophic tipping points. World resources, climate and the medical environment have the potential to cause large scale population crashes - possibly exceeding 80% of world population. We have also learned, from recent discoveries over the past decade, that these crashes can unfold on timescales as short as a few years. The world governments and business leaders are irresponsible not to take drastic new actions to mitigate the damages that might result.
The current article is a perfect example. Given the rate at which super bugs can spread around the world, and how long our existing “free market” would take to respond, there is no excuse not to take drastic preventive steps. When new bugs are discovered, they should be eradicated immediately, while their populations are small, rather than waiting for measurable economic impacts. These issues are discussed further at A3soceity.org.
The argument about whether the use of antibiotics should be limited, or discontinued altogether, is one that will continue to be debated among the medical community for years to come. Bacteria will continue to evolve and out-smart antibiotics, and newer, better, stronger antibiotics will continue to be developed. It's a vicious cycle that will continue to be repeated. Lather, rinse, repeat.
Reply | Report Abuse | Link to thisThis article in particular, however, struck close to home. My youngest son (now almost 3) contracted Klebsiella in the hospital nursery after birth. At 3 weeks old, he was a very sickly child, and I took him to the ER. There, they determined that not only had he contracted the bacteria in his bladder initially, but that he also had it in his lungs. Somehow... They assumed the Klebsiella was introduced via a catheter. He was hospitalized for over a month, they inserted a central line to pump him full of antibiotics, which caused a whole slew of side effects of their own. They performed numerous painful urology tests on my sweet little baby- he was miserable the whole time. I felt so bad for him, and even though I have personal issues with antibiotics myself, he would have DIED without them. The doctors told me from day one they did not expect him to live, even with the antibiotics.
Well, eventually he pulled through. There were many times we weren't sure that he would, and we were angry with the hospital for whatever they did to introduce the bacteria to begin with. My eldest son was terrified that he wouldn't have his baby brother anymore. It was serious business. Needless to say, I'm grateful that they saved his life in the end. His hospitalization even led to the discovery of a previously unknown heart murmur my baby had. So, there was good with the bad.
However, despite the lifesaving antibiotics, he is still effected by the infection AND the antibiotics to this day. He gets sick a lot, his immune system was compromised from both the Klebsiella and the hardcore antibiotics, they wreaked havoc on his little body, on his immune system's ability to fight off infection.
My point in all this is that Klebsiella is one scary bug, but the antibiotics used to fight it aren't much safer either. Both can have long-lasting effects, especially on children and the elderly. We try to avoid antibiotics if possible, but it's not always possible with the lil one because of the devastation to his immune system. It's a double-edged sword, that's for sure.
Oops, I forgot to mention, the doctors assumed a catheter was to blame for the introduction of Klebsiella into my baby's bladder/urinary tract, but they also suggested it could have been introduced during his circumcision- dirty instruments? I don't know really, never will know for sure... But either way, the circumcision was unnecessary to begin with. It makes me think twice now about choices we as parents make for our children, especially when they're not necessary for health. You can imagine my guilt about his infection when it was suggested it could have been the circumcision- something that could have been prevented. And my anger about the other possibility- the catheterization, which was also completely unnecessary (he didn't urinate for about 12 hours, they decided to catherize him- he ended up urinating on his own an hour later, so it was also unnecessary... A procedure they rushed into). Lesson learned. I did not question the doctors' decisions regarding my child when I probably should have, nor was I well-versed on all that can go wrong with these procedures. I have since become more informed, self-educated... And I feel parents should be given more warning, more push to self-educate, as opposed to consenting to doctors without question, especially when they aren't given all the facts about possible risks.
Reply | Report Abuse | Link to thisIf this is the case, I wonder why the discovery of antibiotics was hailed as a medical revolution.
Reply | Report Abuse | Link to thisPlease ZebulonJoe, keep your anecdotes to yourself.
Working in female urology, we often find Klebsiella in urine and treat it easily and effectively with a number of antibiotics. It is by no means a "super bug". We do encounter, however, different strains of multiple bacteria (including E.coli) that are resistant to a variety of antibiotics that are more difficult to treat. Those are becoming more frequent but there are many factors causing this to happen.
Reply | Report Abuse | Link to thisIf you want to make a personal effort to reduce antibiotic resistance, don't call your PCP and expect an antibiotic to treat your bladder infection or your yeast infection over the phone without testing (studies consistently show that a high percentage of people who think they have a bladder or yeast infection actually do not). Also, don't demand antibiotics when you take you child to the pediatrician or every time you have a cold. Antibiotics aren't magic beans that cure everything and we should stop using them so indiscriminately in both humans and animal husbandry.
The world is nowhere near its capacity population-wise; that number is somewhere in the vicinity of 18 billion. I fly commercially around the world and the one thing I consistently notice is how baron and unpopulated the earth really is. You can fly for 6 hours across the northern part of China and see only remote towns and villages with virtually nothing in-between. The same is true in India where we routinely fly from the Bay of Bengal across south central India into Mumbai. Until you get almost on top of the city, the countryside is quite sparsely populated. These are the two most populous countries on earth by a wide margin, yet they both have massive amounts of unused land. A flight north-to-south across Africa would amaze most people with how remote and unsettled the continent is, and Russia could be classified as virtually unpopulated judging by how little civilization one sees travelling east from Moscow.
Reply | Report Abuse | Link to thisFor those who think we are running out of resources—I say, not hardly. Even water is easily accessible using what most of the Middle East already does for its water—desalinization. A water pipeline is far cheaper, and easier to build and maintain than an oil pipeline, and the world is literally crisscrossed with oil pipelines. Google a pipeline map of the US if you doubt me. Other resources are in greater supply than we ever thought. The idea of “peak oil” is now more of a mocking punch line than a real concern. And technology only assures we will continue to discover and gain access to more and more of Earth’s resources.
Food is only a problem of distribution (that money can easily fix) as genetically modified crops yields greatly outstrip heirloom and original varieties. And if you are against eating genetically modified food, don’t ever eat another, tomato, strawberry or banana as there are virtually no markets on earth where such produce is readily available. Even heirloom varieties have significantly cross-pollinated from their original genetic code.
The problem with antibiotic resistance is one that, like countless disease problems of the past, will be addressed and handled by science, particularly with the great future of genetics and nanotechnology.
The Earth was meant to be lived on and there is a reason why man evolved to his superior position among the animal world.
When you learn how stem cells are created by an embryo and can manufacture such you will go far to having it all licked. The answer is obviously not how to make a new band aid fast enough, that's an unending battle of mutations. The answer is to properly replace damage like a happy starfish or planaria (if I remember right cutting a planaria in half gets you 2 planaria not a dead one).
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