The Antibiotic Apocalypse Advances

By Dr. Mercola

The featured video is a fascinating visual demonstration of how bacteria develop resistance to increasingly high doses of antibiotics. In this experiment, E. coli bacteria develop increasing resistance, ultimately surviving antibiotics at a dose 1,000 times higher than they could initially survive, and they do so in a matter of 11 days!

Tami Lieberman, Ph.D., an evolutionary microbiologist at MIT who developed the experiment, told NPR:¹

"Getting more people to understand how quickly bacteria evolve antibiotic resistance might help people understand why they shouldn't be prescribed antibiotics. The drug resistance is not some abstract threat. It's real."

Indeed, an estimated 23,000 Americans die each year from drug-resistant infections, and the death toll will continue to rise until or unless the underlying causes are properly addressed.

Sobering Report Predicts Startling Increase in Deaths From Drug-Resistant Illness

According to the largest, most thorough review of the drug resistance problem to date, by 2050 antibiotic-resistant disease will claim the lives of 10 million people around the world each year. As noted by The Atlantic:²

"The report's language is sober but its numbers are apocalyptic. If antibiotics continue to lose their sting, resistant infections will sap $100 trillion from the world economy between now and 2050, equivalent to $10,000 for every person alive today ...

[R]oughly [1 person will die] every [3] seconds, and more than currently die from cancer.

These are conservative estimates: they don't account for procedures that are only safe or possible because of antibiotics, like hip and joint replacements, gut surgeries, C-sections, cancer chemotherapy and organ transplants.

And yet, resistance is not futile. O'Neill's report includes 10 steps to avert the crisis ... seven of his recommendations focus on reducing the wanton and wasteful use of our existing arsenal. It's inevitable that microbes will evolve resistance, but we can delay that process by using drugs more sparingly."

Factory Farms Are Hotbeds for Dangerous Pathogens

The indiscriminate use of antibiotics in concentrated animal feeding operations (CAFOs) significantly contributes to the development of drug-resistant pathogens, which can then migrate into the human population via a number of exposure routes.

One route of exposure is water contaminated with runoff from CAFO manure, which is commonly applied to fields. As noted by the U.S. Geological Survey:³

"Animal manure harbors not only animal-specific pathogens but also zoonotic pathogens (HEV, Campylobacter jejuni) capable of infecting humans …

Increased concentrations of indicator bacteria after manure application that exceeded Iowa's State bacteria water quality standards suggest that swine manure contributes to diminished water quality and may pose a risk to human health."

The study looked at how the application of manure from swine CAFOs impacted the occurrence of bacteria, protozoa and viral pathogens in the South Fork Iowa River — an area that has an estimated 840,000 hogs.

An "abundance" of HEV and other pathogens, including Escherichia coli, Enterococcus spp., Salmonella sp. and Staphylococcus aureus, were found in the water and bottom sediment collected.

Since these same pathogens were also found in the hog manure, the scientists say this is "evidence that such swine manure applications may play an important role in the spreading of zoonotic pathogens to the surrounding environment."

Pathogens Blowing in the Wind

Drug-resistant pathogens incubated in CAFOs are also spread by winds. As noted by Texas Monthly:⁴

"After Texas Tech Researchers discovered that windstorms may be spreading antibiotic-resistant bacteria from local feedlots, public health experts stood up and took notice."

Nearly 80 percent of the cattle raised in U.S. feedlots — some 8.2 million cows — are congregated on the Southern Great Plains.

Contaminated manure not only runs out into holding ponds the size of lakes in some instances, it can also make its way into nearby waterways and watersheds. Whatever is left to dry on the ground also gets swept many miles in whatever direction the wind blows. 

Tests showed genes from bacteria that are resistant to tetracycline antibiotics were an astonishing 400,000 percent more prevalent downwind than upwind, and in some locations 100 percent of air samples were found to contain drug-resistant microbes.

Antibiotics are but one danger here. CAFO cattle are also routinely given steroids, and scientists have found that when steroids get blown into the surrounding environment, they can disrupt the endocrine systems of aquatic wildlife.

FDA Admits Failure

The FDA issued a long-awaited guidance on agricultural antibiotics in December, 2013. However, it didn't go nearly far enough.

The agency simply asked drug companies to voluntarily restrict the use of antibiotics that are important in human medicine by excluding growth promotion in animals as a listed use on the drug label.

They said this would prevent farmers from legally using antibiotics such as tetracyclines, penicillins and azithromycin for growth promotion.

But the number of loopholes in the guidance made it clear it would not be an effective strategy, and data shows that between 2009 and 2014, sales of medically important antibiotics — 70 percent of which are thought to be used in agriculture — increased by 23 percent.

Now the FDA has decided to try to close at least one of the loopholes it left wide open. As reported by STAT News:⁵

"The [FDA] has signaled it wants to take action to plug a major loophole in the rules governing antibiotic use in livestock to try and slow drug resistance.

The agency published a request for comments on a plan to establish treatment time limits for a number of antibiotics that currently do not come with any instructions on how long they can be used …

That lack of guidance leads some analysts to fear producers may be dosing their animals for substantially longer than they need to.

The FDA document notes some of the labels say 'feed continuously' or 'feed continuously as the sole ration.' … Karin Hoelzer, who works on antibiotic resistance and food safety issues at the Pew Charitable Trusts [says] 'They can be used indefinitely … It's a big problem.'"

A number of advocacy groups, including the Center for Science in the Public Interest (CSPI) and the Natural Resources Defense Council (NRDC), are also petitioning the FDA for additional restrictions on the antibiotics that can be given to livestock, pointing out the agency's failure to quell their use with its voluntary program.⁶ How long it will take for the FDA to finally take meaningful action remains to be seen.   

Infection Rates Remain Poorly Monitored

While it's become quite clear that antibiotic-resistant disease is taking its toll on human health, the U.S. is still dragging its feet when it comes to monitoring the situation.

A heart-breaking Reuters report⁷ reveals an increasingly common situation: Parents take their child to the hospital, where the child succumbs to a drug-resistant infection and dies. One of the more common infections spread in hospitals is methicillin-resistant Staphylococcus aureus (MRSA).

Last year, a MRSA outbreak in the neonatal unit at Chippenham Hospital in Richmond, Virginia, infected nine infants before the outbreak was curtailed. Yet strangely enough, the children's death certificates do not even mention MRSA.

"[A]fter being contacted by Reuters earlier this year about the outbreak, [Shala] Bowser went to Virginia's Division of Vital Records to get a copy of Josiah's death certificate," Reuters states. "The cause of death: 'Sepsis due to (or as a consequence of): Prematurity.'

Sepsis is a complication of infection, but there was no mention of MRSA. 'My heart hurts,' Bowser said, sobbing. 'I saw what this did to him. And then they just threw a bunch of words on the death certificate' …

Fifteen years after the U.S. government declared antibiotic-resistant infections to be a grave threat to public health, a Reuters investigation has found that infection-related deaths are going uncounted, hindering the nation's ability to fight a scourge that exacts a significant human and financial toll."

According to Reuters, tens of thousands of deaths from drug-resistant infections, plus tens of thousands of illnesses from which the individual eventually recovers, go uncounted. Federal and state agencies simply aren't tracking them. Not even the U.S. Centers for Disease Control and Prevention (CDC) is tracking antibiotic-resistant infections, and as Ramanan Laxminarayan, Ph.D., director of the Center for Disease Dynamics, Economics and Policy, told Reuters:

"You need to know how many people are dying of a disease. For better or worse, that's an indicator of how serious it is."

How Does One Address a Health Crisis With Guesswork?

According to Reuters, the CDC statistic of 23,000 Americans dying from drug-resistant infections is actually more akin to a guess opposed to hard data.

"Reuters analyzed the agency's math and found that the estimates are based on few actual reported deaths from a drug-resistant infection. The agency leaned heavily on small samplings of infections and deaths collected from no more than 10 states in a single year, 2011. Most didn't include populous areas such as Florida, Texas, New York City and Southern California.

From those small samples, the CDC then extrapolated most of its national estimates, introducing so much statistical uncertainty into the numbers as to render them useless for the purposes of fighting a persistent public health crisis. Describing the estimates to Reuters, even CDC officials used words like 'jerry-rig,' 'ballpark figure' and 'a searchlight in the dark attempt.'"

New Superbug Emerges

Meanwhile, a strain of E. coli resistant to not just one but two of our last-resort antibiotics has now emerged in the U.S. The sample was collected from a patient in 2014 but was not tested and identified until 2016, when a larger analysis of hospital germs was performed. The E. coli in question is resistant to colistin and carbapenem, two antibiotics used when all other alternatives have been exhausted.

I've previously written about the emergence of mcr-1, a bacterial gene that convers resistance to colistin; the gene blaNDM-5 is similar in that it confers resistance against carbapenem. As reported by STAT News:⁸

"Researchers and health officials have feared the joining of these two genes in a single bacterial strain, as it could set the stage for the rise of superbugs that can't be treated with our current arsenal of drugs. The combination has been detected before in other countries, including Germany, Venezuela, and China, but until now, it has never been seen within the United States.

Fortunately, although the E. coli in this case was resistant to carbapenem and colistin, the strain was susceptible to some other antibiotics … But finding mcr-1 and blaNDM-5 together is still concerning. Each gene is carried on a separate bacterial plasmid, a segment of DNA that has the potential to hop around between bacteria of different strains. Detecting the combination once in the United States means there's likely more out there."

United Nations to Hold Global Summit on Superbug Explosion

Antibiotic resistance is not just an American problem. Far from it. There are no borders when it comes to drug-resistant bacteria, and they can spread far, fast. According to the World Health Organization (WHO), drug-resistant pathogens are now present across the globe. They're everywhere and no one is safe.

Recognizing the situation as a global threat of massive proportions, the United Nations (UN) General Assembly will hold a special meeting to discuss antimicrobial resistance on September 21 in New York City.⁹ Health topics have only been the focus of a General Assembly meeting three times in the UN's history. Previous topics were HIV, non-communicable diseases and Ebola. As reported by Scientific American:¹⁰

"The meeting 'is a clear recognition that this is a worldwide threat to everyone and worldwide action is what we need to address it,' says Ezekiel Emanuel, [Ph.D.], chair of medical ethics and health policy at the University of Pennsylvania …

'The fact we are so concerned about colistin resistance is a sign of how desperate we are,' says Lance Price, [Ph.D.], a microbiologist and director of the Antibiotic Resistance Action Center at The George Washington University. 'It's a shitty drug. It's toxic and doctors don't like to use it, but now they have to use it because it's the only thing that treats some of these drug-resistant infections' …

Yet the actions that are hoped for as a result of the meeting remain meager. No binding agreement is expected. What may be more realistic … is a political declaration of commitment to coordinate further on this issue."

Triclosan Banned for Use in Soap

Besides agricultural and medicinal use of antibiotics, common household products containing antimicrobial ingredients also contribute to growing drug-resistance. Triclosan is one such ingredient, and I recommended avoiding triclosan for many years before the media picked up on it. 

Now, after a four-decades' long delay, the U.S. Food and Drug Administration (FDA) has finally decided to ban the chemical from use in commercial soaps, citing potentially harmful side effects (drug resistance and hormonal effects) and lack of proven effectiveness.^11,12 In a September 2, 2016, press release, the FDA said:¹³

"Companies will no longer be able to market antibacterial washes with these ingredients because manufacturers did not demonstrate that the ingredients are both safe for long-term daily use and more effective than plain soap and water in preventing illness and the spread of certain infections …

This final rule applies to consumer antiseptic wash products containing one or more of 19 specific active ingredients, including the most commonly used ingredients — triclosan and triclocarban. These products are intended for use with water, and are rinsed off after use. This rule does not affect consumer hand 'sanitizers' or wipes, or antibacterial products used in health care settings.

Triclosan Ban Does Not Go Far Enough to Protect Human Health

Unfortunately, while this is a step in the right direction, it's an exceedingly small one. Triclosan and other antimicrobial chemicals will still be permitted in a great number of other products, including Colgate Total toothpaste,¹⁴ deodorants,¹⁵ dishwashing liquid, laundry detergents and much more.

In fact, triclosan and triclocarbon are so ubiquitous these chemicals show up in household dust — and according to researchers, this dust may also contribute to the drug-resistance problem. According to UPI:¹⁶

"The chemicals triclosan and triclocarbon, as well as four other antimicrobial chemicals, were found in house dust by researchers at the University of Oregon, Harvard University and Arizona State University, according [to] a study¹⁷ published in the journal Environmental Science and Technology, suggesting their use in cleaners is contributing to antibiotic resistance …

The researchers then studied dust microbes, finding antibiotic resistance genes, which can be passed between bacteria, linked specifically to the six cleaning chemicals detected in the initial analysis. Samples with higher amounts of triclosan … had higher levels of genes linked to bacteria resistant to multiple drugs … "

How You Can Help Stop the Spread of Antibiotic-Resistant Disease

In light of the growing problem of antibiotic-resistant disease, it would be wise to employ techniques and strategies that will not only reduce your own risk of falling victim, but also help curtail the spread of antibiotic resistance in general. While the problem of antibiotic resistance really needs to be stemmed through public policy on a nationwide level, the more people who get involved on a personal level, the better. Such strategies include: