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6 Things to Know About the Global Superbug Crisis

By Rob Minto

The global superbug crisis is a complicated, long-term problem. The video below explains how it starts, spreads and its impact. But there are many other—sometimes surprising—aspects to this crisis.

There is one key way in which superbugs start. Whether it is in animals or humans, the initial point is where antibiotics kill off drug-susceptible bacteria, leaving drug-resistant bacteria to multiply.

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Pharmaceutical waste in Hyderabad, India. Christian Baars

Superbug Risk Rises as Big Pharma Fails to Disclose Antibiotic Waste Leaked From Factories

By Madlen Davies and Sam Loewenberg

Many of the world's leading drug manufacturers may be leaking antibiotics from their factories into the environment, according to a new report from a drug industry watchdog. This risks creating more superbugs.

The report surveyed household-name pharmaceutical giants like GSK, Novartis and Roche as well as generic companies which make non-branded products for the NHS and other health systems.

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Digitally-colorized scanning electron microscopic image of Enterococcus faecalis. Pete Wardell / CDC

Fact Check: Can This 'Supercharged' Drug Really End Antibiotic Resistance

A breakthrough in antibiotic resistance was reported last week. Scientists had re-engineered the drug vancomycin—used against extremely resistant infections including MRSA—to make it stronger and stop bugs becoming immune to it. Vancomycin has been prescribed for 60 years and is a highly effective antibiotic—yet in some countries bacteria are developing resistance.

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Pollution in Hyderabad. Christian Baars / NDR

Big Pharma's Industrial Pollution Goes Unchecked, Breeds Superbug Crisis

By Madlen Davies

Industrial pollution from Indian pharmaceutical companies making medicines for nearly all the world's major drug companies is fueling the creation of deadly superbugs, suggests new research. Global health authorities have no regulations in place to stop this happening.

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An image of drug-resistant bacteria under the microscope

After 4-Month Battle for His Life, Superbug Survivor Shares His Story

Following a four-month battle for his life, Chris Linaman committed to sharing his story to help raise awareness about the growing threat posed by antibiotic-resistant bacteria. As executive chef at a large medical center, he is also driving change at an institutional level, harnessing his purchasing power to support the responsible use of antibiotics in food animals.

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Photo credit: Peter Muller

It’s Official: KFC Goes Drug-Free to Fight Superbug Crisis

By Lena Brook

What can America's most iconic fast-food chicken chain do to fight the growing epidemic of drug-resistant infections? Set a strong antibiotics policy for its chicken supply!

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Photo credit: National Institute of Allergy and Infectious Diseases

Deadly Superbugs Pose Increasing Threat to Kids

By David Wallinga, MD

Kids can die from superbugs, just as adults do. But a new study last week was among the first I'd seen to dive more deeply and specifically into how this superbug crisis threatens your kids.

The study's findings, which the author called "ominous," appeared in the Journal of the Pediatric Infectious Disease Society. One takeaway was that infections among hospitalized kids due to one nasty superbug, called multidrug-resistant (MDR) Enterobacteriaceae, rose a dramatic 750 percent from 2007 to 2015. One particular variety of the same menace tops a new World Health Organization priority list of global bacterial superbug threats released Monday.

Enterobacteriaceae are a particularly problematic family of gram negative bacteria that includes E. coli, Klebsiella and Salmonella. It's also among the many such superbugs that we already know are found in the U.S. food supply and on farms, as Natural Resources Defense Council's Carmen Cordova blogged Monday.

Strains of Enterobacteriaceae have been popping up in U.S. patients that are pan-resistant (resistant to every medicine), or nearly so, including to colistin and carbapenem, two drugs of last resort that doctors rely upon when all else fails. On U.S. hog farms, too, they've found super-resistant Enterobacteriaceae, some of them carrying resistance to colistin or carbapenems, even thought neither is thought to be used in U.S. hog production.

This study looked over an eight year time period at 94,000 kids discharged from children's hospitals, and who'd also had infections due to Enterobacteriaceae—mostly E. coli urinary tract infections, as it turns out. Thankfully, none of the infections were pan-resistant. But by the end of the period, in 2015, 15 of every thousand of these kids had had infections resistant to multiple antibiotics—more than seven times higher than the incidence among the kids being discharged eight years earlier. Moreover the kids with resistant Enterobacteriaceae infections had hospital stays 20 percent longer compared to kids whose infections were not resistant.

The incredibly rapid rise in MDR Enterobacteriaceae infections among kids is especially ominous. Younger patients have less developed immune systems than adults, so are less able to mount an effective defense against such infections. Much less recognized is the fact that there simply aren't as many antibiotics available to treat sick kids as there are for adults; rising resistance to existing medicines only compounds the already limited choices facing a pediatrician.

One final, worrisome note. To date, super-resistant infections caused by gram negative bacteria like the Enterobacteriaceae have mostly been a problem in hospitals. The fear, and the expectation, was that as resistance worsened, infections would begin to arise among healthier populations out in community settings, as well. But in this study, more than three-quarters of the children with multidrug-resistant infections came to the hospital already infected. That means they contracted those infections from friends, families, food or farms—somewhere else in the community—and not from other patients or staff while in the hospital.

Driving the development and spread of superbugs like this one are U.S. federal policies that still allow the antibiotics important to humans to be routinely given en masse to flocks and herds of food animals, at low doses and over long periods of time in the animal feed or water. Absent tighter federal controls, it's critical that states step up to the plate instead. In Maryland, the Keep Antibiotics Effective Act of 2017 is an important bill trying do just that, by ensuring antibiotics are only given to livestock when they are sick.

That's the kind of leadership that's needed to reverse the trend towards rising numbers of painful, expensive, and ever-harder-to-treat infections in children's hospitals, including at Johns Hopkins, the University of Maryland and elsewhere.

David Wallinga is a physician with more than 20 years of experience in writing, policy and advocacy at the intersection of food, nutrition, sustainability and public health. Wallinga is the senior health officer at Natural Resources Defense Council.

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Antibiotic Resistant Infections Kill 23,000 Americans Each Year, Sicken 2 Million

There's something the farm lobby doesn't want you to know: how much their use of antibiotics in livestock poses a risk to you and your children.

Drug resistant infections are on the rise, according to the Review on Antimicrobial Resistance, "with numbers suggesting that up to 50,000 lives are lost each year to antibiotic-resistant infections in Europe and the U.S. alone. Globally, at least 700,000 die each year of drug resistance in illnesses such as bacterial infections, malaria, HIV/Aids or tuberculosis."

In the U.S., according to the Center for Disease Control and Prevention, at least 2 million people are sickened by antibiotic-resistant infections every year and at least 23,000 die.

"Livestock use of antibiotics is contributing to a public health crisis of antibiotic resistance," said Natural Resources Defense Council (NRDC) senior health officer and physician David Wallinga, MD. "It's you, me and the people we love who will suffer the consequences when the medications we rely on to treat common illnesses no longer work."

Sales of antibiotics for use in food animal production account for 70 percent of total medically important antibiotic sales. That's an increase of 23 percent just since 2009. In 2012, more than 32.2 million pounds of antibiotics were given to farm animals. And while a doctor's prescription is needed for you to get an antibiotic, farmers give virtually all antibiotics to live turkeys, chicken, cattle and hogs without a veterinarian's supervision.

Ohio State University researchers conducted a meta-analysis of medical and scientific studies on antibiotic use in food animals and concluded that "in existing studies, neither the risks to human health nor the benefits to animal production have been well studied."

But, Scientific American said, the farm industry itself is stifling needed research in this area.

Researchers are rarely given access to study livestock in farming operations. Farmers are required by contracts that they have to sign with their customers—big food producers such as Tyson Foods or Perdue Farms—to limit "non-essential people" on their farms. And if the farmer violates the contract, they can be punished monetarily or even lose their contract.

Antibiotics have been used in food production since the 1950s. Some are for therapeutic applications, when an animal is truly sick. Often, they are used to prevent or limit transmission of disease among animals which are confined in close quarters. Many are used simply to make animals grow faster.

But these drugs don't stay confined to the animal receiving them.

A recent study found that 70 percent of pigs on Iowa farms tested positive for MRSA—an antibiotic-resistant staph infection. And the same study found 64 percent of the workers on one farm harbored the superbug. When researchers from the Johns Hopkins School of Medicine drove behind poultry trucks, antibiotic-resistant enterococci was sucked into their car through open windows.

"If regulators wait for this problem to get any worse, controlling it may no longer be possible," said Jonathan Kaplan, director of the Food and Agriculture Program at NRDC. "Future generations are going to wonder why FDA didn't take real action as these life-saving drugs slipped away from us."

Previous U.S. Food and Drug Administration regulations have proven worthless. That's why, in September a coalition of organizations, including the NRDC, petitioned the FDA to withdraw seven medically-important antibiotics from agricultural use.

NRDC Senior Attorney Avinash Kar told EcoWatch, "Experts, the Animal Health Institute and FDA all agree that the FDA's voluntary guidance is likely to have little impact in reducing livestock use of antibiotics—because it addresses only a small portion of use. That's why NRDC is calling on FDA to put an end to the routine use of medically important antibiotics on animals that are not sick, whether it is used for speeding up animal growth or for disease prevention."

But, industry lobbying can hog-tie the FDA's ability to deal with this issue.

According to the Center for Responsive Politics, "Major agribusiness and pharmaceutical interests have spent serious money on lobbying." The American Farm Bureau Federation doled out $5,697,492 for lobbying efforts from 2015 to 2016, and five of their 18 lobbyists previously held government jobs.

The lobbying is working. The FDA requested $7.1 million for fiscal year 2016 to study drug resistance in animals, and got nothing from Congress. Not a dime.

"It's time for the FDA to also act in order to keep antibiotics working, and the time is now," said Steve Blackledge, public health program director at U.S. Public Interest Research Group, which joined the petition to the FDA.Looking ahead, things could get much worse for your health. The 2016 Republican Party platform states:

"We oppose the policies pushed by special interest groups seeking to stop or make more expensive our current system of safe, efficient, and humane production of meat."

The party is now led by Donald Trump, who campaigned against the "FDA food police" and opposes GMO food labeling.

But the problem isn't going away.

Watch here as Dr. Lance Price, director of the Antibiotic Resistance Action Center, talks about factory farms, antibiotics and superbugs at TEDxManhattan:

"Use of antibiotics on the farm most definitely poses a risk to human health," Consumers Union said. The World Health Organization agrees. It noted that 480,000 people develop multi-drug resistant tuberculosis each year and drug resistance is already complicating treatment for HIV and malaria.

Peter Lehner of Earthjustice, stated, "It seems crazy to risk losing the effectiveness of one of our most important inventions—antibiotics—simply because we don't want to make animal factories clean up."

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Scientists Are Freaking Out Over This 25-Year-Old's Solution to Superbugs

After three years of research, a Ph.D. student at the University of Melbourne may have discovered a way to kill superbugs without the use of antibiotics.

Shu Lam believes that she has found the key to averting a health crisis so severe that the United Nations recently declared it a "fundamental threat" to global health.

Shu Lam

Antibiotic-resistant superbugs kill about 170,000 people a year and, according to a British study, are estimated to kill up to 10 million people a year by 2050 and cost the world economy $100 trillion.

"If we fail to address this problem quickly and comprehensively, antimicrobial resistance will make providing high-quality universal healthcare coverage more difficult if not impossible," UN Secretary General Ban Ki-moon told The Guardian. "It will undermine sustainable food production. And it will put the sustainable development goals in jeopardy."

In what is being hailed by scientists in the field as "a breakthrough that could change the face of modern medicine," Lam and her team developed a star-shaped peptide polymer that targets the resistant superbugs, rips apart their cell walls and kills them.

"These star polymers screw up the way bacteria survives," Lam told VICE. "Bacteria need to divide and grow but when our star is attached to the membrane it interferes with these processes. This puts a lot of stress on the bacteria and it initiates a process to kill itself from stress."

A bacterium cell before (left) and after being treated by the star-shaped polymers. University of Melbourne

Lam told The Telegraph the polymers have been effective in treating mice infected by antibiotic-resistant bacteria and are relatively non-toxic to the healthy cells in the body. The reduction in toxicity is because of the larger size of the polymers which make them too big to enter healthy cells.

Lam's findings were recently published in the Nature Microbiology journal and while the results are promising in the lab and on mice, she said there is still a long way to go.

"We still need to do a lot of studies and a lot of tests—for example, to see whether these polymers have any side effects on our bodies," she explained to Vice. "We need a lot of detailed assessments like that, [but] they could hopefully be implemented in the near future."

Professor Greg Qiao, her Ph.D. supervisor, told The Telegraph they will need at least five more years to fully develop her project unless millions of dollars are invested into speeding up the process.

However, "The really good news about this is that, at the moment, if you have a superbug and you run out of antibiotics, there's not much you can do. At least you can do something now," he said.

So what would the star polymer treatment look like in the future? As Lam explained in an interview with VICE:

"The quickest way to make this available to the public is through topical application, simply because you go through less procedures as opposed to ingesting these molecules into the body. So when you have a wound or a bacterial infection on the wound then you [generally] apply some sort of antibacterial cream.

"The star polymers could potentially become one of the anti-bacterial ingredients in this cream. Ultimately, we hope that what we're discovering here could replace antibiotics. In other words, we also hope that we will be able to inject this into the body to treat serious infections, or even to disperse it in the form of a pill which patients can take, just like somebody would take an antibiotic."

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