Part III: The terrifying realities of antimicrobial resistance that will keep you up at night

As promised, today’s post will focus on the terrifying realities of antimicrobial resistance. I'm generally not an alarmist, but these two issues are Not Good. We are on our way to a post-antibiotic age of medicine.

The terrifying realities of antimicrobial resistance that will keep you up at night

CRE: Carbapenem resistant enterobacteriaceae This week, I saw headlines about a “nightmare bacteria” that killed two people and infected at least five more. Turns out the nightmare wasn’t such a surprise—the infections were caused by carbapenem-resistant enterobacteriaceae, or CRE.

Enterobacteriaceae are a family of bacteria that includes familiar disease-causing bugs including as Salmonella, E. coli, Enterobacter, and Shigella as well as other bacteria that don’t make us sick. In fact, some of the bacteria found in this family live benignly in the digestive tracts of humans and animals. Others, however, can cause serious illness or death.

What’s particularly frightening is that carbapenems, a particular class of antimicrobials, are usually used as the last-ditch effort to fight infection when other antimicrobials have failed. Bacterial infections treated with carbapenems are nearly always resistant to multiple other drugs. This means that if bacteria are resistant to carbapenems, they’re almost certainly resistant to all other antimicrobials. There are a few drugs that are used to treat CRE, though none of them are particularly effective. If those fail, you're in big trouble.

That’s right: CRE are resistant to basically every antimicrobial. If you get a CRE infection, your chances of survival are 50-50.

CRE are a serious threat to hospital patients. People are unlikely to come across CRE in their daily lives. However, people who are receiving hospital treatment are vulnerable to CRE infections.

I haven’t found any direct evidence linking CRE directly to animal agriculture. However, because carbapenem is only used when all other antimicrobials fail, if the bacteria weren’t already resistant, carbapenem wouldn’t have to be used in the first place! If you’d like to learn more, I recommend starting with Carl Zimmer’s piece “The ‘Nightmare Bacteria:’ An Explainer.”

Foodborne illness is a direct result of animal agriculture When you get food poisoning, it doesn’t matter whether the culprit is ground beef or cantaloupe: the microbes that traveled from your salad to your stomach came from the fecal matter of an animal. Maybe it was the cow you were eating, or one of its neighbors, or maybe it was an animal whose manure runoff contaminated the ground that the cantaloupe grew on. Either way, your gastrointestinal distress is tied directly to the bugs living in the digestive systems of agricultural animals.

CDC estimates that 48 million, or 1 in 6, Americans get a foodborne illness each year. Antimicrobial-resistant infections from food cause 430,000 illnesses each year in the US. Multi-drug resistant Salmonella causes 100,000 illnesses annually. Some strains of illness-causing microbes are becoming less resistant, while others are getting stronger.

A white paper from the Center for Science in the Public Interest shows a bleaker picture. It identifies 55 foodborne illness outbreaks from 1973 to 2011 that were associated with antimicrobial resistant microbes. Foods most likely to be implicated in these outbreaks were dairy, ground beef, and poultry. More than half of the outbreaks were due to multi-drug resistant microbes.

Maybe even more concerning is the fact that 58% of the outbreaks in that 38 year period occurred between 2000 and 2011. That’s right—more than half of foodborne illness outbreaks caused by drug resistant microbes since 1973 have occurred in the 21st century. The number of human illnesses caused by food contaminated by resistant microbes is on the rise.


This series has raised a lot of questions for me, and I plan to continue exploring this issue. Are there any related questions you’d be interested in having me research? I’ll totally do the work for you!


Special thank you to John Phillips for setting me straight on carbapenems. He's going to be a great pharmacist.

Friday Five: Salmonella, abortion, bubonic plague, rabies, Tom Hanks

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

Government shutdown, Foster Farms, and drug-resistant Salmonella

Foster Farms—a chicken processor who was the source of a Salmonella outbreak earlier this year—has been implicated in selling meat that has sickened at least 278 people in 17 states. Although the processor insists the problem is due to consumers insufficiently cooking their chicken, they have decided to revamp their procedures rather than be shut down by the USDA. This particular outbreak consists of seven strains of Salmonella, four of which are drug resistant—and due to the government shutdown, the CDC cannot properly investigate the problem and may be missing information that could reduce illness or save lives. This is a perfect example of a useful government program that should be funded regardless of politics…salmonella doesn’t care if you vote red or blue.

 

Abortion news

There’s lots going on this week regarding abortion. A woman who will have to leave the country to terminate her pregnancy since she is carrying twins who have anencephaly is highlighting Northern Ireland’s total ban on abortion. Ohio passed a budget that included three abortion restrictions, and the ACLU is suing the state, claiming the rules have nothing to do with the budget and are unconstitutional. The Nebraska Supreme Court upheld a ruling stating a pregnant foster child was not mature enough to elect to have an abortion, so she must deliver the baby and place it for adoption. Arsonists have tried to attach the Planned Parenthood in Joplin, Missouri twice in one week. Finally, some good news: California expanded access for abortions by allowing nurse practitioners, physician’s assistants, and certified nurse-midwives to perform abortions.

 

Bubonic plague may be an issue for Madagascar

Unless Madagascar gets its rat population under control, it’s likely to face a bubonic plague epidemic starting this month. That’s right, the Black Death is endemic in the island nation. Rats abound in the main prison, and the concern is that if the bacteria is introduced to those rats, the fleas they carry will be able to spread bubonic plague to inmates, employees, and visitors. And you can’t just kill rats—you have to kill the fleas, too. No word on what’s being done to avert this potential disaster.

 

Rabies vaccines are way too pricey

Fewer than 10 people have been documented as surviving full-blown rabies, but if a person who has been bitten receives the rabies vaccine before serious symptoms develop, they are likely to survive. Rabies kills about 24,000 people, mostly children, annually across Africa (approximately 26,000 die in Asia). Rabies experts at a conference this week in Dakar, Senegal suggested the best preventive measure is to tie up dogs since the post-bite treatment is cost prohibitive to most people who are bitten in Africa. The treatment requires four or five injections that cost about $13 each. Seems to me that rabies vaccine manufacturers Sanofi Pasteur and Novartis should be striking a deal with someone to lower these costs and save a huge number of lives.

 

Tom Hanks has Type 2 diabetes

During an interview with Dave Letterman, America’s favorite actor Tom Hanks announced he has Type 2 diabetes due to years of uncontrolled high blood sugar. Hanks doesn’t blame his weight fluctuations for movie roles, but says, “I think it goes back to the lifestyle I’ve been leading since I was probably seven, not 36.”  He joins the ranks of Paula Deen, Randy Jackson, Billie Jean King, Patti LaBelle, Larry King, and 25.8 million Americans. Can you imagine if Paula Deen, Larry King, and Tom Hanks did a diabetes prevention campaign? That’d be TV ratings gold.

http://www.youtube.com/watch?v=wBhZoTN2bvM