superbugs

White House declares war on ‘superbugs’ .

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U.S. President Barack Obama.(Reuters / Jonathan Ernst)

U.S. President Barack Obama.

 

The Obama administration has unveiled a $1.2 billion plan to combat drug-resistant bacteria, also known as ‘superbugs.’ Five out of six Americans are on antibiotics, and 23,000 die annually of drug-resistant infections.

Released to the public on Friday, the National Action Plan for Combating Antibiotic Resistant Bacteria envisions efforts to rein in over-prescription of antibiotics by doctors, use of “medically important antibiotics” in food animals, and the spread of drug-resistant bacteria, while promoting the development of new and more effective antibiotics for human use.

“We know that 5 out of 6 Americans are prescribed antibiotics each year. That adds up to 262 million antibiotic prescriptions annually,” president Obama said in an exclusive interview with WebMD. “And studies have consistently shown that a lot of America’s antibiotic use is unnecessary.”

One of the main causes of antibiotic-resistant bacteria is the use of antibiotics when they are not needed, the president said. Drug-resistant infections are on the rise: according to government statistics, there are two million infections a year in the US, resulting in 23,000 deaths.

The plan envisions $1.2 billion in funding to various government agencies. The Department of Health and Human Services (HHS) would begin research on new antibiotics, while the Department of Agriculture is to start reducing “irresponsible use” of antibiotics in livestock and poultry. A newly created Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria, with up to 30 members managed by the HHS, would be entrusted with oversight of the plan.

“We’re seeing an increase in drug-resistant organisms that are affecting every community,” Centers for Disease Control and Prevention (CDC) director Dr. Tom Frieden told The Hill, “and are at risk, really, to undermine much of modern medicine.”

The CDC would use the $264.3 million increase in funding to develop prevention programs in every state, potentially forestalling 600,000 infections and $8 billion in medical costs, Dr. Frieden said.

Some questions remain as to where the money would come from. President Obama says some of the funding is already in the 2016 budget, but it appears the rest will have to get approval from the Republican-controlled Congress.

“Wherever we can act without Congress, we will. But to get the whole job done, we need Congress to step up,” Obama told WebMD.

The plan has already faced some criticism for not going far enough to reduce antibiotic use in agriculture. Industrial farming accounts for the vast majority of antibiotic consumption in the US, and is on the rise around the world.

“The plan continues to allow the routine feeding of antibiotics to animals that live in the crowded conditions endemic to industrial farms,” said a statement by environmentalist group Natural Resources Defense Council.

Antibiotics for Traveler’s Diarrhea May Spur Growth of Superbugs.

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The overuse of antibiotics to treat travelers’ diarrhea may contribute to the spread of drug-resistant superbugs, a new study suggests.

Antibiotics should be used to treat travelers’ diarrhea only in severe cases, said the study authors.

The study was published online Jan. 22 in the journal Clinical Infectious Diseases.

“The great majority of all cases of travelers’ diarrhea are mild and resolve on their own,” lead author Dr. Anu Kantele, associate professor in infectious diseases at Helsinki University Hospital in Finland, said in a journal news release.

The researchers tested 430 people from Finland before and after they traveled outside of the country. About one in five of those who traveled to tropical and subtropical regions unknowingly returned with antibiotic-resistant gut bacteria.

Risk factors for catching antibiotic-resistant gut bacteria include having travelers’ diarrhea and taking antibiotics for it while abroad. More than one-third of the travelers who took antibiotics for diarrhea came home with the antibiotic-resistant bacteria, according to the study.

Eighty percent of travelers to South Asia who took antibiotics to treat diarrhea contracted the antibiotic-resistant gut bacteria. Other regions that posed a high risk were Southeast Asia, East Asia, North Africa and the Middle East, the study found.

People who get the antibiotic-resistant bacteria may not develop noticeable symptoms. But they can still unknowingly spread the superbugs in their own countries.

“More than 300 million people visit these high-risk regions every year,” Kantele said. “If approximately 20 percent of them are colonized with the bugs, these are really huge numbers. This is a serious thing. The only positive thing is that the colonization is usually transient, lasting for around half a year.”

International travelers need to be educated about how to safely treat traveler’s diarrhea. They should more cautious about taking antibiotics to treat diarrhea, the study authors said.

In general, travelers with diarrhea should drink plenty of fluids and use over-the-counter, nonantibiotic anti-diarrheal drugs. Seek medical attention if there are symptoms such as high fever, bloody stools or serious dehydration, Kantele advised.

Antibiotic breakthrough could turn the tables in battle against superbugs .

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The powerful antimicrobial teixobactin was discovered using a new technique that could speed up the discovery of new antibiotics to tackle resistance
A scanning electron micrograph of methicillin-resistant Staphylococcus aureus. Teixobactin kills a wide range of antibiotic-resistant bacteria, including MRSA.

A scanning electron micrograph of MRSA (methicillin-resistant Staphylococcus aureus)
Scientists have discovered a new class of antibiotic using a revolutionary procedure hailed as a game changer in the hunt for medicines to fight drug-resistant infections. The antibiotic, called teixobactin, kills a wide range of drug-resistant bacteria, including MRSA and bugs that cause TB and a host of other life-threatening infections.

It could become a powerful weapon in the battle against antimicrobial resistance, because it kills microbes by blocking their capacity to build their cell walls, making it extremely difficult for bacteria to evolve resistance.

“Teixobactin kills exceptionally well. It has the ability to rapidly clear infections,” said research leader Kim Lewis, director of the Antimicrobial Discovery Center at Northeastern University in Boston, US.

The public health threat of resistance was highlighted last year in a World Health Organisation report that warned the world was entering a “post-antibiotic era”. The UK’s chief medical officer, Sally Davies, has put antibiotic resistance on the government’s national risk register, alongside terrorist attacks and pandemic flu, and warned that without new antibiotics, more people will die after routine operations in the next 20 years. In December, a report commissioned by David Cameron warned that failure to tackle drug-resistant infections will cost the global economy up to £64tn ($100tn) by 2050.

In studies on mice, the new antibiotic wiped out infections of Staphylococcus aureus and Streptococcus pneumoniae, which can cause life-threatening blood and lung infections. It was also effective against Enterococcus, which can infect the heart, prostate, urinary tract and abdomen.

Most antibiotics are isolated from bacteria or fungi that churn out lethal compounds to keep other microbes at bay. But scientists have checked only a tiny fraction of bugs for their ability to produce potential antibiotics because 99% cannot be grown in laboratories.

Lewis’s group found a way around the problem by developing a device called an iChip that cultures bacteria in their natural habitat. The device sandwiches the bugs between two permeable sheets. It is then pushed back into the ground where the microbes grow into colonies.

The researchers found that after two weeks in the ground, the microbial colonies had grown enough to run tests on them. To do this, they covered the top of the iChip with layers of pathogens. Bugs that produced natural antibiotics revealed themselves by killing the pathogens above them.

Working with a Massachusetts-based company, NovoBiotic, and researchers at the University of Bonn, Lewis’s group screened 10,000 soil bacteria for antibiotics and discovered 25 new compounds. Of these, teixobactin was the most promising.

Teixobactin’s ability to kill bugs is only part of the attraction of the compound. Writing in the journal Nature, the scientists describe how none of the bacteria treated with the antibiotic showed signs of developing resistance.

The reason for the drug’s apparent resilience was discovered by Tanja Schneider in Bonn. Most antibiotics target bacterial proteins, but bugs can become resistant by evolving new kinds of proteins. Teixobactin works differently. It launches a double attack on the building blocks of bacterial cell walls themselves. “That’s an Achilles’ heel for antibiotic attack,” Schneider said. “It would take so much energy for the cell to modify this, I think it’s unlikely resistance will appear this way.”

Though promising, Lewis said that years more work lie ahead before the drug could be available. Human clinical trials could begin within two years to check its safety and efficacy, but more development would follow that. At the moment the drug would have to be given as an injection, but an oral pill would be more attractive.

Another shortcoming of teixobactin is that it only works against bacteria that lack outer cell walls, known as Gram-positive bacteria, such as MRSA, Streptococcus and TB. It doesn’t work against Gram-negative bacteria, which include some of the most worrying antibiotic-resistant pathogens, such as Klebsiella, E. coli and Pseudomonas.

Despite these limitations, the discovery of the antibiotic, and the process used to grow previously ungrowable microbes, has raised hopes among researchers in the field.

“What most excites me is the tantalising prospect that this discovery is just the tip of the iceberg,” said Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh. “It may be that we will find more, perhaps many more, antibiotics using these latest techniques.”

Superbugs to kill ‘more than cancer’

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bacteria
Drug resistant E.coli bacteria are already a significant problem in Europe
Drug resistant infections will kill an extra 10 million people a year worldwide – more than currently die from cancer – by 2050 unless action is taken, a study says.

They are currently implicated in 700,000 deaths each year.

The analysis, presented by the economist Jim O’Neill, said the costs would spiral to $100tn (£63tn).

He was appointed by Prime Minister David Cameron in July to head a review of antimicrobial resistance.

Mr O’Neill told the BBC: “To put that in context, the annual GDP [gross domestic product] of the UK is about $3tn, so this would be the equivalent of around 35 years without the UK contribution to the global economy.”

The reduction in population and the impact on ill-health would reduce world economic output by between 2% and 3.5%.

The analysis was based on scenarios modelled by researchers Rand Europe and auditors KPMG.

They found that drug resistant E. coli, malaria and tuberculosis (TB) would have the biggest impact.

In Europe and the United States, antimicrobial resistance causes at least 50,000 deaths each year, they said. And left unchecked, deaths would rise more than 10-fold by 2050.

Graph

Mr O’Neill is best known for his economic analysis of developing nations and their growing importance in global trade.

He coined the acronyms Bric (Brazil, Russia, India and China) and more recently Mint (Mexico, Indonesia, Nigeria and Turkey).

He said the impact of the would be mostly keenly felt in these countries.

“In Nigeria, by 2050, more than one in four deaths would be attributable to drug resistant infections, while India would see an additional two million lives lost every year.”

Global map of deaths

The review team believes its analysis represents a significant underestimate of the potential impact of failing to tackle drug resistance, as it did not include the effects on healthcare of a world in which antibiotics no longer worked.

Joint replacements, Caesarean sections, chemotherapy and transplant surgery are among many treatments that depend on antibiotics being available to prevent infections.

The review team estimates that Caesarean sections currently contribute 2% to world GDP, joint replacements 0.65%, cancer drugs 0.75% and organ transplants 0.1%.

This is based on the number of lives saved, and ill-health prevented in people of working age.

Without effective antibiotics, these procedures would become much riskier and in many cases impossible.

The review team concludes that this would cost a further $100tn by 2050.

Mr O’Neill said his team would now be exploring what action could be taken to avert this looming crisis.

This would include looking at:

  • how drug use could be changed to reduce the rise of resistance
  • how to boost the development of new drugs
  • the need for coherent international action concerning drug use in humans and animals

Mr O’Neill said the support of the Bric and Mint nations was vital.

He noted that China would be hosting the G20 summit in 2016 and said he hoped this issue would be a focus of discussion.

‘Compelling’

He said scientists seemed more certain that drug resistance would be a major problem in the short term, than they were over climate change.

Dr Jeremy Farrar, the director the Wellcome Trust, said: “By highlighting the vast financial and human costs that unchecked drug resistance will have, this important research underlines that this is not just a medical problem, but an economic and social one too.”

Prof Dame Sally Davies, chief medical officer for England, said: “This is a compelling piece of work, which takes us a step forward in understanding the true gravity of the threat.”

The review team concludes that solving the problem of drug resistance will be far cheaper than doing nothing and there was “cause for optimism” that the right steps could be taken.

This included university researchers and biotech entrepreneurs “teeming with ideas” including new drugs, vaccines and alternative therapies such as antibodies.

Laura Piddock, professor of microbiology at the University of Birmingham, is focusing her research on bacteria such as E. coli and salmonella, which are responsible for a growing level of drug resistant infections.

Both are so-called gram-negative bacteria, which have a complex cell wall that acts as a barrier to drugs. If they do penetrate the wall, they are “vacuumed out” by the cell.

She said: “My team is looking at what are the switches in those bacteria which turn that vacuum cleaner off, and at molecules which would have the same effect. If we can do that, we can make the bacteria sensitive to antibiotics.”

Prof Piddock said there had not been enough global investment in finding new drugs.

She said: “It is very difficult to find drugs against bacteria like E.coli because they are so naturally resistant.

“We need more investment and new business models to ensure the pipeline is filled with promising molecules, to ensure that we can solve this problem, and make sure the drugs are there when patients need them.”

Superbugs ‘more deadly than AIDS’ as antibiotics become increasingly useless, according to The World Health Organisation .

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Reuters / Getty
Risk: Dame Sally Davies

An infected scratch could become an everyday killer as antibiotics become increasingly useless, the world’s top doctors have warned.

The World Health Organisation said superbugs are now more deadly than the 80s Aids epidemic in a major report which declared, “the era of safe medicine is coming to an end”.

WHO Europe antimicrobial resistance adviser Dr Lo Fo Wong warned: “Everyone is potentially in danger.”

The WHO warned cash must urgently be pumped into developing new drugs after examining data from 114 countries.

The report warned of growing antibiotic resistance in seven bacteria linked to diseases such as sepsis, diarrhoea, pneumonia, urinary tract infections and gonorrhoea.

Dr Keiji Fukuda, assistant director general for health security, said: “Without urgent action, the world is headed for a post-antibiotic era in which common infections which have been treatable for decades can once again kill.”

England’s chief medical officer Dame Sally Davies has called for restrictions on prescribing antibiotics for mild infections and incentives for drugs firms to produce new medicines.

She said resistance was being fuelled because drugs were being unnecessarily used for mild infections.

Patients can help by only using prescribed antibiotics, making sure they complete the treatment and never sharing left-over prescriptions, the WHO said.

Microbiologist Prof Laura Piddock, of the University of Birmingham, said: “The world needs to respond as it did to the Aids crisis.

“We need a better understanding of resistance and development of new antibiotics.”

Superbugs on the rise in kids.

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Rates of third-generation cephalosporin-resistant (G3CR) and extended-spectrum ß-lactamase (ESBL)–producing Enterobacteriaceae infections are on the rise in kids, in both inpatient and outpatient settings across the country, according to a new study.
Latania K. Logan, MD, from the Rush University Medical Center in Chicago, Illinois, and colleagues studied 368,398 pediatric (from patients aged up to 18 years) isolates of Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis from approximately 300 laboratories participating in the Surveillance Network between January 1999 and December 2011. They identified 1.97% of the isolates as G3CR and 0.47% as ESBL producers. In the period 1999-2001, the prevalence of both, respectively, was 1.39% and 0.28%.
The researchers found the highest proportion of the isolates—just over half—in the 1- to 5-year-old age group, but the prevalence of the antibiotic-resistant bugs increased across all the demographic and age groups studied, including in outpatient populations.
The investigators found that about two-thirds of both the G3CR and ESBL isolates were E coli (67.8% and 65.2%, respectively, and three-quarters (74%) of the ESBLs were resistant to 3 or more antibiotic classes.
The researchers concluded, “The identification of host factors and exposures leading to infection in children is essential.”
The study comes at a time when drug resistance is of utmost concern. Late last year, the Centers for Disease Control and Prevention issued a “threat” report on the subject and cited improper use of antibiotics as the leading cause of the problem. The investigators declared that up to half of all antibiotics prescribed are unnecessary.
The American Academy of Pediatrics made the subject part of its “Choose Wisely” list and a new online learning module.

UK raises alarm on deadly rise of superbugs.

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Britain to call for G8 action against spread of drug-resistant bacteria by clamping down on overuse of antibiotics

Britain is to urge the G8 to take action against the spread of drug-resistant microbes as medical and veterinary experts warn that co-ordinated international action is needed to prevent soaring rates of potentially lethal infections turning into a public health catastrophe.

Resistant strains of bacteria are on the rise

David Willetts, the science minister, will propose far-reaching measures that would clamp down on the overuse of antibiotics by GPs and hospital doctors. He will also try to restrict usage on farms and fisheries, where the drugs are blended with feed to boost yields.

Willetts will push for a consensus on ways to ramp up the discovery of new drugs to fight bacteria, speed their approval and delivery to patients, and strengthen cross-border surveillance for emerging resistant strains.

“Across the G8, we should regard the spread of antibiotic resistance as a global challenge that is up there with climate change, water stress and environmental damage, and there are genuine policy consequences that follow from that,” Willetts told the Guardian ahead of Wednesday’s meeting of science ministers at the Royal Society in London.

Drug-resistance is an inevitable consequence of antibiotics. The drugs wipe out susceptible infections but leave resistant organisms behind. The survivors multiply and, in time, can become immune to even the strongest antibiotics. Though improved surveillance and hygiene has reduced levels of life-threatening MRSA and C difficile “superbugs” in hospitals, resistant strains are on the rise.

In Britain, doctors see ever more resistant strains of TB, E coli andKlebsiella, which causes pneumonia. Some 80% of gonorrhoea is now resistant to the frontline antibiotic tetracycline. Of serious concern is the rise of resistance to powerful drugs called carbapenems, the antibiotics of last resort. The first few cases were detected in Britain in 2003, but since then the numbers have soared to 217 cases in the first six months of 2011.

Willetts has asked England’s chief medical officer, Dame Sally Davies, to brief the meeting after she warned in a March report that untreatable infections posed a “catastrophic threat” to the population.

Davies has asked for antibiotic resistance to be added to the government’s national risk register, a move that makes the issue easier to raise abroad.

Davies has already briefed senior figures in Whitehall on the threat and has rallied international experts and chief medical officers in other countries to push the EU and World Health Organisation to beef up their action plans. Ultimately, she seeks a UN treaty that would ban antibiotics in food production, such as fish farming and fruit growing, streamline the regulatory process for licensing new drugs, and commit nations to educational drives that instil more prudent usage of the drugs.”The soaring number of antibiotic-resistant infections poses such a great threat to society that in 20 years’ time we could be taken back to a 19th century environment where everyday infections kill us as a result of routine operations,” Davies said.

The government is to publish its antimicrobial resistance strategy next month. It will set out plans to slow the emergence and spread of drug-resistant bugs, maintain the effectiveness of existing drugs and bolster support for researchers.

The G8 meeting is seen as an opportunity to urge other nations to follow suit. “We can’t tackle the problem on our own and urgently need coordinated international action,” Davies said.

New research published by the Guardian also reveals that GPs in some areas are almost three times more likely than elsewhere to prescribe antibiotics. Keith Ridge, NHS England’s chief pharmaceutical officer, said he was aware of this worryingly wide variation and keen to see if lessons from hospitals’ improved prescription of antibiotics could now be applied to England’s 8,500 GP practices.

Davies said: “Our proposals are far-reaching, including stimulating development of new drugs through some sort of public-private partnership, cutting down the antibiotics given to farm animals and used in medical practice, making infection surveillance go across borders, and getting countries to sign up to their own education programmes.”

Dr Clare Gerada, chair of the Royal College of GPs, said some GPs were over-prescribing antibiotics to patients simply because they were overworked, increasing the long-term risks.

“I’m not blaming them. I’ve been there myself, at the end of a very busy clinic. If you’re running over time and have a queue of patients waiting, sometimes the least worst option is to give a prescription, even though you know that medically it’s of little value,” she said.

In the past, drug resistance was countered by a steady flow of new antibiotics on to the market. Over the past 60 years, the pharmaceutical industry released three generations of drugs, starting with natural penicillins, then synthetic penicillins, and most recently the carbapenems. But the supply has dried up. The number of new drugs in the pipeline is at an all-time low as research was shelved in favour of more profitable drugs in the 1990s, coupled with the difficulties in discovering new medication.

Meanwhile, other experts are warning that increasing use of the drugs on farms poses a threat to people. Recent studies have shown that the overuse of antibiotics in intensive livestock farming could lead to the evolution of strains of dangerous bacteria, including MRSA, E coli and salmonella, that are resistant to some of the strongest antibiotics. An increasing body of evidence shows they can spread from farms to farm workers and their families as well as to consumers through affected meat.

Farms in the UK are not supposed to use antibiotics routinely, as happens in many non-EU countries, but the Guardian has uncovered clear problems with this regime as the current monitoring of usage does not give government regulators enough information to decide how the drugs are used in practice.

Antibiotics are routinely dumped into animal feed in the US – where 80% of antibiotics are used for animals – and Latin America and other regions because they help animals put on weight faster.

Zac Goldsmith, the Conservative MP who has tabled a motion in parliament for stronger regulation, said dealing with antibiotics on farms was as urgent as changing prescribing practices and hygiene in hospitals. “We need to phase out the routine use of antibiotics on intensive farms altogether, starting with those most important in human medicine.”

John Rex, vice-president and medical director for infection at Astra Zeneca, said necessary changes were planned for the regulatory process too. “The idea that we as a society should wait for these cases before we start drug development is a non-starter. Bacterial infections can kill you in a couple of days, We are now treating young women with complicated urinary tract infections with intravenous antibiotics, not a pill. We are seeing strains of gonorrhoea for which we have no antibiotics, not just a small number, not just one, but zero,” he said.

This summer, the European Medicines Agency will overturn this system by allowing trials of antibiotics to be done differently. Trials will no longer need to recruit people with the same infection in the same place.

Instead, they can pool people with infections at any body area, such as the lungs, stomach, or skin, as long as they are caused by the same bug. The shift means trials can be run much faster, said Rex. The US Food and Drug Administration is expected to make similar changes to its guidelines.

Source: Guardian