Antibiotic Resistance Beginning To Affect Treatment

Troubling discussions:

Several times a week Brad Spellberg struggles with a difficult decision. A patient stumbles into his emergency room in southern California suffering from familiar symptoms: pressure when she urinates, pain in her side, fever and nausea. Based on these clues Spellberg can quickly diagnose the problem as a kidney infection, but the trouble lies in deciding what he should do next. He knows the patient is hurting and of course he wants to help, but more than his patient’s health hangs in the balance.

Like any emergency room clinician Spellberg has two disparate options. The first is to treat the patient with a powerful antibiotic called carbapenem, administered intravenously. It would wipe out a variety of bacteria that might be causing the infection, but there is a catch. Deploying this precious resource may make it less likely he can use it to treat a future patient. The drug would kill susceptible bacteria but it would also fuel resistance by allowing the few microbes that are able to survive carbapenem to thrive and multiply. Spellberg’s second option is to send the patient home with a lower-level class of drug, a quinolone. The stakes of his decisions are high. If a relatively mild bacterium is behind the patient’s infection, a quinolone would neutralize it and the patient would recover. But if the infection is caused by a drug-resistant pathogen, the patient would not recover without carbapenem and the untreated infection may worsen.

Spellberg’s catch-22 comes down to an issue of timing. He will not know exactly what bug is causing the patient’s infection for several days because there are no fast, cheap diagnostic tests available. So it will take three days for lab workers to identify the patient’s assailant. Spellberg cannot wait that long to make his choice. His dilemma, sadly, is not uncommon. Across the country doctors are struggling with the same issues he faces as the chief medical officer at the Los Angeles County + University of Southern California Medical Center.

Such situations now represent a key front against encroaching antibiotic resistance. And there is alarming evidence that we are quickly losing ground. In August, for example, the World Health Organization issued new guidance on sexually transmitted diseases. It said that the standard drugs used to treat gonorrhea are often no longer effective due to escalating resistance. Now WHO recommends employing two drugs against the bacterium that causes the infection. Moreover, earlier WHO analysis concluded that antibiotic-resistant pathogens are now present in every part of the world—jeopardizing a century of medical advances.

The threat of antibiotic resistance has become so dire that the United Nations General Assembly is holding a meeting to discuss it this month in New York City…

One little-discussed issue is community-acquired infections—situations in which people contract a superbug through food, drink or by touching a contaminated surface and then putting their hands in their mouths, Spellberg says. In such situations patients may unwittingly pick up superbugs that can reside in the gut without causing any issues for weeks or years. It is only when those superbugs go elsewhere in the body—the urinary tract, for example—that they can become dangerous or even deadly.

First, ask yourself what his decision would be if it was his child. Know this is out there, in the event you or a loved one need treatment, and ask for the more aggressive treatment. They will be hesitant to deny it, because nobody asks, and if you needed it after all, you will probably sue, and drive up their malpractice insurance rates. Be the squeaky wheel.

Also notice in the first paragraph, it is “she” who has the kidney infection. These infections are associated with sexual activity, and because of biological factors, they are showing up more often in women.

Also notice – he mentions fish being dosed with antibiotics.

I used to know a Fisheries Biologist who ran one of the largest catfish farms in the US. He literally oversaw several hundred massive multi-acre ponds, and collected novelties in his own pond, trying to grab two-headed catfish, and other curiosities out of the electrocution conveyer belt before they were killed – without getting shocked himself.

He once explained how rigorously the USDA controlled what they put in the water. He was not allowed to treat his fish with antibiotics. If something broke out, he made the call on whether to hold and hope for the best, harvest early and sacrifice future growth, or trash the pond and start over. Treatments, beyond those designed to help water quality, and a precious few for parasites, were not used because the penalties would have been immense.

At the same time, he talked about how across the border in Mexico, they were using everything, even including steroids, to bulk the fish up. And the fish needed meds to keep them alive. In some of the Tilapia ponds, the Ammonia downwind would make your eyes water. The Mexicans didn’t care. They could fill the ponds with penicillin if they wanted.

Since it is Mexico, the USDA had no oversight, and the Mexicans didn’t care, because everything was being filleted and shipped up north to get the rich Americans to buy it at higher prices. At the border, customs had no idea what the fish were given before they were filleted, and USDA didn’t test for drugs.

There is a reason these genes come from third world places like India, rural China, and Mexico. We use drugs, but they are strictly controlled. Overseas, they take it to a whole new level.

This is migrants bringing in diseases that are preferentially infecting the less sexually restricted. Right now, medicines are free, and they work well, so beyond some minor possible reduction in fertility, this has no selective effect.

But conditions change, economic Apocalypses shutter drug factories, reduced human immunity causes outbreaks, and economic collapses leave everyone too poor for all the medicine they need. When that goes down, I expect the shift in our populations toward K will not just be environmentally adaptive. It will be genetic too.

Start training your amygdala to make you compulsively wash your hands, avoid infection, and shun areas where carriers may congregate.