C-Diff and the nature of bacteria

C. diff spread 'fast and easy'
Excerpt:

The genetic code of C. difficile mutates rapidly. By comparing the genetic code of batches of C. difficile, researchers can work out how related different batches of C. difficile are. Doing this on a large scale, involving 151 samples from infections in 19 countries, allowed researchers to build up a picture of the spread of the antibiotic resistant strains.

It showed there was an strain called FQR1 which started in the US and spread across the country and to Switzerland and South Korea.

A second strain FQR2 started in Canada before spreading across North America, Europe and Australia. It entered the UK on four separate occasions.

Comment: Star Tribune article today: For human reasons, bacteria are winning Excerpt:

What makes the rapid loss of antibiotics to drug resistance particularly alarming is that we are failing to make new ones. We are emptying our medicine chest of the most important class of medicines we ever had. And the cause can be traced, for the most part, to two profound problems.

The first is economic. Historically, the drug industry thrived on antibiotics. But if an antibiotic is useful against only one type of bacterium, relatively few people need it during its patent life. And if an antibiotic is "broad spectrum," meaning it works on many different types of bacteria, wider use shortens its commercial life because it quickens the pace at which bacteria develop resistance. Moreover, antibiotics are designed to cure an acute disease -- not to palliate a chronic one -- so people need them only for a limited time. Compared with drugs that are used for years to treat widespread conditions like high cholesterol or asthma, antibiotics pale as a corporate investment.

The second challenge stems from the nature of bacteria. Though brainless, they are brainy, enjoying a highly effective collective intelligence. Large numbers of independently mutating bacteria test adaptations to group problems, like how to survive antibiotics. What works -- like modifying the bacterial proteins to which antibiotics would otherwise bind -- wins. As bacteria become more adept at evading antibiotics, it has become much harder to find drugs that can beat them back. Merge these two problems -- scientific and economic -- and the result is a drug-development disaster: The prospects are so discouraging that few companies bother to try anymore

Final comment: I am currently (and hopefully forever) C-Diff free! Image source

The dearth of new antibiotics

NIH superbug outbreak highlights lack of new antibiotics

Excerpt:

As doctors battled a deadly, drug-resistant superbug at the National Institutes of Health’s Clinical Center last year, they turned to an antibiotic of last resort.

But colistin, as it’s called, is not a fancy new creation of modern biotechnology. It was discovered in a beaker of fermenting bacteria in Japan — in 1949.

... Between 1945 and 1968, drug companies invented 13 new categories of antibiotics, said Allan Coukell, director of medical programs at the Pew Health Group.

Between 1968 and today, just two new categories of antibiotics have arrived.

In 2011, the Food and Drug Administration approved one new antibiotic, which fights one of the many bacteria, Clostridium difficile, causing deadly hospital-borne infections.

“What kept us out of trouble for the last 60 years is that every time drug resistance caught up to us, the pharmaceutical companies would go back to the drawing board and develop the next generation of drugs to keep us ahead of the game,” said Brad Spellberg, an infectious diseases physician in Los Angeles who heads a microbial resistance task force for the Infectious Diseases Society of America. “That’s the part of the equation that’s changed. Drug companies are no longer trying to get one step ahead.”

... As a result, only four of the world’s 12 largest pharmaceutical companies are researching new antibiotics, said David Shlaes, a drug development veteran and consultant. Last year, Pfizer, the world’s biggest drug company, closed its Connecticut antibiotics research center, laying off 1,200 workers.

The company said it was moving the operation to Shanghai. But Shlaes said Pfizer is struggling to open the Chinese facility and has largely abandoned antibiotics. While a new antibiotic may bring in a billion dollars over its lifetime, Shlaes said, a drug for heart disease may net $10 billion. Depression and erectile dysfunction drugs — typically taken daily for years, unlike antibiotics, which are used short-term — are also more profitable than antibiotics.

Comment: Image Source: Clostridium difficile. Optimer Pharmaceuticals is not mentioned by name in the article but it developed Dificid (which finally ended my C-Diff infection) Also worth reading:

• CDC: Why is antibiotic resistance a food safety problem?
• Mayo Clinic: Antibiotics: Misuse puts you and others at risk

Superbugs in Delhi drinking water

Scientists find superbugs in Delhi drinking water

Excerpt:

A gene that makes bugs highly resistant to almost all known antibiotics has been found in bacteria in water supplies in New Delhi used by local people for drinking, washing and cooking, scientists said on Thursday.

The NDM 1 gene, which creates what some experts describe as "super superbugs", has spread to germs that cause cholera and dysentery, and is circulating freely in other bacteria in the Indian city capital of 14 million people, the researchers said.

"The inhabitants of New Delhi are continually being exposed to multidrug-resistant and NDM 1-positive bacteria", said Mark Toleman of Britain's Cardiff University School of Medicine, who published the findings in a study on Thursday.

A "substantial number" of them are consuming such bacteria on a daily basis, he told a briefing in London. "We believe we have discovered a very significant underlying source of NDM 1 in the capital city of India," he said.

NDM 1, or New Delhi metallo-beta-lactamase 1, makes bacteria resistant to almost all antibiotics, including the most powerful class, called carbapenems.

It first emerged in India three years ago and has now spread across the world. It has been found in a wide variety of bugs, including familiar pathogens like Escherichia coli, or E. coli.

No new drugs are on the horizon for at least 5-6 years to tackle it and experts are concerned that only a few major drug companies, such as GlaxoSmithKline (GSK.L) and AstraZeneca (AZN.L), still have strong antibiotic development programmes.

Toleman's study, carried out with Cardiff University's Timothy Walsh and published in The Lancet Infectious Diseases journal, investigated how common NDM 1-producing bacteria are in community waste seepage -- such as water pools or rivulets in streets -- and tap water in urban New Delhi.

The researchers collected 171 swabs from seepage water and 50 public tap water samples from sites within a 12 kilometre radius of central New Delhi between September and October 2010.

The NDM 1 gene was found in two of the drinking-water samples and 51 of seepage samples, the researchers said, and bacteria positive for NDM 1 were grown from two drinking-water samples and 12 seepage samples.

"We would expect that perhaps as many as half a million people are carrying NDM 1-producing bacteria as normal (gut) flora in New Dehli alone," Toleman said.

Experts say the spread of superbugs threatens whole swathes of modern medicine, which cannot be practiced if doctors have no effective antibiotics to ward off infections during surgery, intensive care or cancer treatments like chemotherapy.

Comment: In light of the above, GlaxoSmithKline and Astrazeneca could be good investments! Image source: Rivers of Sewage: India’s Rivers Are Slowly Dying

The first thing that a traveller to India learns is not to drink the tap water. And with good reason: millions of tonnes of sewage are dumped daily into India’s rivers – and some of them, such as the holy Yamuna and Ganges rivers – are slowly choking to death, jeopardizing the lives and livelihoods of millions of people.

"We talk a lot about industrial pollution of our rivers, but sewage pollution is a big problem," said Sunita Narain, the director of the Centre for Science and Environment on Thursday. "What is happening to the Yamuna is reflective of what is happening in almost every river in India. The Yamuna is dead, we just haven't officially cremated it yet."

Some of these rivers are the only source of water for drinking and domestic use for many poor Indian citizens, so while a tourist can make do with some plastic-packed substitute, the impact of industrial and human waste is further worsening the water crisis in a country that depends on its rivers for water in agricultural and human consumption.

A study done by the Central Pollution Control Board showed that around 70 percent of the pollution in the Yamuna is human excrement. In large metropolises such as New Delhi, 3.6 billion tonnes of sewage alone are dumped daily – but only half of that amount is effectively treated and the rest flows down the Yamuna, resulting in widespread waterborne illnesses such as diarrhea from drinking and bathing in the affected water.

Note to self: Not a destination!