Superbugs – The Annihilators that Threaten Humanity

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Illustration – VladimirL

“Antibiotic resistance is one of the three greatest threats to human health.” ~ WHO, 2009

TIMELINE REPORT:

June 2007 – 2008, N. Ireland:

Five hospitals in Northern Ireland’s Northern Trust area were hit by the spread of the Clostridium difficile bug between June 2007 and August 2008. At one time more than 60 deaths were linked to the bug, but the inquiry concluded that it was linked to 31 deaths. The bug can cause mild or severe diarrhoea, severe inflammation of the bowel in some cases which can be life threatening, or no symptoms at all.

In 2009, Health Minister Michael McGimpsey announced a public inquiry into the outbreak.

1 October 2010, US:

U.S. Rep. Louise Slaughter (D-NY), chairwoman of the House Rules Committee, submitted testimony on the threat posed by antibiotic-resistant pathogens to the US military. According to Slaughter, soldiers with combat injuries face deadly threats of multi-drug resistant (MDR) infections after they are wounded. Between 2004 and 2009, at least 3,300 members of the armed forces were treated for Acinetobacter infections, according to the Department of Defense (DOD) statistics.

31 July 2010, China:

Healthcare alarm raised by the resistance rates of MRSA in Chinese hospitals, which has more than doubled from 30% to 70%, according to Professor Xiao Yonghong of the Institute of Clinical Pharmacology at Beijing University. Public health experts say the rampant over-use of antibiotics in China is primarily caused by China’s under-funded healthcare system where hospitals derive up to half of their operating income from selling drugs. In some cities, such as Chongqing, almost half of all drugs sold are antibiotics.

8 April 2011, New Delhi, India:

NDM-1, a gene that causes a wide range of bacteria to become resistant to antibiotics, has been found in the water supply in Delhi, with worrying implications for the rest of the globe.

International travel and medical tourism have already brought the gene, known as NDM-1, to the UK. A team of scientists reported last year that they had found NDM-1 positive bacteria in a small number of patients who had visited India for kidney or bone marrow transplants, dialysis, pregnancy care or burns treatment, while others had undergone cosmetic surgery. NDM-1 can cause many types of bacteria – including E coli and Klebsiella pneumoniae – to become resistant to powerful antibiotics called carbapenems, which are used when other antibiotics fail to work.

Poor sanitation in India, where 650 million people do not have access to a flush toilet and probably not to clean water either, is a major issue in the spread of bacteria carrying the gene. High temperatures, which are important for NDM-1 mobility, a crowded population, massive antibiotic over-use, under-use or misuse and poor infection control also contribute to the spread of the bug.

2 June 2011, Germany:

The E.coli outbreak in Germany creates a panic worldwide as scientists describe this particular strain of E.coli as “extremely aggressive and toxic.” Even worse, the strain is resistant to antibiotics, making it one of the world’s first widespread superbug. Food infections rack up a noticeable body count while sickening thousands. In Germany, the number of infections continue to rise with a total of 2,808; 839 of them with life threatening kidney disease. The outbreak, which causes 26 deaths in Germany, spread in a very limited way across the rest of Europe, causing 91 confirmed cases and a single death. These have largely been in people who had recently travelled from Germany.

3 July  2011, Ontario, Canada:

Deadly outbreak of a highly contagious superbug has claimed the lives of 15 patients in southern Ontario, raising questions whether enough is being done to prevent and control the spread of hospital-acquired infections.

Niagara Health System, a sprawling network of seven hospitals serving 434,000 people in a dozen of communities, has declared an outbreak of Clostridium difficile, commonly known as C. difficile, at three of its sites.

C. difficile is a particularly menacing infection that causes diarrhea and travels from person to person through hand contact. It is one of the most common infections in hospitals and long-term care homes.

15 January 2012, Haiti:

The devastating earthquake that rocked Haiti back in January 2010 obviously left the poverty-stricken country in even worse economic and infrastructural shape than it was prior to the disaster. But the arrival of United Nations (UN) peacekeepers shortly thereafter made things even worse. According to many scientists and experts, these officers brought in a deadly “superbug” strain of cholera that has already killed at least 7,000 Haitians.

Prior to the arrival of UN peacekeepers in Haiti, there had never been a single known case of cholera in the country. But ABC News reported that top scientists involved with researching the source of this mysterious disease outbreak have concluded that all the factors point to UN peacekeepers as the source of the outbreak.

Multi-drug Resistant Bacteria

It’s a case of ‘life imitating art’. An invisible enemy, microscopic; An epidemic with no cure and scores of fallen lives. It’s uncanny that what was a figment of sci-fi literature in George Orwell’s 1984 has become a reality today. One of the most gravest issues that face humanity is the emergence of multi-drug resistant bacteria or the ‘superbug’. It survives, constantly mutates and becomes omnipotent, making it impossible to treat with any known form of antibiotics. It is a scourge that ails the healthcare industry worldwide, has crossed borders, and grown to become a global healthcare nightmare. The superbug has become the very nemesis and antithesis of everything that medicine has stood for through ages.

acinetobacter
Trius Therapeutics is carrying out IND-enabling studies for its Gyrase-B development candidate with activity against gram-negative bacterial pathogens including multidrug resistant strains of E. coli (shown here), Klebsiella, Acinetobacter, and Pseudomonas. Illustration – Genengnews.com

How Did Superbug Come Into Existence?

A superbug is bacterial infection resistant to known antibiotics. The extensive use of antibiotics is playing an important role in the spread of Drug resistant bacterias. In some countries, antibiotics are sold without a prescription, and thus misuse and overuse of antibiotics by doctors, as well as patients, gives rise to bacterial drug resistance.

Other areas of concern are the mass scale incorporation of antibiotics in live stock feeds. Though the superbugs of varying types and intensities are found worldwide, it differs in its reason for existence. In developed countries, infections occur due to overprescription, wrong dosage intake, improper livestock & agricultural practices etc. In developing world, all these factors plus others like overpopulation, bad sanitation, improper drainage etc allow M DRB to survive and thrive.

Who Are These Micro Terrorists?

Infections involving multi-drug resistant bacteria are a major concern for most healthcare facilities since this alone is responsible for the maximum number of mortalities than diseases alone. Following are some of the most lethal bacterias discovered so far:

1.Extended Spectrum Beta Lactamase Enterobacteria:

Approximately 20% of K. pneumoniae infections and 31% of Enterobacter infections in intensive care units (ICUs) in the United States now involve strains not susceptible to known antibiotic therapy.

2.Methicillin-resistant Staphylococcus aureus :

MRSA has shown a continuous increase in its prevalence in countries defying borders. In the US alone, 50% of Staph Aureus Infections are MRSA and in Asian countries, a whopping 90%. It is resistant to most antibiotics. MRSA infected a little over 20,000 people last year and causes and/or contributes to thousands of deaths annually and it is getting ever more difficult to combat the bug. MRSA starts out as a skin infection but can travel quickly downstream to the heart, lungs and bones where it rips into tissue like a piranha.

3.Carbapenemases:

The increasing use of carbapenems spectrum of antibiotics, due to the spread of ESBLs, is creating a vicious cycle and increasing the development of carbapenemase-producing bacteria resistant to the antibiotic. Carbapenems are powerful, broad-spectrum antibiotics, which are often considered to be the last line of defence against multi-resistant strains of bacteria, such as E. coli and K. pneumoniae.

4.Klebsiella pneumoniae Carbapenemase:

This is the most prevalent strain resistant to previously effective carbenepems. K.pneumonia is a hospital acquired pathogen. The spread of KPC producing pneumonia is dangerous, as it is one of the leading cause of nosocomial infections in compromised patients.

5.New Delhi Metallo beta-lactamase 1 (NDM-1):

One of the newer and deadlier strains. The NDM-1 gene produces enzymes which make bacteria resistant to most antibiotics and can spread from one strain of bacteria to another, particularly in patients receiving antibiotic therapy. It is found in E.Coli, the most frequent cause of urinary tract infections.

6.Clostridium difficile :

The incidence rate and severity of Clostridium difficile (Cd) has increased rapidly over the past decade, since the bacterium originating from North America has acquired new virulence. It has now spread to Europe as well.

Catch 22

Health experts have been giving us repeated warnings about multi-drug resistant organisms for so long that it has become a part of our collective existence. It is just that the gravity of the situation has not seeped into our minds yet. Resistance to antibiotics was identified even before Fleming’s wonderdrug revolutionised the health industry.

Incidentally, penicillin was discovered in the 1940’s but the discovery of Beta Lactamase, a bacterial enzyme capable of destroying penicillin preceded the revolution by a few years. Microbes were always one step ahead of us. It thus became a vicious cycle – partners in crime. The more antibiotics we used, the more resistant strains we produced. And today we stand at the crossroads, like rats in a maze, caught in a dilemma to use or not to use antibiotics.

Prevention 

– Judicious antibiotic use. Trust your doctor and do not demand an antibiotic unless he/she prescribes. Take the antibiotics as prescribed and complete the course.

– Preventing the availability of counter drugs and self medication

– Absolute quality control regulations at hospitals

– Regulation and quality control of livestock facilities and feeds

– Healthy food habits

– Eating cooked food

– Consumption of fresh fruits and vegetables after washing them thoroughly

-Maintaining personal and collective hygiene

– Proper sanitation infrastructure

– Repeated Washing of Hands – a point that can be emphasised over and over

superbugs
David Livermore, director of the Antibiotic Resistance Monitoring & Reference Laboratory at the Health Protection Agency, holds a plate which was coated with the antibiotic-resistant bacteria called Klebsiella with a mutation called NDM 1 and then exposed to various antibiotics, in his laboratory in north London 9 March 2011. Photo – Suzanne Plunkett/Reuters

Bête Noire – The Other Side of the Story

We can blame populations, animal livestock feeds, and the medical fraternity for the curse that looms large over us. And yet there are grey areas that remain undisclosed and undiscovered as of yet. The fact that we are getting closer to a biological ticking time bomb is an impending reality. Over the world, at both civilian and military biological research laboratories, superbugs are being “engineered’ by virologists and researchers for Biological Weapons Defence Programmes. Just the thought of these strains getting into wrong hands or inadvertently getting out of control is of major concern. Giant pharmas are notorious for alleged “experiments,” known as “Pilot Studies,” that have test runs in unsuspecting, less privileged communities across nations.

The E.Coli outbreak in Germany, according to forensic evidence, suggests the strain was resistant to a dozen antibiotics from different classes, which experts say is impossible to happen at one go in a natural environment. They insist that it simply defies the laws of genetic permutation and combination in the wild. This can only happen unless it is exposed to the various antibiotics at different stages which is what happens in bioengineering facilities. These facts seem stranger than fiction…

Alternative theories point fingers at the nexus between overzealous trade policies, its beneficiaries and Drug-Pharma cartels. This could be just another conspiracy theory. Perhaps, we ignoramuses, are truly to blame for all the known and unknown dangers of the biological world. In the Capitalist world that we are living today, nothing is what it seems. From the food that we eat to the air that we breathe, everything has a price. And we, the masses, pay heavily for it.

UPDATED: World Economic Forum (WEF) in its latest report titled ‘Global Risks 2013‘ categorized ‘The Dangers of Hubris on Human’ as one of the three top global risks and says that antibiotic resistant bacteria (ABR) is emerging as the deadly silent killer.

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