Thames study: Rivers can be a source antibiotic resistance

Space Daily via SPX: Rivers and streams could be a major source of antibiotic resistance in the environment. The discovery comes following a study on the Thames river by scientists at the University of Warwick's School of Life Sciences and the University of Exeter Medical School.

The study found that greater numbers of resistant bacteria exist close to some waste water treatment works, and that these plants are likely to be responsible for at least half of the increase observed.

Antimicrobial resistance is one of the largest threats to human health for a century, the researchers argue. Increasingly large amounts of antibiotics are released into the environment through both human and agricultural use, with surface run off from farming activities (including fertiliser and animal slurry) washed straight into rivers after heavy rainfall. Co-lead on the research, Professor Elizabeth Wellington of the University of Warwick, said:

"Antibiotic resistance naturally occurs in the environment, but we don't yet know how human and agricultural waste is affecting its development. We've found that waste water discharges effect resistance levels and that improvements in our treatment processes could hold the key to reducing the prevalence of resistant bacteria in the environment.

"We found antibiotic resistance in the group Enterobacteriaceae which includes gut bacteria and pathogens."...

Thames River at night, shot by Cristian Bortes Cristian Bortes , Wikimedia Commons via Flickr, under the Creative Commons Attribution 2.0 Generic license

Predicting superbugs' countermoves to new drugs

Intern Daily: With drug-resistant bacteria on the rise, even common infections that were easily controlled for decades - such as pneumonia or urinary tract infections - are proving trickier to treat with standard antibiotics. New drugs are desperately needed, but so are ways to maximize the effective lifespan of these drugs.

To accomplish that, Duke University researchers used software they developed to predict a constantly-evolving infectious bacterium's countermoves to one of these new drugs ahead of time, before the drug is even tested on patients.

In a study appearing in the journal Proceedings of the National Academy of Sciences, the team used their program to identify the genetic changes that will allow methicillin-resistant Staphylococcus aureus, or MRSA, to develop resistance to a class of new experimental drugs that show promise against the deadly bug.

When the researchers treated live bacteria with the new drug, two of the genetic changes actually arose, just as their algorithm predicted. "This gives us a window into the future to see what bacteria will do to evade drugs that we design before a drug is deployed," said co-author Bruce Donald, a professor of computer science and biochemistry at Duke.

Developing pre-emptive strategies while the drugs are still in the design phase will give scientists a head start on the next line of compounds that will be effective despite the germ's resistance mutations....

Some antibiotics, shot supplied by Wellcome Images, Wikimedia Commons, under the Creative Commons Attribution 4.0 International license 

Superbugs could kill 10 million people a year

CBS News: Warnings about the dangers of antibiotic-resistant "superbugs" are taking on new urgency with the release of a frightening new report from the British government. The report says higher rates of drug-resistant bacterial infections could result in 10 million deaths a year by 2050. The report puts the financial toll at a potential $100 trillion.

"That's a tremendous impact," CBS News medical contributor Dr. David Agus told "CBS This Morning." And the problem is not just hypothetical. "It's a real threat today. It's going to be a bigger threat," he said.

Superbugs such as Methicillin-resistant Staphylococcus aureus, commonly called MRSA, are currently blamed for about 23,000 deaths a year in the United States. Earlier this year, the World Health Organization warned that antibiotic-resistant strains of bacteria have now spread worldwide and could lead to a "post-antibiotic era in which common infections and minor injuries...can once again kill." The WHO report called the problem "so serious that it threatens the achievements of modern medicine."

The risk has grown in recent years as the overuse of common antibiotics encouraged growth of drug-resistant strains. "Every time somebody has a fever, a doctor can give them an antibiotic. We have to stop that," Agus said. Antibiotics don't work against viral infections like a cold or the flu, but patients often ask for the drugs anyway, and too often doctors comply...

Colorized transmission electron micrograph showing USA 300 strain of Staphlococcus aureus, shown in gold, outside a white blood cell, shown in blue. National Institute of Allergy and Infectious Diseases (NIAID). From the National Institutes of Health

New method for quickly determining antibiotic resistance

A press release from Uppsala University: Scientists from Uppsala University, the Science for Life Laboratory (SciLifeLab) in Stockholm and Uppsala University Hospital have developed a new method of rapidly identifying which bacteria are causing an infection and determining whether they are resistant or sensitive to antibiotics. The findings are now being published in the Journal of Clinical Microbiology.

‘Clinical use of the method would mean that the right antibiotic treatment could be started straightaway, reducing unnecessary use of antibiotics,’ says Professor Dan I. Andersson of Uppsala University, who headed the study jointly with Professor Mats Nilsson of SciLifeLab in Stockholm and Stockholm University.

Antibiotic resistance is a growing medical problem that threatens human health all
over the world. Today, many people are dying because of infections caused by resistant bacteria. When an infected person is treated with antibiotics, ‘empirical therapy’ is usually provided. This means that the choice of antibiotic is based on the resistance situation of the bacteria in a large population (such as the Swedish population), rather than on the resistance, if any, of the bacteria in the infected person’s body. The result is sometimes selection of an antibiotic drug that is ineffective against the bacteria concerned, because the latter is resistant to the drug chosen. This, in turn, boosts the use of antibiotics, especially what are known as ‘broad-spectrum’ antibiotics that work on many types of bacteria. One possible solution to these problems would be for us to have reliable methods of quickly and easily identifying the bacterial species causing the infection and its resistance pattern, and apply the correct treatment immediately.

Professor Andersson continues: ‘This is just what we’ve been working on in our study. We have developed a new method that permits identification of both the species and the resistance pattern of bacteria in urinary infections in less than four hours. By comparison, the resistance determination done at present takes one to two days.’...

Agar plate with colonies, image from NOAA

"Third wave" of malaria resistance lurks on Thai-Cambodia border

IRIN: Public health experts and scientists warn history's third major bout of drug-resistant malaria could spread across Asia to Africa unless "radical action" is taken. Artemisinin-resistant strains on the Thailand-Cambodia border threaten the treatment's efficacy and pose containment challenges.

"The bad news is that drug-resistant parasites are actually found in a wider area than we previously thought," said Nicholas White, professor of Tropical Medicine at the University of Oxford, and author of a July 2014 study that revealed drug-resistant malaria parasites have spread to critical border regions of Southeast Asia (including the Cambodia-Thailand and Myanmar-Thailand borders), and that resistance to Artemisinin, the world's most effective anti-malarial drug, is now widespread in the region.

Artemisinin is effective against malaria, but it must be used in a combination of several drugs. In 2007, the World Health Assembly (WHA) issued a resolution calling for the end of monotherapies (or using a single drug) to treat malaria as this practice was causing resistance. A full dose of Artemisinin Combination Therapy (ACT) is now prescribed to prevent the development of drug resistance.

According to White, who also chairs the Worldwide Antimalarial Resistance Network, despite the new evidence of resistance along the Thailand-Cambodia border, not all hope for effective interventions is lost. He told IRIN: "The good news is that we can still treat it using longer ACT courses and we can map its spread using a molecular marker."...

Drug-resistant malaria spreading in southeast Asia

Steve Baragona in VOA News: From Vietnam to Burma, the leading drug against malaria is losing potency, according to a new study in the New England Journal of Medicine. On the plus side, the same issue of the journal reports that a new antimalarial drug looks promising in an early test.

Artemisinin-based drugs have helped make dramatic gains against malaria worldwide. “If we lose this class of drugs, it’s really going to be a global health catastrophe,” said Dr. Chris Plowe at the University of Maryland School of Medicine. “There’s nothing on the shelf that’s ready to replace those.”

Plowe and colleagues studied resistance rates in seven Asian and three African countries. The worst problems were along the Thailand-Cambodia border, where the first artemisinin drug failures were reported. But they found significant resistance from southern Vietnam to central Burma.

The fact that it’s on the move in Southeast Asia “speaks to the possibility that from there it can jump into Africa, which is the big concern, ultimately,” said Columbia University microbiologist David Fidock, who was not involved in the research. That’s what happened with resistance to previous malaria drugs, and it cost countless lives.

In fact, Plowe said that part of the world has proved to be a drug-resistant malaria hotspot. “It’s happened again and again, with at least four different antimalarial drugs, where resistant parasites popped up along the border between Thailand and Cambodia,” he said....

Iwona Tesarowicz of B. Oleksyn laboratory made this image of artemisinin's molecular structure. Public domain

WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health

A press release from the World Health Organization: A new report by WHO–its first to look at antimicrobial resistance, including antibiotic resistance, globally–reveals that this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. Antibiotic resistance–when bacteria change so antibiotics no longer work in people who need them to treat infections–is now a major threat to public health.

“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” says Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security. “Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”

The report, "Antimicrobial resistance: global report on surveillance", notes that resistance is occurring across many different infectious agents but the report focuses on antibiotic resistance in seven different bacteria responsible for common, serious diseases such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea. The results are cause for high concern, documenting resistance to antibiotics, especially “last resort” antibiotics, in all regions of the world. Key findings from the report include:

• Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumoniae–carbapenem antibiotics–has spread to all regions of the world. K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients. ...
• Resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E. coli–fluoroquinolones–is very widespread. ...
• Treatment failure to the last resort of treatment for gonorrhoea–third generation cephalosporins–has been confirmed in Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom. More than 1 million people are infected with gonorrhoea around the world every day.
• Antibiotic resistance causes people to be sick for longer and increases the risk of death. For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection. Resistance also increases the cost of health care with lengthier stays in hospital and more intensive care required....

Extensive use of antibiotics in agriculture creating public health crisis

Seed Daily via SPX: Citing an overabundance in the use of antibiotics by the agriculture and aquaculture industries that poses a threat to public health, economics professor Aidan Hollis has proposed a solution in the form of user fees on the non-human use of antibiotics.

In a newly released paper published in the New England Journal of Medicine, Hollis and co-author Ziana Ahmed state that in the United States 80 per cent of the antibiotics in the country are consumed in agriculture and aquaculture for the purpose of increasing food production.

This flood of antibiotics released into the environment - sprayed on fruit trees and fed to the likes of livestock, poultry and salmon, among other uses - has led bacteria to evolve, Hollis writes. Mounting evidence cited in the journal shows resistant pathogens are emerging in the wake of this veritable flood of antibiotics - resulting in an increase in bacteria that is immune to available treatments.

If the problem is left unchecked, this will create a health crisis on a global scale, Hollis says. Hollis suggest that the predicament could be greatly alleviated by imposing a user fee on the non-human uses of antibiotics, similar to the way in which logging companies pay stumpage fees and oil companies pay royalties.

"Modern medicine relies on antibiotics to kill off bacterial infections," explains Hollis. "This is incredibly important. Without effective antibiotics, any surgery - even minor ones - will become extremely risky. Cancer therapies, similarly, are dependent on the availability of effective antimicrobials. Ordinary infections will kill otherwise healthy people."...

A scanning electron micrograph of MRSA, from the National Institutes of Health

'Superbugs' found breeding in sewage plants

Terra Daily via SPX: Tests at two wastewater treatment plants in northern China revealed antibiotic-resistant bacteria were not only escaping purification but also breeding and spreading their dangerous cargo. Joint research by scientists from Rice, Nankai and Tianjin universities found "superbugs" carrying New Delhi Metallo-beta-lactamase (NDM-1), a multidrug-resistant gene first identified in India in 2010, in wastewater disinfected by chlorination.

They found significant levels of NDM-1 in the effluent released to the environment and even higher levels in dewatered sludge applied to soils. The study, led by Rice University environmental engineer Pedro Alvarez, appeared this month in the American Chemical Society journal Environmental Science and Technology Letters. "It's scary," Alvarez said.

"There's no antibiotic that can kill them. We only realized they exist just a little while ago when a Swedish man got infected in India, in New Delhi. Now, people are beginning to realize that more and more tourists trying to go to the upper waters of the Ganges River are getting these infections that cannot be treated. "We often think about sewage treatment plants as a way to protect us, to get rid of all of these disease-causing constituents in wastewater.

But it turns out these microbes are growing. They're eating sewage, so they proliferate. In one wastewater treatment plant, we had four to five of these superbugs coming out for every one that came in." Antibiotic-resistant bacteria have been raising alarms for years, particularly in hospital environments where public health officials fear they can be transferred from patient to patient and are very difficult to treat....

A white blood cell interacting with MRSA bacteria (an antibiotic resistant strain of staphylococcus aurea), National Institutes of Health

A new weapon in the war against superbugs

A press release from the American Friends of Tel Aviv University: In the arms race between bacteria and modern medicine, bacteria have gained an edge. In recent decades, bacterial resistance to antibiotics has developed faster than the production of new antibiotics, making bacterial infections increasingly difficult to treat. Scientists worry that a particularly virulent and deadly "superbug" could one day join the ranks of existing untreatable bacteria, causing a public health catastrophe comparable with the Black Death.

Now research led by Dr. Udi Qimron of Tel Aviv University's Department of Clinical Microbiology and Immunology at the Sackler Faculty of Medicine has discovered a protein that kills bacteria. The isolation of this protein, produced by a virus that attacks bacteria, is a major step toward developing a substitute for conventional antibiotics. "To stay ahead of bacterial resistance, we have to keep developing new antibiotics," said Dr. Qimron. "What we found is a small protein that could serve as a powerful antibiotic in the future."

...Bacteriophages, often referred to as "phages," are viruses that infect and replicate in bacteria. Because they coevolved with bacteria, they are optimized to kill them. As proof of their endurance, phages are the most common life form on earth, outnumbering bacteria 10 to one. In places like the former Soviet Union, phages have been used to treat bacterial infections for the past hundred years. Harmless to humans, they inject their DNA into bacteria and rapidly replicate, killing their hosts.

...Dr. Qimron and his colleagues set out to understand how all 56 proteins found in T7, a particularly virulent phage that infects Escherichia coli bacteria, contribute to its functioning. They discovered that one of the proteins, called 0.4, impedes cell division in E. coli, causing the cells of the bacteria to elongate and then die. The protein is common to many bacteria and a similar process occurs in all bacteria, so the finding may have wide application.

...The major challenge for pharmaceutical companies will be figuring out how exactly to deliver the protein as a drug, said Dr. Qimron. In the meantime, he continues to hunt for other proteins that kill bacteria.

Bacteriophages shot by Mostafa Fatehi, Wikimedia Commons, under the Creative Commons Attribution 3.0 Unported license

Academies urge action on drug resistance and development policy

T.V. Padma in SciDev.net: Science academies from eight developed and five emerging economies have urged developing countries to take a lead in tackling increasing drug resistance and pledged to support policymaking for sustainable development.

In two joint statements released last week (29 May) they noted the need for new drug discovery and development to tackle growing drug resistance worldwide, and they pledged to support policymaking for sustainable development through inter-academy and research collaboration.

In the statement on drug resistance, the academies say there is a need for enhancing research and development capacity in developing countries; regular monitoring of drug sensitivity; tracking resistance in real-time; carrying out regular surveys on the impacts of antibiotics released into the environment; and promoting drug regulation policies.

On sustainable development policy after 2015, the deadline for meeting the UN Millennium Development Goals (MDGs), they pledge to proactively engage with international, national and regional policymakers with an eye on "providing objective expertise" and ensuring "scientific rigour to gathering evidence"....

Parasite 'resistant to malaria drug artemisinin'

Rebecca Morelle in the BBC: New drug-resistant strains of the parasite that causes malaria have been identified by scientists. Researchers found parasites in western Cambodia that are genetically different from other strains around the world.

These organisms are able to withstand treatment by artemisinin - a frontline drug in the fight against malaria. Reports of drug resistance in the area first emerged in 2008. The problem has since spread to other parts of South East Asia. The study is published in the journal Nature Genetics.

The lead author, Dr Olivo Miotto, of the University of Oxford and Mahidol University in Thailand, said: "All the most effective drugs that we have had in the last few decades have been one by one rendered useless by the remarkable ability of this parasite to mutate and develop resistance. "Artemisinin right now works very well. It is the best weapon we have against the disease, and we need to keep it."...

Antibiotics resistance 'as big a risk as terrorism'

Fergus Walsh in BBC News: The danger posed by growing resistance to antibiotics should be ranked along with terrorism on a list of threats to the nation, the government's chief medical officer for England has said. Professor Dame Sally Davies described it as a "ticking time bomb".

She warned that routine operations could become deadly in just 20 years if we lose the ability to fight infection. Dame Sally urged the government to raise the issue during next month's G8 Summit in London.

Dame Sally said: "If we don't take action, then we may all be back in an almost 19th Century environment where infections kill us as a result of routine operations. We won't be able to do a lot of our cancer treatments or organ transplants."

She said pharmaceutical companies needed to be encouraged to develop new drugs, because the manufacture of antibiotics was not viewed as profitable. "We haven't had a new class of antibiotics since the late 80s and there are very few antibiotics in the pipeline of the big pharmaceutical companies that develop and make drugs," she said.

"We haven't as a society globally incentivised making antibiotics. It's quite simple - if they make something to treat high blood pressure or diabetes and it works, we will use it on our patients everyday "Whereas antibiotics will only be used for a week or two when they're needed, and then they have a limited life span because of resistance developing anyway."...

Bacteria on an agar plate, shot by HansN., Wikimedia Commons, under the Creative Commons Attribution-Share Alike 3.0 Unported license

Antibiotic resistance flourishes in freshwater systems

Terra Daily via SPX: The author Dr. Seuss may have been on to something when he imagined that microscopic communities could live and flourish on small specs of dust, barely visible to the naked eye. In fact, such vibrant communities exist - in a material with a Seussical sounding, yet scientific name called 'floc'.

McMaster University researchers have now discovered that floc - "goo-like" substances that occur suspended in water and that host large communities of bacteria - also contain high levels of antibiotic resistance.

"This has important public health implications because the more antibiotic resistance there is, the less effective our antibiotic arsenal is against infectious diseases," said Lesley Warren, the principal investigator for the study that looked at floc in different freshwater systems.

The research was led by Warren, professor of earth sciences and Gerry Wright, scientific director of the Michael G. DeGroote Institute for Infectious Disease Research, both of McMaster, along with Ian Droppo, a research scientist at Environment Canada.

They examined floc collected from Hamilton Harbour, which is impacted by sewer overflow; Sunnyside Beach in Toronto, which is impacted by wastewater; a rural stream near Guelph, impacted by light agricultural activities; and a remote lake in a natural preserve area in Algonquin Park, accessible only by float plane.

...They were surprised to discover that genes encoding resistance to clinically relevant antibiotics were present in floc bacteria at all four sites, although resistance varied in intensity based on human influence. That is, there was less antibiotic resistance detectable from Algonquin Lake compared to Hamilton Harbour, which harbored the highest concentration of floc trace elements. "What this tells us is that antibiotic resistance is widespread in aquatic environments ranging from heavily impacted urban sites to remote areas," said Warren...

Tonnage and percentage of veterinary use of antibiotics in the Netherlands in 2002 per compound class. Antibiotic names are in Dutch. Graph by Tnvaessen, public domain

Race against time as malaria resistance grows

Brendan Trembath in ABC Sydney (Australia): There is new evidence that resistance to the main treatments for malaria is increasing. Scientists have found resistant strains of the parasite on the border between Thailand and Burma.

A few years ago researchers also found malaria resistance in parts of western Cambodia. In the study, published in The Lancet, Professor Francois Nosten and fellow scientists say increased resistance in the region has "seriously compromised" the effort to eliminate the deadly disease.

"Malaria is particularly resistant to drugs in this part of the world," he said. "The concerns are that if we lose these drugs to resistance, we have no new treatment for this disease.

"These drugs, the Artemisia derivatives have been adopted as the standout treatment for any case of malaria worldwide, because they are very effective. "But of course obviously if the parasite that causes malaria becomes resistant to them, then we will be in great trouble." Professor Nosten says there are no back-up drugs in the development pipeline....

A mosquito, shot by Alvesgaspar, Wikimedia Commons, under the Creative Commons Attribution-Share Alike 3.0 Unported license

Antibiotic pollution may increase groundwater nitrate

Chemical & Engineering News: Decades after spawning a health care revolution, antibiotics are now common pollutants. Scientists' biggest concern about these emerging contaminants is that they promote the spread of resistance. But new research suggests they also harm the microbes that cleanse groundwater of dangerous compounds, particularly nitrates...

High nitrate levels in drinking water can cause methemoglobinemia, a disease that decreases the blood's oxygen carrying capacity. Naturally-occurring bacteria in groundwater, such as Pseudomonas putida, can remove nitrates by reducing them to nitrogen gas.

In Cape Cod, Mass., very high nitrate levels co-occur in groundwater with one of the most common antibiotics in the clinical arsenal: sulfamethoxazole (SMX). For nearly a decade, microbiologist Ronald Harvey and colleagues from the U.S. Geological Survey have tracked SMX and other groundwater pollutants at an aquifer that originates at the Otis Air National Guard Base, a heavily polluted site on Cape Cod. Other researchers had shown that high doses of SMX can interfere with bacterial nitrate reduction. But no one knew if a similar response might occur at environmentally-relevant concentrations.

To answer that question, Harvey's team first cultured bacteria from a non-contaminated portion of the aquifer. Next, they added nitrate to the cultures at levels measured in the environment, along with SMX at doses ranging from 0.005 to 2,000 µM. Bacterial growth rates dropped at all doses. At the environmentally relevant concentration of 0.005 µM SMX, the amount of total nitrate that the bacteria removed from the culture fell by nearly half. "We're demonstrating a clear biological effect," Harvey says. "And we're showing that in the same bacteria that live in this particular aquifer."…

The structure of sulfamethoxazole, rendered by osmodiar, Wikimedia Commons, under the Creative Commons Attribution ShareAlike 3.0 License