In the past few
years, there have been many "superbugs" appearing in hospitals around
the world.
But a new type of
pneumonia has emerged in China that is important.
Doctors in Hangzhou
in southeastern China have detected a type of pneumonia that is both highly
drug-resistant and very deadly. It also spreads easily.
The
bacterium, a type of Klebsiella pneumoniae, pictured above, killed
five people in an intensive care unit in Hangzhou in 2016, researchers reported in the journal Lancet Infectious Diseases.
"This
fatal outbreak happened in a brand new hospital with very good hygiene,"
says microbiologist Sheng Chen, who co-led the study at the Hong Kong
Polytechnic University. "Drug-resistant strains shouldn't have appeared so
quickly." The microbe canan fights off all drugs available in China, Chen
says. "We don't have anything in China to stop it," he says.
"There is a drug available in the U.S. that should be effective against
it, but we haven't tested it yet."
In the outbreak, the
five patients who died were all older than 53. They were all on ventilators
after undergoing major surgeries. And they died from severe lung failure, multi
organ failure or septic shock, the researchers found.
When Chen and his team sequenced the microbes found in the
infections, they were shocked at what they saw. These bacteria aren't like
other multidrug-resistant pneumonia reported before. They are a fusion of two
dangerous forms.
In
the past three decades, two types of K. pneumoniae have
appeared in hospitals. The first is a drug-resistant form, called CRE, which can fight off even the toughest antibiotics.
Last January, this type of pneumonia killed a woman in Nevada. That strain resisted 26
antibiotics.
The
second type of K. pneumoniae causes a very
severe form of the disease and is known as "hypervirulent."
"The disease
progresses very fast," Chen says. "It starts in the lungs and then
infects other organs, like the liver."
This hypervirulent
form — which is widespread across Chinese hospitals — causes
more damage to the body than other strains do. It can spread through
communities. And it can even sicken young, healthy adults, Chen says.
For years, doctors feared the two types would one day
combine. And now that it has happened,
scientists around the world need to be on alert for these triple-threat
strains, researchers at Rutgers University write in a commentary about the new
study.
"Their
study describes an alarming event," epidemiologists Liang
Chenand Barry Kreiswirth write about the emergence of this worrying
pneumonia. "Failure to control its early spread right now, will make a
global epidemic of carbapenem-resistant [CRE], hypervirulent K. pneumoniae hard to avoid," the researchers
write.
How can we stop
the spread of antimicrobial resistance?
New
drug-resistant pathogens are cropping up around the world every year. Many have
adapted to resist a few drugs. Others are "superbugs," resistant to
many, many drugs, including last-resort antibiotics.
Eventually, all
the antibiotics we have could become ineffective, scientists say. Medicine
would step back in time to the 19th century, when doctors' hands were tied,
when a simple cut on your finger could be deadly. Basic medical procedures,
such as C-sections, would be too dangerous to perform.
But
this medical dystopia is not inevitable,
says Ramanan Laxminarayan, who directs the Center for
Disease Dynamics, Economics & Policy in Washington, D.C.
"This is an
avoidable disaster," he says. And even reversible — maybe, to a degree, he
says.
Take
for instance, the antibiotic chloroquine in Malawi. Back in 1993, the country
stopped using chloroquine to treat malaria because of rising resistance. By
2009, the malaria pathogen had largely lost its resistance and once again
became vulnerable to the antibiotic, a study reported a few years ago. All the pathogen needed
was a hiatus from the drug to drop its resistance. And the country could again
use chloroquine to treat malaria.
Other experts we
talked to share Laxminarayan's optimism. They say individuals can take a few
precautions and really help stop the spread of antibiotic resistance globally —
and keep their home and communities safer, at the same time.
So what can you
do?
1.
Put down that strip of bacon.
In
the U.S., doctors and nurses prescribe about 8 million pounds of antibiotics
each year, says Lance Price, who directs the Antibiotic Resistance
Action Center at George Washington University.
But farmers use
more than four times that much — or 34 million pounds, Price says. That's about
the weight of two Eiffel Towers.
Farmers use
antibiotics to prevent disease among livestock but also because the drugs — for
reasons that are still unclear — boost animals' growth.
"This is a
big driving force of antibiotic resistance," he says. "The conditions
in modern farms are perfect for the spread of bacteria. You've got 10,000 pigs
or birds all crammed together, all defecating on each other. Introducing
antibiotics is the magic ingredient for creating drug-resistant bacteria."
And to make
matters worse, this wellspring of resistance is all attached to a massive
distribution system — America's supermarkets.
"The meat is
inevitably tainted with these bacteria," Price says. "So they end up
in stores across the country."
To stop the spread
of these superbugs, Price says, Americans need to stop buying meat raised with
antibiotics. Period. "This is a really, really important choice to
make," he says. "It's the only way to make progress in this
area."
"This makes
demands on retailers to stock antibiotic-free meat," he says, "which
then places demands on producers to raise animals without antibiotics."
Look for meat labeled as "No antibiotics," "Raised without
antibiotics" or "USDA-certified organic." For organic meats,
animals can't be given antibiotics, although this doesn't apply to eggs and
small chicks destined to be chicken.
Raising animals
without antibiotics is typically more expensive. So if your budget can't afford
organic meat, then think about simply cutting out pork.
With pigs, farmers
often use massive amount of antibiotics, Price says.
"It's the way
they're typically raised," Price says. The animals spend almost their
entire lives in confined pens. And they're given antibiotics throughout almost
their entire life.
We often hear that
antibiotic resistance is like climate change: A few countries ruin it for
everybody. Any one person's contribution is a tiny drop in the world's vast
ocean of antibiotic use.
That is true,
Price says. But with antibiotic resistance, you can have an impact on your
local community — or even state — which can protect you and your family from
superbugs.
There's even proof
of this: Sweden.
Every time you use
an antibiotic, you raise the risk of developing resistant bacteria on your skin
or inside your body. Those pathogens can spread through households, classrooms
and communities.
But
Sweden has been ultravigilant about keeping antibiotic-resistant bacteria out
of the country. Doctors are extremely prudent about prescribing antibiotics.
The health care system constantly monitors for the presence of resistant
strains. And the government banned the use of antibiotics as growth promoters
on farms way back in 1986.
As a result, the
country is a sanctuary for antibiotics. The drugs have preserved their potency.
And doctors can prescribe antibiotics that here in the U.S. we've essentially
abandoned because of built-up resistance.
"America can
revitalize these amazing antibiotics, too, if we start using them more
carefully," Price says adds. "But everybody needs to change. It needs
to be across the board."
To
make your home, town or country an antibiotic sanctuary, don't demand
antibiotics from doctors. Better yet, be proactive, says James Johnson, an infectious disease doctor at the
University of Minnesota.
"Tell your
doctor, 'We'd like to talk about ways to avoid using antibiotics. Are there
alternatives we can try or use a wait-and-see approach more often?' " he
says.
"When a
doctor offers antibiotics, challenge it!" Johnson adds. "Ask, 'How
confident are you in the diagnosis? Are you sure it's caused by bacteria, not a
virus? If it is a bacterial infection, how sure are you that this drug will
work?' Sometimes doctors need permission not to prescribe antibiotics, and they
might be relieved."
Then try out a
similar conversation at your kids' play groups, he says. Try something like:
"We're working to keep superbugs out of our home. So we're being careful
about using antibiotics and eating meat raised with antibiotics. Are you
interested in doing the same?"
Bacteria easily
pass around families and communities, Johnson says. Every time an antibiotic
gets used, resistant strains gain an advantage and can crop up. Once they're
out in the community, everyone is vulnerable.
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