So I was reading articles today and I came across this one. I think its time for another brief discussion/rant on antibiotics, antibiotic resistance and the pharmaceutical industry.
Let Us Begin With The Title Article
Briefly, A Nevada woman in her 70's contracted an infection of Klebsiella pneumoniae, which you may be surprised to know is a normal constituent of the bacteria that live on your skin and in your intestines. However it causes problems when it finds itself in other places:
Figure 1: Klebsiella pneumoniae
It can lead to the development of pneumonia if it infects the respiratory tract (pneumonia is just the accumulation of fluid in the lungs, so it can be caused by a variety of things), blood infections, and even meningitis.
Now we know, and have known for quite some time that Klebsiella have been gaining resistance to a wide variety of antibiotics, and the strain of bacteria that infected this woman was discovered to be a carbapenem-resistant enterobacteriacae. Thats a fancy name which is given to a bacteria that is commonly found in our digestive tract (thats the enterobacteriacae part), and carbapenem is the class of antibiotics that are given when all other antibiotics have failed to work.
In this woman's case, the hospital screened the Klebsiella that infected her against all 14 classes of antibiotics they had available and found it was resistant to EVERYTHING. As a result, the doctors were powerless to stop the infection. She was placed into isolation and treated as best they could but succumbed to her infection.
You can read more about this woman here:
https://www.statnews.com/2017/01/12/nevada-woman-superbug-resistant/
It's Just This One Type of Bacteria... That's The Real Problem Right?....RIGHT?
WRONG
See bacteria can share their genetic material, they of course rapidly share genes among members of the same species, but also can (and readily DO) share genetic material across species (Source). They do this through two processes, one called conjugation (Source For Additional Reading) and another called homologous recombination (Primary Source For Additional Reading, also I have discussed homologous recombination in a previous post Here).
These processes, which are EXTREMELY common provide a mechanism by which these antibiotic resistant bacteria can spread very advantageous genes to other bacteria. What sort of genes just might be advantageous to a bacteria? Maybe ones which stops it from dying when in the presence of an antibiotic.
Often times genes for antibiotic resistance are encoded on small circular pieces of DNA called plasmids, that bacteria can readily share. These plasmids are energetically costly for the bacteria to maintain (they don't want to replicate a bunch of extra DNA for no reason mind you.. thats a waste of food). If they are maintained for a long time or there is complementarity to their own genome, they can then incorporate genes more permanently into their own genome. In order to keep these energy hogging plasmids around the bacteria require some sort of reason to do so... like living in an environment with antibiotics around. It's a good thing we take so much care to use antibiotics sparingly... OH WAIT... shit.
As a side comment, plasmid sharing isn't the only mechanism by which genes can be shared, through conjugation (meaning direct contact) cells can share genomic DNA directly. Resesrch has shown that large pieces of a genome were able to be transferred from one cell to a different one and recombined into the new cells genometransfered.
Antibiotics Are Everywhere... but why?
Doctors Have Been Over-prescribing Them For DECADES
For many decades doctors just chucked antibiotics around like they were candy, oh you have the sniffles? Here take some amoxicillin. They gave that shit out even when they knew the issue was caused by a virus (which can't be treated by an antibiotic... they don't do shit against viruses, most interfere with specific parts of the bacterial cell cycle... which viruses do not have since they are not cells!).
However Doctor's over prescribing antibiotics is just the tip of the ice berg of issues.
They are All Over the Damn Place in Consumer Products
Did you ever wash your hands with antibacterial hand soap? It likely had one of two compounds in it triclocan or triclocarban in it. These two compounds while they are not directly classified as antibiotics (they are a bit different) do place bacterial organisms under selective stress. This makes them more susceptible to picking up antibiotic resistance genes through the mechanisms we discussed above. So glad we were including this in our damn tooth paste.
On the plus side the United States Food and Drug Administration banned the marketing of antibacterial soaps containing these compounds over health concerns (and hopefully concerns over the increasing prevalence of antibiotic resistant microbes....)(Source).
So yes we were filling our water supply with trace quantities of antimicrobial compounds from all our antibacterial consumer products, but even that is not the major cause of concern. What is you ask?
Antibiotic Use In Agriculture
Yes, this is the real source that should concern every one of us. We are pumping livestock full of antibiotics to allow them to grow larger, leading to them excreting mass quantities of these antibiotics which then enter our water supplies. Sure there are human health concerns due to the exposure of trace quantities of the antibiotics but that should not be concern numero uno. Rather we are exposing a wide variety of bacteria to these antibiotics, providing them ample time to crack the code and develop resistances to them.
You only have to look so far as the Nevada woman from the article I began with and the bacteria she was infected with resistant to 14 different classes of antibiotics. To realize that providing bacteria with the necessary continuous selective pressure to learn to evade death by antibiotics is a terrible idea. Are fatter cows really worth it?
Okay Antibiotics Abuse is Bad... Why Don't We Just Make New Ones?
Pharma Doesn't Want To Spend The Money On The Necessary Research!
The large pharmaceuticals companies are at the end of the day profit driven entities. Why spend tens of millions working on a new antibiotic which people would only need sporadically when they can work on the latest and greatest penis pill, that people will buy up like candy? A little foresight would tell any rational person that if everyone is dying off from incurable infections there won't BE too many people to buy those damn sex pills... but hey what do I know right!?
We are Not With Out Hope: Academic Researchers
I wrote an article a while back about a new antibiotic that was discovered from studying the human microbiome (HERE), so we are not only reliant on work being done at the large pharma companies for potential new antibiotic avenues. However even if the antibiotics are found, someone has to make them and get them into doctors hands... which comes back down to pharma...
Conclusions
Antibiotic resistant bacteria are becoming a bigger issue with each passing year. The ability of bacteria to transfer these resistances to other currently non-resistant bacteria is a property that should cause us all at least a mild bit of concern. Reducing the rampant abuse of antibiotics should be something we are all demanding RIGHT NOW, as that is the easiest way to slow the development of more resistant strains (remember no environmental pressure, no reason to keep the resistance genes around for the bacteria).
We should also be demanding that the large pharma companies invest in new antibiotics, not every aspect of those companies functions should be about maximizing profits. At some point there needs to be someone willing to do something for the good of everyone, even if doing so may only generate a small (rather than a huge) profit.
# Additional Sources
1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC372703/
2 http://mbe.oxfordjournals.org/content/15/4/385.full.pdf
3 http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378393.htm
4 http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm517478.htm
5 http://www.ucsusa.org/food_and_agriculture/our-failing-food-system/industrial-agriculture/prescription-for-trouble.html#.WHmMVPkrJPY
6 http://www.pharmaceutical-journal.com/news-and-analysis/features/why-are-there-so-few-antibiotics-in-the-research-and-development-pipeline/11130209.article
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