{"id":109087,"date":"2018-04-16T12:00:55","date_gmt":"2018-04-16T11:00:55","guid":{"rendered":"https:\/\/www.transcend.org\/tms\/?p=109087"},"modified":"2018-04-09T11:28:47","modified_gmt":"2018-04-09T10:28:47","slug":"super-gonorrhea-raises-the-stakes-in-the-war-against-superbugs","status":"publish","type":"post","link":"https:\/\/www.transcend.org\/tms\/2018\/04\/super-gonorrhea-raises-the-stakes-in-the-war-against-superbugs\/","title":{"rendered":"\u2018Super Gonorrhea\u2019 Raises the Stakes in the War against Superbugs"},"content":{"rendered":"<div id=\"attachment_109088\" style=\"width: 410px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/drugs-pills-meds.jpg\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-109088\" class=\"wp-image-109088\" src=\"https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/drugs-pills-meds-1024x504.jpg\" alt=\"\" width=\"400\" height=\"197\" srcset=\"https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/drugs-pills-meds-1024x504.jpg 1024w, https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/drugs-pills-meds-300x148.jpg 300w, https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/drugs-pills-meds-768x378.jpg 768w, https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/drugs-pills-meds.jpg 1356w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><p id=\"caption-attachment-109088\" class=\"wp-caption-text\">Antibiotic resistance is not new but recent developments increase the urgency for action. Shutterstock<\/p><\/div>\n<p><em>5 Apr 2018 &#8211; <\/em>There has been a lot of news over the past few weeks about the rise of superbugs and antibiotic overuse, including a <a target=\"_blank\" href=\"https:\/\/www.theguardian.com\/commentisfree\/2018\/mar\/30\/super-gonorrhoea-antibiotic-crisis-drug-resistant-bugs\" >nasty sexually transmitted infection<\/a> in the United Kingdom. A British man is the first in the world to be diagnosed with a strain of gonorrhoea resistant to all strains of antibiotics used to treat the infection.<\/p>\n<p>Superbugs have tended to pose the greatest risk to people with compromised immune systems, such as cancer patients, and those who were injured or underwent surgery. But the sexual transmission of these bugs means antibiotic resistant infections can spread much more widely.<\/p>\n<p>So what exactly are superbugs, and how scared should we be?<\/p>\n<p><strong>Super but not new<\/strong><\/p>\n<p>\u201cSuperbugs\u201d aren\u2019t the bug equivalent of superheroes. The term describes bacteria that have become resistant to antibiotics. How \u201csuper\u201d they are depends on how many antibiotics they have become resistant to.<\/p>\n<p>\u201cAntibiotic resistance\u201d and \u201cdrug-resistant infections\u201d also refer to the same phenomena. They describe microorganisms that have evolved to become impervious to being killed by treatment with antibiotics.<\/p>\n<p>There is a common misconception that antibiotic resistance means your body has become resistant to antibiotics. This is not true.<\/p>\n<p>Antibiotic resistance is nothing new. Alexander Fleming\u2019s 1945 <a target=\"_blank\" href=\"https:\/\/www.nobelprize.org\/nobel_prizes\/medicine\/laureates\/1945\/fleming-lecture.pdf\" >Nobel Prize acceptance speech for the discovery of penicillin<\/a> discusses the development of resistance. He includes a scenario of Patient X, who:<\/p>\n<blockquote><p><em>buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails.<\/em><\/p><\/blockquote>\n<p>Indeed, resistance has been reported for <em>every<\/em> antibiotic ever introduced \u2013 <a target=\"_blank\" href=\"https:\/\/antimicrobialresistance101.files.wordpress.com\/2015\/04\/antibiotic-resistance-history-graph.png\" >generally within a few years<\/a> of deployment.<\/p>\n<p><strong>How do they become resistant?<\/strong><\/p>\n<p>Bacteria are able to fight antibiotics by a variety of methods:<\/p>\n<ul>\n<li>They build stronger cell walls to stop the drugs from entering<\/li>\n<li>They actively spit them out so the antibiotic can\u2019t reach a lethal concentration inside the cell<\/li>\n<li>They produce enzymes that modify and inactivate the antibiotics and<\/li>\n<li>They alter the target of the antibiotic so it no longer interacts with the drug.<\/li>\n<\/ul>\n<p>One or more of these resistance mechanisms may already be naturally present in a very small fraction of the millions of bacteria exposed to an antibiotic. This is called \u201cinnate resistance\u201d. Most of the bacteria are killed, but this small population survives and grows.<\/p>\n<p>In other cases, resistance develops through evolution (a process known as \u201cinduced resistance\u201d). Bacteria grow rapidly. Under optimal conditions the population can double in as few as 15-30 minutes.<\/p>\n<p>When exposed to sub-lethal doses of antibiotic, bacteria can become tolerant. They accumulate beneficial mutations over multiple generations. They then pass on this resistance to their progeny when they divide.<\/p>\n<blockquote><p><strong><em>Read more: <a target=\"_blank\" href=\"http:\/\/theconversation.com\/we-know-why-bacteria-become-resistant-to-antibiotics-but-how-does-this-actually-happen-59891\" >We know _why_ bacteria become resistant to antibiotics, but _how_ does this actually happen?<\/a> <\/em><\/strong><\/p><\/blockquote>\n<p>Bacteria are also very promiscuous. They exchange pieces of genetic material (plasmids) that carry the codes for resistance. This allows for the rapid spread of resistance between different types of bacteria.<\/p>\n<p>An example is highlighted by <a target=\"_blank\" href=\"https:\/\/www.theaustralian.com.au\/news\/world\/the-times\/drug-resistance-spreads-to-humans-at-shocking-rate\/news-story\/fc0d3487e6f353a1f4569c1770721d34\" >recent news reports<\/a> of resistance to a \u201clast resort\u201d antibiotic, colistin. A gene called mcr-1 (mobilized colistin resistance) was found to be contained in plasmids in <em>E. coli<\/em> bacteria collected from Chinese pig farms in 2011 (<a target=\"_blank\" href=\"http:\/\/www.thelancet.com\/journals\/laninf\/article\/PIIS1473-3099(15)00424-7\/fulltext\" >though it was not reported until 2015<\/a>).<\/p>\n<div id=\"attachment_109089\" style=\"width: 410px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/pigs-porcos-animal.jpg\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-109089\" class=\"wp-image-109089\" src=\"https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/pigs-porcos-animal.jpg\" alt=\"\" width=\"400\" height=\"267\" srcset=\"https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/pigs-porcos-animal.jpg 754w, https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/pigs-porcos-animal-300x200.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><p id=\"caption-attachment-109089\" class=\"wp-caption-text\">A gene that makes bugs resistant to antibiotics of \u2018last resort\u2019 was found in Chinese pig farms. Zawinul\/Shutterstock<\/p><\/div>\n<p>While colistin resistance was already known, the potential for resistance to be quickly spread by this new mechanism is of great concern. For some infections, colistin is the only antibiotic that still works. Indeed, the mcr-1 gene has now been found in <a target=\"_blank\" href=\"https:\/\/www.nature.com\/articles\/s41467-018-03205-z\" >multiple types of bacteria in more than 30 countries<\/a> (including a <a target=\"_blank\" href=\"http:\/\/www.cidrap.umn.edu\/news-perspective\/2016\/05\/highly-resistant-mcr-1-superbug-found-us-first-time\" >patient in the United States in 2016<\/a>).<\/p>\n<p>The <a target=\"_blank\" href=\"http:\/\/www.searo.who.int\/mediacentre\/releases\/2015\/1612\/en\/\" >World Health Organisation is now warning<\/a> that we face a return to a \u201cpre-antibotic era\u201d. It warns:<\/p>\n<blockquote><p><em>Common infections and minor injuries which have been possible to treat for decades may once again kill millions. Resistance to antibiotics will make complex surgeries and management of several chronic illnesses like cancer extremely difficult.<\/em><\/p><\/blockquote>\n<p>Before antibiotics, 40% of deaths were due to infection. If we do not act, <a target=\"_blank\" href=\"https:\/\/amr-review.org\/sites\/default\/files\/160525_Final%20paper_with%20cover.pdf\" >a review commissioned by the United Kingdom government<\/a> predicts that by 2050 drug-resistant infections could cause 10 million annual deaths.<\/p>\n<p><strong>How did we get here?<\/strong><\/p>\n<p>This rise in resistance is largely driven by excessive antibiotic use. The same UK report indicates that up to two-thirds of the world\u2019s antibiotics are not used to treat humans, but are given to animals grown for food. This animal use is often as a food additive, not as therapeutic treatment for an infection.<\/p>\n<p>Of the remaining antibiotics used in humans, up to two-thirds may be inappropriately prescribed.<\/p>\n<p>This huge overuse of antibiotics inevitably drives the development of resistance by unnecessarily exposing a much greater population of bacteria to antibiotics. Sub-lethal concentrations, such as in waste water from farms, fosters resistance.<\/p>\n<p>Alarmingly, <a target=\"_blank\" href=\"http:\/\/www.pnas.org\/content\/early\/2018\/03\/20\/1717295115\" >a recent study<\/a> shows that <a target=\"_blank\" href=\"https:\/\/www.theguardian.com\/science\/2018\/mar\/26\/calls-to-rein-in-antibiotic-use-after-study-shows-65-increase-worldwide\" >our use of antibiotics is increasing even more<\/a>.<\/p>\n<blockquote><p><strong><em>Read more: <a target=\"_blank\" href=\"http:\/\/theconversation.com\/why-the-health-and-agriculture-sectors-need-to-work-together-to-stop-antibiotic-resistance-69031\" >Why the health and agriculture sectors need to work together to stop antibiotic resistance<\/a> <\/em><\/strong><\/p><\/blockquote>\n<p>So, given we already have <a target=\"_blank\" href=\"https:\/\/www.statnews.com\/2017\/01\/12\/nevada-woman-superbug-resistant\/\" >people dying from bacteria resistant to all known antibiotics<\/a>, and these bacteria are <a target=\"_blank\" href=\"https:\/\/apnews.com\/afcee30eb24848d38f9b855fbcc9a4ba\" >becoming increasingly prevalent<\/a>, what\u2019s stopping a global pandemic tomorrow?<\/p>\n<p>It really comes down to the fact that, unless you\u2019re immunocompromised or have an injury allowing the bacteria to get into your body, most bacteria aren\u2019t particularly effective at spreading infections.<\/p>\n<p>This is why the <a target=\"_blank\" href=\"https:\/\/news.nationalgeographic.com\/2018\/03\/gonorrhea-evolving-untreatable-spd\/\" >reports<\/a> of a <a target=\"_blank\" href=\"https:\/\/www.theguardian.com\/commentisfree\/2018\/mar\/30\/super-gonorrhoea-antibiotic-crisis-drug-resistant-bugs\" >\u201csuper-gonorrhea\u201d case in the UK <\/a>are alarming. The sexually transmitted bacteria (<em>Neisseria gonorrhoeae<\/em>) <a target=\"_blank\" href=\"http:\/\/www.who.int\/mediacentre\/news\/releases\/2017\/Antibiotic-resistant-gonorrhoea\/en\/\" >causes nearly 80 million infections a year<\/a>. This bacteria now has the potential to carry and spread high levels of antibiotic resistance through a much larger population of both people and other bacteria.<\/p>\n<div id=\"attachment_109090\" style=\"width: 410px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/cama-bed.jpg\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-109090\" class=\"wp-image-109090\" src=\"https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/cama-bed.jpg\" alt=\"\" width=\"400\" height=\"267\" srcset=\"https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/cama-bed.jpg 754w, https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/cama-bed-300x200.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><p id=\"caption-attachment-109090\" class=\"wp-caption-text\">Super-gonorrhea has the potential to spread antibiotic resistance to many more people.<br \/> The Five Aggregates\/Shutterstock<\/p><\/div>\n<p><strong>Fight against superbugs<\/strong><\/p>\n<p>It\u2019s not all doom and gloom. Nations and international organisations are increasingly devoting attention and resources to fight the rise of antibiotic resistance. Strategies include more sparing use of existing antibiotics, and <a target=\"_blank\" href=\"https:\/\/longitudeprize.org\/\" >investment and incentives to develop diagnostics<\/a> that can decide when antibiotics are needed.<\/p>\n<blockquote><p><strong><em>Read more: <a target=\"_blank\" href=\"http:\/\/theconversation.com\/when-the-drugs-dont-work-how-we-can-turn-the-tide-of-antimicrobial-resistance-71711\" >When the drugs don\u2019t work: how we can turn the tide of antimicrobial resistance<\/a> <\/em><\/strong><\/p><\/blockquote>\n<p>Non-antibiotic approaches, such as vaccines, phage therapy, and microbiome manipulation, are garnering increased consideration.<\/p>\n<p>Initiatives to re-invigorate the discovery of new antibiotics include efforts such as <a target=\"_blank\" href=\"https:\/\/www.gardp.org\/\" >The Global Antibiotic Research &amp; Development Partnership<\/a>, the <a target=\"_blank\" href=\"http:\/\/www.carb-x.org\/\" >Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator<\/a>, and Australia\u2019s own global effort to crowdsource antibiotics from international chemists, <a target=\"_blank\" href=\"http:\/\/www.co-add.org\" >The Community for Open Antimicrobial Drug Discovery<\/a>.<\/p>\n<p>We must keep our attention on the threat posed by drug resistant infections and invest in antimicrobial research to keep the potential global catastrophe at bay.<\/p>\n<p><em>_________________________________________<\/em><\/p>\n<p style=\"padding-left: 30px;\"><a href=\"https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/Mark-Blaskovich.jpg\" ><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-109091 size-full\" src=\"https:\/\/www.transcend.org\/tms\/wp-content\/uploads\/2018\/04\/Mark-Blaskovich-e1523269662923.jpg\" alt=\"\" width=\"100\" height=\"100\" \/><\/a><em><a target=\"_blank\" href=\"http:\/\/theconversation.com\/profiles\/mark-blaskovich-14013\" >Mark Blaskovich <\/a>&#8211; Senior Research Officer, The University of Queensland <\/em><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><em>Republish <\/em>The Conversation<em> articles for free, online or in print, under Creative Commons license.<\/em><\/p>\n<p><a target=\"_blank\" href=\"http:\/\/theconversation.com\/super-gonorrhoea-raises-the-stakes-in-the-war-against-superbugs-94302?utm_medium=email&amp;utm_campaign=Latest%20from%20The%20Conversation%20for%20April%206%202018%20-%2098698569&amp;utm_content=Latest%20from%20The%20Conversation%20for%20April%206%202018%20-%2098698569+CID_501ce8f34521d6cb63460cacc9e73e80&amp;utm_source=campaign_monitor_global&amp;utm_term=Super%20gonorrhoea%20raises%20the%20stakes%20in%20the%20war%20against%20superbugs\" >Go to Original \u2013 theconversation.com<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>5 Apr 2018 &#8211; Superbugs used to pose the greatest risk to people with compromised immune systems and those who had surgery. But their sexual transmission means antibiotic resistance can spread much more widely.<\/p>\n","protected":false},"author":4,"featured_media":109091,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[52],"tags":[],"class_list":["post-109087","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health"],"_links":{"self":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts\/109087","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/comments?post=109087"}],"version-history":[{"count":0,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts\/109087\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/media\/109091"}],"wp:attachment":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/media?parent=109087"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/categories?post=109087"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/tags?post=109087"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}