Super bugs

[jajrussel]

I was just glancing at an article that states there should be a concern about using antibiotics on animals for food production, and I had this question.

 

Evolution is about survival of the fittest, and I do not doubt that stronger bugs servive. My question is how does removing the antibiotics reverse Evolution?

 

It seems to me that what they are asking is for us to stop trying to survive. This would be cheaper, but the long term effects would seem to me to be less beneficial. Actually I'm not sure it would be cheaper. It would put us in a catch-up phase and put off the cost to a time when it would be more expensive.

 

In the present the need four greater production will escalate more rapidly to compensate for the greater death rate before processing with at the minimum of two outcomes, worse growth conditions for the animal, producing best case conditions for the bacteria, or facilities expansion which would allow current legal growing conditions to be maintained at the additional cost of expanding.

 

It would seem that facilities expansion would lower the need for antibacterial drugs while limiting the expansion rate of bacteria through cleaner growing conditions. This combined with cleaner processing methods should reduce the harmful effects on human consumption.

 

It seems to me that by simply saying no more antibiotics we are preparing society for a period of stagnation that will leave us unprepared for the next super bug simply because research is maintain by present needs, and information tends to be lost or forgotten if not maintained. Then the cost when needed will be staggering, as it has been in the past.

Edited June 28, 2015 by jajrussel

[John Cuthber]

Did you stop to think about "We will eat less meat" as a possible outcome?

Also, you say "production will escalate more rapidly to compensate for the greater death rate before processing".

Do you think the antibiotics are being used to stop the animals getting sick and dying?

They aren't.

[jajrussel]

Did you stop to think about "We will eat less meat" as a possible outcome?

Also, you say "production will escalate more rapidly to compensate for the greater death rate before processing".

Do you think the antibiotics are being used to stop the animals getting sick and dying?

They aren't.

It is true that we can eat less meat. It is also true that we can eat less of anything. Is it beneficial? Yes, and No,depending on the quality of our purpose. It is true that too much of anything is as bad for you as not enough.

 

To eat, or not eat meat is a philosophical decision. Should we allow meat to become a poison simply to support the philosophy?

 

A grower is not going to administer antibiotics for no economical reason. The reason they administer antibiotics is to keep the animal alive to the point of processing, thus increasing profit margin. The animals intent is as food.

 

Biblically, we were nor meant to eat meat, but then biblically eating meat was sanctioned under specific conditions. Another philosophical argument that carries about the same weight as a vegan one.

 

The argument I present is one of human benefit. How do we increase our benifit of survival by taking actions that seem designed more toward uplifting a philosophical view through stagnation?

 

Yes, there is a danger of evolution through manipulation, but this danger is evolution, and it is not going to go away simply because we decide to withdraw our support. What will happen is that we will be caught ill prepared because we chose to allow one philosophy, over another. One that is not geared toward growth, but stagnation.

Edited June 28, 2015 by jajrussel

[Strange]

Evolution is about survival of the fittest, and I do not doubt that stronger bugs servive. My question is how does removing the antibiotics reverse Evolution?

 

It won't reverse it. It will help prevent more microbes becoming resistant. In other words, it won't make thinbgs better but might stop them getting worse.

 

It seems to me that what they are asking is for us to stop trying to survive.

 

I don't see why. Giving antibiotics to animals has nothing to do with our survival.

 

However, running out of usable antibiotics will limit people's ability to survive minor infections and essential surgery.

Edited June 28, 2015 by Strange

[Danijel Gorupec]

My question is how does removing the antibiotics reverse Evolution?

 

 

How I see it, super-bugs are not more advanced than ordinary bugs. This 'super' is a bit of misnomer. Super-bugs are resistant to antibiotics, but this does not mean that they are better fit overall. So super-bugs might never evolve if antibiotics are not widely present. That is why restricting antibiotics should work..... In fact, I suspect that without antibiotics, given looong enough time, super-bugs would eventually perish being 'less fit'.

 

 

Speaking generally, as I understood it, appeals to decrease antibiotic usage is because overuse:

 

- to a farmer it might be cheaper and quicker to administer wide-spectrum high-dosage antibiotics than to make elaborate and time-consuming medical investigation about the most efficient treatment

- because of low price, administering antibiotics can be used as a sort of insurance against much worse outcome for a farmer (on a farm, disease can spread quickly)

- medical personnel (veterinarians) built habit of being easy on antibiotics (not sure why - is it from laziness or from pressure asserted on them)

 

Obviously, when you look at it from a perspective of a single farmer or veterinarian, administering generous amounts of antibiotics might be beneficial. However from wider perspective, this is a risky behavior. So, my understanding is that there are no serious appeals to remove antibiotics from farming - just to administer them responsibly. Keeping farm animals healthy is important for human health too, so it would be stupid to remove antibiotics completely.

[John Cuthber]

Hello!
Is anyone listening?

 

They don't feed antibiotics to cattle because the cattle are ill (much).

 

They use thembecause it makes the cattle grow faster and eat less.

https://en.wikipedia.org/wiki/Antibiotic_use_in_livestock#Drugs_and_growth_stimulation

 

So, what they are doing is using large amounts of these drugs in sub-therapeutic doses in lots of animals wandering about on farms.

That's pretty much a guaranteed way to produce resistance.

Then the meat from those animals enters the human food chain.

Does that seem sensible to anyone here?

[CharonY]

Absolutely, and there is more. Antibiotics are released as waste and manure into soil and aquifers and create selective situations there, and I think that these may even be larger pools of resistance determinants. Also, in many mass production facilities animals are culled rather than treated as it is cheaper that way.

[jajrussel]

 

It won't reverse it. It will help prevent more microbes becoming resistant. In other words, it won't make thinbgs better but might stop them getting worse.

 

 

I don't see why. Giving antibiotics to animals has nothing to do with our survival.

 

However, running out of usable antibiotics will limit people's ability to survive minor infections and essential surgery.

I can understand this argument better. We don't want things to get worse. However, if an infection is minor we will survive with nominal treatment. The fear of nominal treatment is as bad as no treatment. The fear is super bugs that are the result of nominal treatment. A process of normal treatment that doesn't go away simply by withholding treatment. The hope is to slow this process down. In the meantime people die, or endure prolonged suffering in the name of what? Progress? Society, benifits if we allow illness to take its course? Explain that to those who are ill, and remain ill because treatment is withheld through fear, or because it appears that the illness appears more due to a viral infection. I can understand the reluctance to give treatment that is not needed, but often we are betting the farm on a professionals opinion that a viral infection won't lead to a bacterial infection, and that treating both is of no benifit, because possibly in the future the antibacterial treatment may be weakened because of today's treatment. The argument sounds logical, but is more easily accepted by someone who is not sick, than by someone who actually is. The doctor who thinks that a viral infection that produces dead meat in the body can not lead to a bacterial infection is a fool. As is the doctor who thinks a resulting bacterial infection can not lead to a prolonged viral infection is. Can we guarantee that withholding treatment will result in a better future? A better understanding of what is actually ailing us would be better. How many years did I suffer through of none ending throat infections, colds,and flue symptoms to finally have a doctor say this is the result of allergies, and like magic life got better. All I knew was that until then antibiotics lessoned the suffering. A proper diagnosis is the best thing, but until then I did all I could to get the antibiotics, because they helped.

 

Now, I have seemed to have answered my own question. The reason for giving antibiotics to animals is simply to help insure that their investment survives to processing without improving growth conditions, so perhaps the practice should be controlled, but from a humane standpoint what if the animals get sick? Do we withhold preventive treatment for fear we might create a super bug? I wouldn't do this to my dog. I would prefer him to be well. I would not withhold preventive medicines for fear of creating a superbug. I can hardly see the rightness of doing this to an animal simply because it's intent is to be used for food.

 

Frank Herbert wrote 'that fear is the mind killer.'

 

When we allow the fear of creating a super bug to control what we can and can not do aren't we actually accepting that our natural state should be one of fear? Wouldn't it be better to say the possibility exist to the point of probability. Then prepare through proper research? I could stop eating meat, but that field of plants across the way is more likely to make me sick than the small amount of meat I can afford to eat, still I do have my allergy medicine, so maybe not.

Edited June 28, 2015 by jajrussel

[Danijel Gorupec]

@John Cuthber... Thanks for reminding me about this point (I recall now that I heard about it sometime before)... But I am not sure what is the meaning of those big bold letters you use. In your first post you were not clear about what you are talking about - at least I did not get your point.

 

Also, it is clear that meat from those animals enters the human food chain (that's the whole idea)... but you are again not clear why are you mentioning this.

[CharonY]

Well, OP seems under the impression that therapeutic use of ABs are the reason for the rise of multiple-resistant strains whereas John highlighted that we actually throw massive amounts of ABs around for production reasons. Also jajrussel still seems to ignore that point and thinks it is about keeping cattle healthy. It is not as the amount used are too low dosed to have therapeutic effects. It just makes them fatten faster (the same way growth hormones were used before bans),

[jajrussel]

I missed a lot of replies while writing my thoughts. I am sorry to have fallen behind in my own thread. It is in part due to this keyboard putting words in my mouth, then requiring correction, and the fact that I am a slow thinker.

Edited June 28, 2015 by jajrussel

[John Cuthber]

@John Cuthber... Thanks for reminding me about this point (I recall now that I heard about it sometime before)... But I am not sure what is the meaning of those big bold letters you use. In your first post you were not clear about what you are talking about - at least I did not get your point.

 

Also, it is clear that meat from those animals enters the human food chain (that's the whole idea)... but you are again not clear why are you mentioning this.

The big bold italic letters were because, even though I had made it clear when I said "Do you think the antibiotics are being used to stop the animals getting sick and dying?

They aren't." that antibiotics are not (generally) used therapeutically in animal husbandry people were still posting as if that was the reason for them.

viz

"The reason they administer antibiotics is to keep the animal alive to the point of processing,"

and

"to a farmer it might be cheaper and quicker to administer wide-spectrum high-dosage antibiotics than to make elaborate and time-consuming medical investigation about the most efficient treatment

- because of low price, administering antibiotics can be used as a sort of insurance against much worse outcome for a farmer (on a farm, disease can spread quickly)

- medical personnel (veterinarians) built habit of being easy on antibiotics (not sure why - is it from laziness or from pressure asserted on them)"

Perhaps I should have used flashing colours because it seems that Jajrussel still hasn't got it since he says "The reason for giving antibiotics to animals is simply to help insure that their investment survives to processing "

 

Now the fact that animals are treated with antibiotics and then get into the food chain means that people are exposed to the resistant bacteria that are encouraged by the farming practice.

So it's important- if they were zoo animals it would mater less because most people wouldn't ever be exposed to the resistant bacteria.

[StringJunky]

The big bold italic letters were because, even though I had made it clear when I said "Do you think the antibiotics are being used to stop the animals getting sick and dying?

They aren't." that antibiotics are not (generally) used therapeutically in animal husbandry people were still posting as if that was the reason for them.

viz

"The reason they administer antibiotics is to keep the animal alive to the point of processing,"

and

"to a farmer it might be cheaper and quicker to administer wide-spectrum high-dosage antibiotics than to make elaborate and time-consuming medical investigation about the most efficient treatment

- because of low price, administering antibiotics can be used as a sort of insurance against much worse outcome for a farmer (on a farm, disease can spread quickly)

- medical personnel (veterinarians) built habit of being easy on antibiotics (not sure why - is it from laziness or from pressure asserted on them)"

Perhaps I should have used flashing colours because it seems that Jajrussel still hasn't got it since he says "The reason for giving antibiotics to animals is simply to help insure that their investment survives to processing "

Living proof that we see what we want to see ...we proactively invent the world around us in our minds.

[Danijel Gorupec]

Thanks, John, for your explanations.... But just for you to see how things can get wrong when you are not explicit enough:

 

- "Do you think the antibiotics are being used to stop the animals getting sick and dying?"... my understanding was that you are referring to antibiotic overuse - in a sense that it is unnecessarily given for every little bit, but still for medical reasons.

 

- "Then the meat from those animals enters the human food chain." ... my understanding was that you are concerned that it is antibiotics that could be consumed by humans.

[jajrussel]

Well, OP seems under the impression that therapeutic use of ABs are the reason for the rise of multiple-resistant strains whereas John highlighted that we actually throw massive amounts of ABs around for production reasons. Also jajrussel still seems to ignore that point and thinks it is about keeping cattle healthy. It is not as the amount used are too low dosed to have therapeutic effects. It just makes them fatten faster (the same way growth hormones were used before bans),

So you are saying antibiotics are an alternative growth hormone, and that this growth has nothing to do with the animals wellbeing.

 

Could it be that one, the amount of antibiotic is low because it is expensive. Is low because it is preventive, or is low because it is under legal control.

 

Typically, for all concerned less is always better. Not because it is true, but because a well sounding proverb often justifies misuse. How many times have I been told to take all my antibiotics as proscribed to then read that I would have been better off to have let nature take its course. Your statement seems to be counter to your own argument, but I am still trying to understand it. Superbugs exist because of the low dosage? Would there be a problem if the dosage were proper?

 

It is possible that growers see antibiotics as a growth hormone. I am sure they are cheaper. They look at results then follow their own guidance. When something seems to be working it is difficult to accept advice. To my knowledge antibiotics do not work like a vaccination. They are not really preventive medicine. They only work if the problem exist. The grower would see no beneficial result. Then would have to rely on ill given advice. Pherhaps by someone who sells antibiotics. We tend to see what we want to see. If the result is greater yields all the better. In truth I am not sure that I disagree with the case you present. I am sure that I don't totally understand it, because I thought at first you were vegan, presenting a week vegan argument. Promoting the phylosopy by attacking the base of a different phylosopy by pointing out weakness based on wrong thinking. A point easily defended when applied correctly. I am a assuming now that I am wrong. I am just not sure how wrong I am.

 

I was not ignoring facts. I was unaware that antibiotics were a substitute for growth hormone, and was busy writing when that was posted. Truthfully my assumtion was and is that an animals well being promotes it's value, so naturally I assumed that to be the purpose for feeding, or giving the animal antibiotics.

[John Cuthber]

They are using the antibiotics to increase the rate at which the animals grow. it isn't a growth hormone, but the effect is similar.

They don't use much because they don't need to. It is expensive and using more of it would not work better (they wouldn't grow faster).

 

The advice given to people when they take antibiotics is that you should always take all of them.

For a lot of times when people are prescribed antibiotics they are a waste of time and money (This is another thing that contributes to resistance)

Sometimes people would be better off not taking them at all.

 

if they did not give the animals low doses of antibiotics there would be no reason for the resistant bugs to develop.

If they used higher levels of antibiotics there would be less chance of resistance developing.

 

The problem is that there are two different "right" doses.

The right dose for fast growth is a lot less than the right dose for antibacterial therapy.

[CharonY]

 

They don't use much because they don't need to. It is expensive and using more of it would not work better (they wouldn't grow faster).

 

Also, at therapeutic concentrations it is actually harmful for growth. Also even if used only at lethal concentrations, manure and other effluents would still be a source of sub-lethal concentrations of antibiotics (as it is quite stable and will be released to the environment. I.e. there is no use of AB that would entirely prevent the rise and spread of resistances (though rate is, as pointed out, likely to be slower if minimized).

 

Or to make it more specific, the largest (in terms of total volume) reservoir of resistance determinants is not in a treated person/animal or meat (even if applied at sub-lethal doses) but rather wastewater and similar effluents. In these matrices a massive amount of e.g. resistance plasmids and similar sources of mobile resistance elements have been found.

In terms of impact the direct transmission in hospitals is of course the largest concern.

Edited June 28, 2015 by CharonY

[jajrussel]

Hello!

Is anyone listening?

 

They don't feed antibiotics to cattle because the cattle are ill (much).

 

They use thembecause it makes the cattle grow faster and eat less.

https://en.wikipedia.org/wiki/Antibiotic_use_in_livestock#Drugs_and_growth_stimulation

 

So, what they are doing is using large amounts of these drugs in sub-therapeutic doses in lots of animals wandering about on farms.

That's pretty much a guaranteed way to produce resistance.

Then the meat from those animals enters the human food chain.

Does that seem sensible to anyone here?

I read the article. An intresting collection of statements. Some talk about concern. People have been doing it for years. China is still doing it. India is the worlds provider. Apparently unaware that their success is the means of their own down fall. Indias only hope is that the rest of the world realizes the possible evils of Indias products, and bans their evil use. To which I predict that the only actual guarantee resulting from the ban is an increased cost of the products of its intended use. I can't even call the whole thing a conspiracy, because Indias biggest addict lives right next door, and they don't seem to be in any hurry to ban anything.

 

I will eventually read it again, and maybe this time I won't feel like someone is trying to pull my chain.

Edited June 28, 2015 by jajrussel

[CharonY]

I am wondering why you are specifically naming India and China. This practice is common everywhere. Ca. 75-80% of antibiotics used in the US are used on livestock (as opposed to medical use).

Or are you talking about production? In that case it should be noted that these are US or EU-owned. They just moved their manufacturing sites overseas. A few countries in the US are starting to ban the practice but from I have heard it is still in common use (I think either Denmark or Sweden being one of the exceptions).

But blaming countries is just silly. Rather, blame our desire for cheap meat.

Edited June 29, 2015 by CharonY

[jajrussel]

I am not blaming anyone. The article stated that most of the drugs are manufactured in India, and that China was the biggest user. It was a poor attempt at sarcasm by me.

 

Actually, I view both countries as being two of the most practical countries in the world.

Edited June 29, 2015 by jajrussel

[CharonY]

Actually, that entry is rather bad in this regard as the source it cites is rather poorly sourced itself (not your fault, rather a general issue of encyclopedia). It is based on estimates that are themselves based on estimates within surveys. But that being said, it hints at a different problem, AB use almost worldwide is not regulated and monitored well enough (although countries, including China are starting to pick it up since the last couple of years).

But obviously it would make a lot of sense since India are the most populated countries and are also areas where production is outsourced to. It is likely that the US would be roughly next on the list. But as John mentioned, stopping the use of AB for meat production would cut shit tons of ABs from the environment.

[Danijel Gorupec]

There is one thing that remains unanswered in this thread...

 

It is not obvious to me how can low concentrations of antibiotics create bugs resistant to high concentrations of antibiotics? There are hints in this thread that this is an obvious consequence, but I don't see it clearly.

 

I know very little about antibiotics, so I use following analogy: If some bacteria does very good at 25 degrees Celsius, but I increase temperature to 40 degrees Celsius forcing them to develop coping mechanisms and change themselves - how can this create a super bug that can live in autoclave temperatures? My understanding is that organisms change only as much as needed, not more.

 

To be clear, I do expect that higher-than-natural concentrations of antibiotics will somewhat increase the probability of super-bug creation. How much this probability is increased is an important factor of the problem discussed in this thread. If added antibiotics increase likelihood of super-bug creation only marginally (in comparison to natural likelihood) then maybe it is worth it.

 

----

 

Another thing comes in mind: if, as I understood this thread, farmers give antibiotics to animals not for therapeutics effects but for side-effects, wouldn't then be worth investigating this issue a bit further? Can we create a poor antibiotic with nice side-effects for farming usage (because 'gain weight faster while eating less' sounds like useful magic)... And how come those farmers give the whole spectrum of various antibiotics to their animals - why don't they just settle with the cheapest antibiotic type so that they don't rubbish all of them?

[jajrussel]

Actually, that is why I stated the thread. I was hoping that someone with a background in biology would tell me why the antibiotics given to food animals is wrong to the point where people would demand that it would be banned completly. Are they just crying wolf? Is it an economic reason? Is the reason simply philosophical? Is there any proof that the AB's will actually cause harm, or is it rebels who will take any cause offered just so they can stomp their feet, shake their fist, and incite riot simply becasue it makes them feel alive while giving them a sense of purpose?

 

The article implies that the practice of giving AB's to food animals has been going on for years for practical reasons. Where is the practicality of forcing a ban if the only reasons offered is that there are just some concerns that something might happen? There seems to be plenty of government control mentioned in the article in place to address most concerns. So why force a ban?

Edited June 29, 2015 by jajrussel

[StringJunky]

If ABs are given in suboptimal doses, bacteria have strategies for nullifying their effects. This gives a window for some of the bacteria to mutate into a fully antibiotic-resistant version, which can then persist further down the food chain or even dominate. the colony.

 

Think of antibiotics as evolutionary selectors; if you keep selecting, for the fittest, the antibiotics will eventually fail. The more times you use a particular antibiotic across subjects, the quicker you are selecting for the fittest, so, it renders the antibiotic useless sooner. The important thing with maintaining antibiotic efficacy is to only use them when absolutely necessary.

[CharonY]

There is one thing that remains unanswered in this thread...

 

It is not obvious to me how can low concentrations of antibiotics create bugs resistant to high concentrations of antibiotics? There are hints in this thread that this is an obvious consequence, but I don't see it clearly.

 

I know very little about antibiotics, so I use following analogy: If some bacteria does very good at 25 degrees Celsius, but I increase temperature to 40 degrees Celsius forcing them to develop coping mechanisms and change themselves - how can this create a super bug that can live in autoclave temperatures? My understanding is that organisms change only as much as needed, not more.

 

To be clear, I do expect that higher-than-natural concentrations of antibiotics will somewhat increase the probability of super-bug creation. How much this probability is increased is an important factor of the problem discussed in this thread. If added antibiotics increase likelihood of super-bug creation only marginally (in comparison to natural likelihood) then maybe it is worth it.

 

----

 

Another thing comes in mind: if, as I understood this thread, farmers give antibiotics to animals not for therapeutics effects but for side-effects, wouldn't then be worth investigating this issue a bit further? Can we create a poor antibiotic with nice side-effects for farming usage (because 'gain weight faster while eating less' sounds like useful magic)... And how come those farmers give the whole spectrum of various antibiotics to their animals - why don't they just settle with the cheapest antibiotic type so that they don't rubbish all of them?

 

First, as StringJunky indicated, ABs do not create resistance, they select for it. Resistances emerge by mechanisms such as mutations and horizontal gene transfer. I.e. resistance has to be present in the population to begin with. However, without ABs they do not confer any fitness advantage and will stay in low amounts (which reduces the risk of multiple resistances, which is the real issue here) and do not spread further or may vanish over time again.

At lethal doses the selection is strong, killing off all sensitive strains while only those with resistance survive (there are exceptions like persisters and biofilms, which I will ignore for now).

 

However, at sub-lethal doses (what that level is may differ from strain to strain), it still creates a selective advantage for the already resistant, but gives the sensitive ones still the chance to gain resistance (e.g. by horizontal gene transfer) or to accumulate sufficient mutations that they spontaneously become resistant. So while the selection is weaker, it still exist. And considering that the pool is much larger, as the concentrations are found in wastewater, aquifers and soil, whereas lethal doses mostly at point of application, the overall impact is likely to be higher (as newer research starts to suggest). For example, the amount of resistance genes in soil increase significantly after applying manure. Also, it has been known for years that wastewater sludge is a massive pool of rseistance plasmids that are able to spread resistance rapidly. These plasmids have found to confer resistances to a wide range of ABs at the same time, which, again is the real issue here.

 

The food improvement seems to be due to the actions of ABs on gut biota, therefore as long as they affect bacteria, they will affect resistance. The only way to stop it is to use something else (such as hormones, which is also not ideal).

 

Also there are not good regulations in place that I know of. E.g. in Germany the use of ABs for livestock was banned, however the actual use has not decreased a bit. Farmers just declare it for therapeutic use and continue to use it to fatten up livestock. The amount of ABs in effluents has, increased in most countries rather than decreased.

 

And yes, it has been used for years. And that is one of the reasons why we suddenly find multiple resistant strains popping up in many places and slowly and steadily run out of antibiotics to use. There are some last-line antibiotics that are only used if the patient does not react to any other treatment (such as vancomycin). But recently strains with resistances against those have been found, too.

 

From a disease standpoint, this is nothing short of a disaster. About 10-20 years ago we were in good spirit and were talking about the arms race between chemists and bacteria to develop ever new ABs to combat resistances. The arrival of multiple resistant strains, coupled with high genetic mobility has show over the last few years that we are losing. Badly. In the 90s about 10% of infections were resistant to treatment. Today we are easily above 50% and last-line antibiotics have seen a rise in use (which means they are not last-line anymore). At the same time, the development and production of new antibiotics have been declining and there are many reasons for that.

Although crucial, it has become harder and harder to develop antibiotics to which bacteria are sensitive but does not harm the patient too much. The Obama administration has initiated funding for development of new drugs (which is mostly claimed by small companies).

 

But most working on this field know that it is just a band-aid. If we continue to do what we are doing we are promoting resistances at a vastly higher rate than we can hope to cope with. Alternatives to ABs are being developed, but there is nothing that is no killer treatment yet (and even then we do not know how resistances may evolve and how we may screw it up again. We had the means to overcome bacterial diseases in our hands and we manage to turn it into shit (almost literally).

 

If that sounds gloom and doom to you, I feel like that because I have been following the lit for years. In contrast to things like ebola scares the numbers, unfortunately, add up. Almost all areas imply resistance increase and we see little incentives for us to reduce it to crucial (i.e. therapeutic uses).

It is a sad fact that most likely people will only start thinking about it once we actually monitor deaths related to resistances in more detail. Current clinical practice does not always collect this data. But estimates in the US are on the order of 20k deaths (2013) associated with resistant strains, of which over half are Clostridium difficile. What is worse, however, is that in non-fatal diseases the number of reported multiple resistances are also increasing, not only locally, but globally (the WHO gave a report last year, I think).

 

Unfortunately I think the time to react was about 15 years ago.

Edited June 29, 2015 by CharonY