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| Credit to Wikipedia |
Shaking in your boots at this pink slime? You ought to be, this isn't the Ghostbusters' pink slime, this is Klebsiella Pneumoniae. Why is Klebsiella scary enough to put on then horror blog? The story all starts with Alexander Fleming, the Scottish biologist who officially discovered penicillin in 1928. Before the discovery of penicillin, people died of bacterial infections all the time- tuberculosis, pneumonia, urinary tract infections, infected pimples or sores, sore throats, food poisoning, small cuts to surgeries. The very first patient to receive purified penicillin succumbed to his infection, because what was then the world's supply of purified penicillin was not enough to rid him of the infection he got from a rosebush scratch. When Alexander Fleming received his nobel prize for the discovery of antibiotics, he made a speech in which he warned that resistance would eventually occur. I hate to ring the 'we didn't listen' bell, but fast forward seventy years to the 90's, and we were partying pretty hard with antibiotics- not to imply that we still aren't.
Antibiotics didn't get their real boom until the second world war, around which time we figured out how to scale up and mass produce penicillin. After that, the availability of antibiotics skyrocketed, prices dropped, and we started handing them out like candy. Doctors gave pushy patients with viral respiratory infections antibiotics, when a placebo would have done the patient just as much good; We gave antibiotics out freely as preventative measures; The livestock industry is overflowing with inappropriate use of antibiotics to encourage growth, enough that they're suspected to use more antibiotics on the whole than the healthcare industry. And then, there was MRSA.
MRSA stands for Methicillin Resistant Staphylococcus Aureus. You're probably familiar with it, as the media's had a field day trying to scare the pants off of everyone with ramblings about this 'new superbug', never mind that it's been around since the 1962 (just two years after the introduction of Methicillin). S. Aureus has been blow-for-blow with us since the introduction of antibiotics, with Penicillin resistant strains showing up three years before we began mass-producing Penicillin in 1943- all the way to Vancomycin (1972) resistant strains in 2002. [2]The mechanisms of resistance vary from excreting enzymes that actually destroy antimicrobial compounds (Penicillinase), to alteration of surface proteins and development of specialized outer membranes that block antibiotic contact, to developing molecular pumps that selectively remove uptaken antimicrobials. These mechanisms are often seen in other antimicrobial resistant microbes[3]. How did these microbes develop resistance?
We did it to them- we put them under what's called selective pressure, and caused evolution. When you take an antibiotic, you don't ever quite manage to wipe out all the bacteria- especially if you don't take them like you're supposed to and don't finish the prescription out. The weaker bacteria are culled off, leaving the more resistant bacteria to reproduce and repopulate. After a few passages like that, you eventually end up colonized with something that's a lot tougher than your starting product. That then gets passed along from patient to patient, to healthcare worker, to family, and out to the community. What's more is that bacteria are actually capable of sharing genes among one another, so resistance can be conferred both intra- and inter-species of bacteria. It's not hard to imagine that, on its own, S. Aureus may not have developed some of its present resistance mechanisms, but perhaps coming in contact with a few other naturally occurring bacteria in your body that had also survived, it may have borrowed some resistance genes. Think you don't have a lot of natural bacteria? In fact, at any given time, you have ten times as many bacteria in and on you than you have cells in your body.
This all ties back to K. Pneumoniae, which, with Carbapenem resistance, had a small epidemic in 2011 at the US National Institutes of Health. In the end, 18 people became infected, and 11 people died from pneumonia. The CDC currently ranks this pathogen as an 'urgent' threat to public health, stating that "these bacteria are immediate public health threats that require urgent and aggressive action". There are three other bacteria in this category, and Klebsiella does not have the highest body count. Drug resistant K. Pneumoniae comes in at a modest 9,000 infections and 600 deaths, with the kicker that there are Carbapenem Resistant Enterobacteriaceae with resistance to all presently available antibiotics. The worst offender is Clostridium Difficile at 14,000 deaths and over $1,000,000,000 in medical expenditures.[2] In addition to all this, we have Tuberculosis that is resistant to every antibiotic we can throw at it. Today, in the United States, we are watching patients die from infections we could treat just five years ago.
It gets better, because AstraZenica, Pfizer, and other drug companies have either substantially reduced their research into new antibiotics, or have closed their antimicrobial research divisions altogether. The reasons are mainly a question of cost-benefit, given that the market forces typically value an antibiotic in the tens to low hundreds of dollars. With all the low and even medium-hanging fruits picked, a lot of drug companies feel that the reward isn't worth the effort, and they're probably right. We've seen resistance to every drug presently available, and even to novel drugs we've never used before. Resistance is developing faster and faster to fewer and fewer drugs, and bacteria are starting to gain broadly neutralizing defenses against antimicrobials, possibly rendering future drugs completely worthless.
To put things bluntly, the age of antibiotics is over. And the CDC agrees with me.
Fight the Fear
All hope is not yet lost, stay your hand a while longer, preppers! Do I come bearing a miraculous herbal remedy, or a secret celebrity diet? No, just good science! There is hope in fighting microbes with microbes. The Russians and east Europeans have been working with something known as phage therapy in the realm of antimicrobials since the early 1900s. The idea is simple- you use several lytic viruses that are tuned to infect bacteria (henceforth, bacteriophages), and use it to wipe out the target pathogen. It's a lot more specific than antibiotics, with the added advantage that the viruses are evolving to remain competitive against the bacteria at the same time bacteria are evolving to compete against them. In a series of studies done in the former Soviet Union by Slopek et al, researchers utilized a few select bacteriophages per patient to fight infections, including those caused by Staphylococci, Pseudomonas, Escherichia (E. Coli), Klebsiella, and Salmonella. The results were actually really good. Utilizing orally, topically, and mucosally administered lytic phages, they attempted to neutralize the infection. During the course of treatment, the researchers obtained cultures during both the symptomatic and post-symptomatic period to determine the presence or non-presence of the pathogen. Once negative cultures were obtained, they continued to administer the phage for 14 days, and if phage resistance was noted, then they switched phages. In the studies, success rates (determined by improvement concurrent with negative cultures) varied from 75% to 100%. In these studies, among 518 antimicrobial resistant infections, the success rate of antimicrobial phage therapy was near 94%. [4]Efficacy could potentially be boosted by attenuating bacteriophages to a person's individual strain of pathogenic bacteria, by administering phages as a cocktail, and/or by administering the phages concurrently with antimicrobial agents.
Unfortunately, the USDA's policy on phage therapy of any kind if very limited. I don't know why, perhaps because they feel that viruses are too poorly understood- and they aren't. The official policy on phage therapy in the United States maintains that any virus utilized pharmaceutically must be of one specific genome with no mutations allowed, and no cocktails allowed. What this translates into, when presented in the light of clinical trials in which phages cannot be swapped when resistance is noted, is not very good success rates. It also means that even if you did get a good success rate, we'd just circle back to our present chemical antimicrobial resistance issue.
There's more good news. With the encouragement of the CDC, a lot of hospitals are adopting antimicrobial stewardship programs, which are interdisciplinary teams of healthcare professionals that monitor antibiotic use to determine how appropriate the use of a given antibiotic is, viewed through the lens of the patient and the bacteria in question. It's a Band-Aid on the face of 'too little too late', but it will help slow the rise of antimicrobial resistance.
One of the best new hopes on the horizon for controlling resistant pathogens is the emerging science of the human microbiota. In and on all of us live trillions of bacteria, which can contribute to our health in exchange for us giving them some place safe to live. Research indicates that a healthy gut microbiota can contribute to controlling flare-ups of irritable bowel syndromes, ulcers, and even obesity (not to imply that an unhealthy microbiota is the cause of obesity). There's some speculation going on that a healthy microbiota may help prevent establishment of bacterial pathogens in your body.
One of the best new hopes on the horizon for controlling resistant pathogens is the emerging science of the human microbiota. In and on all of us live trillions of bacteria, which can contribute to our health in exchange for us giving them some place safe to live. Research indicates that a healthy gut microbiota can contribute to controlling flare-ups of irritable bowel syndromes, ulcers, and even obesity (not to imply that an unhealthy microbiota is the cause of obesity). There's some speculation going on that a healthy microbiota may help prevent establishment of bacterial pathogens in your body.
What Can I Do?First and foremost, listen to your doctor. If you're prescribed antibiotics, take them, and take them all. Second, support science and public health research, and support politicians that support that. Third, practice good hygiene, such as washing your hands, regular showers, covering coughs and sneezes, etc. Avoid products that advertise that they contain antibiotics, and choose small-farm, locally raised livestock if possible. Get vaccinated, and follow the CDC on your social media network of preference- they'll provide you with accurate news and good suggestions when things are happening. The most important thing you can do is get educated on the subject, and share the knowledge you gain here.
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