In January, Columbia University announced that four patients had contracted an unusual version of the Irving Medical Center in New York And coli , common bowel bacteria. Although most of the news was ignored in the media, she bounced through the world of infectious diseases experts. And coli is a relatively common bacterium and benign in the intestines where it otherwise lives, but in misplaced places – such as salad or minced meat or in our bloodstream – may be deadly. To prove antibiotics against And coli Infection, even half of the patients die with it within two weeks.
That's why Columbia And coli it was so worrisome. In the past ten or two years And coli has developed antibiotic resistance to the other. The ultimate hope of some infected patients is antibiotic colistin, a toxic substance with potential side effects such as kidney and brain damage. Columbia And coli had a mutation in the MCR-1 gene, which gives a frightening attribute: leakproofness for colistin.
"We are looking for the next antibiotic on the shelf, and there's nothing there," says Erica Shenoy, deputy director of infection control at Massachusetts's General Hospital. "We are confronted with the spirit of patients with infections that we can not cure."
Since the experimental miracle drug known as Penicillin Hospitalized in Boston in 1942 to save 13 nightclub victims, medical researchers have discovered more than 100 new antibiotics. We should have each of them – and they are not enough. Not just that And coli , Drug Resistant Soaps Staphylococcus . Enterobacteriaceae and Clostridium difficult antibiotics consistently prevail; One study has shown that the number of deaths from resistant infections has increased five times between 2007 and 2015. Recently, mushroom-resistant versions have been developed Candida auris they appeared in hospitals in New York and Chicago, killing half of the infected patients.
US Centers for Disease Control and Control have reported that 2 million people in the United States suffer from bacteria or fungi that are resistant to key antibiotics and 23,000 die from them. "It is likely to be a major underestimation," says Karen Hoffmann, head of the Association of Experts on Infection Control and Epidemiology. "We do not have a good reporting system for multi-drug resistant organisms, so we do not know exactly." According to studies, the US health care system for treating patients with these solid insects amounts to more than $ 3 billion a year.
This dreary trend should be accelerated. The World Health Organization predicts that the worldwide mortality rate of microbes will decrease from the current 700,000 per year to 10 million by 2050. At this time, they will overcome cancer, heart disease and diabetes as the leading cause of death in 2010. Before antibiotics, small incisions, caries or routine surgery can lead to life-threatening bacterial infections. Penicillin, "miracle medicine" and other antibiotics have changed all of this and saved countless lives over the years. But the miracle medicine seems to end.
Doctors learn how to identify and isolate already stable gangs to prevent large epidemics. They seek to increase the use of antibiotics to slow down the development of resistant strains. It is too late, too late: the strategy will only give us some time. At the moment, the oldest and the poorest patients in the hospitals are most affected, but the risks are widening. "We see healthy young people with urinary tract infections and skin infections for which we have no tablet," says Helen Boucher, a specialist in infectious diseases at the Tufts Medical Center in Boston. "And maybe we will not be able to do organ transplantation or even routine surgery like swapping the joints. We should all be scared."
Medical experts rely on brand new strategies to tackle infections. To find new ways to kill insects, they seek exotic locations – viruses and fish sludge, and even other planets. They use insight into genomics and other areas to develop new technologies that can kill and prevent their spread. In addition, they monitor practice in hospitals and other areas of bacterial distribution and use more holistic strategies to address bacteria in our bodies, as well as in our hospitals and medical practices.
Alternative sounds promising but far away. It's not clear we can invent a new weapon before the superperi, like the army of the zombie at the door, overpower our defenses.
"We have to invest heavily in other approaches," said Margaret Riley, a drug resistance researcher at Massachusetts University. "And we have to do this 15 years ago."
New bug hunters
Part of the problem of drug resistance is that microbes develop into new species with an alarming rate. While people need 15 or more years to mature enough to have offspring, microbes like And coli multiply every 20 minutes. For several years, it will be able to go through the evolutionary shift that humanity needed to achieve millions of years. This change may involve gaining genetic attributes that allow them to resist medication. People who take antibiotics are the perfect laboratory for developing microbial resistance. "Research has shown that when a new antibiotic is introduced, the first resistant microbes appear about a year later," says Shenoy of Mass General.
In the pharmaceutical pipeline there is little to replace the antibiotics against which the bugs have become resistant. This is because the development of a new antibiotic costs about $ 2 billion and lasts for about 10 years, with little hope of finding a blockbuster drug justifying such an investment. "The purpose of the new antibiotic is to use it as little as possible and as short as possible," says Jonathan Zenilman, head of the Department of Infectious Diseases at Johns Hopkins Bayview Medical Center in Baltimore. "Why would a pharmaceutical company want to develop a cure for such a market?"
Medical researchers now look for other approaches. He recruits a biologist with a sense of evolution in the war against insects. In the 1990s, Riley began investigating at Harvard and Yale how viruses kill bacteria and how bacteria are killed. In the year 2000, her colleague leisurely asked her if she had any work on human health. "I've never thought about it," she says. "But suddenly everything went for me, and I've covered this question."
Over the last two decades, Riley has been working on the application of a virus strategy to the problem of resistant infections in humans. Viruses, called "phages", which are basically pieces of genetic material wrapped in protective protein, break through the bacterial cell wall and digest its genetic machinery, transforming the bacterium into a virus-producing plant. Riley also considers that bacteria sometimes kill other bacteria in the food competition. Bacterial colonies sometimes win the competitor by producing toxic proteins called "bacteriosi".
Riley's goal is not just to kill dangerous bacteria, but also to protect those useful. Of the approximately 400 billion bacteria that live in or on each of our bodies, the vast majority are useful or harmless – only one tenth of a million percent of them are potentially harmful, she says. Widespread broad spectrum antibiotics such as penicillin, ciprofloxacin and tetracycline do not distinguish between good and bad bacteria – they all eliminate them. This not only results in the appearance of resistant bacteria but also causes problems for the patient.
"The antibiotic is like throwing an H-bomb on an infection," says Riley. "They kill 50 percent or more of all bacteria in the body, and the lack of healthy bacteria is associated with obesity, depression, allergies, and other problems." Remove the colonies of infectious bacteria without damage to the normal flora or by creating a soil for the reproduction of resistant insects.
ImmuCell, a biotech company in Portland, Maine, has developed bacteriocin that cures milk cows for mastitis, a dairy industry that costs $ 2 billion a year. According to Riley, laboratories like her can adapt phage and bacteria to direct virtually any kind of microbial infection of a human with no risk of new resistance. "These are stable, robust killing mechanisms that developed 2 billion years ago," she says.
In Poland, Georgia and Bangladesh, several clinical trials on phage therapy have already been successfully completed. In the west, there were successful attempts at stomach fatigue. There are currently no studies on serious infections, but successfully treating the risk for multiple risk drug-resistant patients in California in 2017, according to regulations on emergency food and drug administration, has led to the development of more researchers in the United States beans treatments. One or more of these studies could take place over the next few years, says Riley, including one anti-tuberculosis-resistant tuberculosis and another anti-lung infection in patients with cystic fibrosis. Bacterios are behind. The US government has pledged $ 2 billion to develop these alternatives, "but that's far enough," she says.
Cancer researchers explore drugs that can boost the immune system. These immunotherapies can help the weakened patients to fight against resistant insects trying to gain strength. Researchers have produced human antibodies in cows and other animals that can be injected into the patient. In an emergency, Brigham and the Boston-based Women's Hospital, Harvard, reported that they injected a combination of antibodies and antibiotics to rescue patients with a drug-resistant infection. The results were not published. Somewhere else, little has been done to improve access to studies in infected patients. Researchers also work on vaccines against resistant staphylococci and other resistant bacteria, but they are just research efforts. "These non-antibiotic treatments are still in the early stages of research," said David Banach, Head of Infection Prevention, UConn Medical Center, Farmington, Connecticut. "But we still have to think about new approaches."
Given the tremendous urgency of the problem, why does it take so long to harmonize promising solutions with testing and availability? Because there's a lot of money in it, says Tufts Boucher. The government invests billions in research, but private investment in research on drugs and devices has not been realized. According to Boucher, pharmaceutical companies have little chance of using a drug that probably will not consume millions of people, or at a price of tens of thousands of dollars per dose. "The economic model is broken," she says.
Although antibiotics are the true medicines in their effects, our current problems are partly due to the fact that the drug relies heavily on them. Physicians prescribe it for ear infections, inflammation of the throat and urinary tract infections. Surgeons use them to prevent postoperative infections. Since bacteria can develop resistance, antibiotics are most useful as part of a holistic approach to controlling bacterial spread and tackling infections. As antibiotics gradually lose their utility, medical experts now emphasize multiple strategies to prevent insects.