As I suggested a few years ago, the Soviet Union 
did not use antibiotics as widely as in the U.S. 
or even Europe. They attacked infections with 
macrophages, a different biological approach. 
With so many former Soviet doctors living in the 
United States, it might be wise for U.S. 
hospitals to start employing them and their skills ....

Mitchel Cohen,1518,druck-811560,00.html

Resistant Bacteria

Antibiotics Prove Powerless as Super-Germs Spread

Antibiotics were once the wonder drug. Now, 
however, an increasing number of highly resistant 
-- and deadly -- bacteria are spreading around 
the world. The killer bugs often originate in 
factory farms, where animals are treated whether 
they are sick or not. By SPIEGEL Staff

The pathogens thrive in warm, moist environments. 
They feel comfortable in people's armpits, in the 
genital area and in the nasal mucous membranes. 
Their hunting grounds are in the locker rooms of 
schools and universities, as well as in the 
communal showers of prisons and health clubs.

The bacteria are transmitted via the skin, 
through towels, clothing or direct body contact. 
All it takes is a small abrasion to provide them 
with access to a victim's bloodstream. Festering 
pustules develop at the infection site, at which 
point the pathogens are also capable of corroding 
the lungs. If doctors wait too long, patients can die very quickly.

This is precisely what happened to Ashton Bonds, 
a 17-year-old student at Staunton River High 
School in Bedford County, in the US state of 
Virginia. Ashton spent a week fighting for his 
life -- and lost. This is probably what also 
happened to Omar Rivera, a 12-year-old in New 
York, who doctors sent home because they thought 
he was exhibiting allergy symptoms. He died that same night.

The same thing almost happened at a high school 
in the town of Belen, New Mexico. Less than two 
weeks ago, a cheerleader at the school was 
hospitalized after complaining about an abscess. 
Twelve other female students had been afflicted 
with suspicious rashes. All the students tested 
positive for a bacterium that the US media has dubbed the "superbug."

The school administration in Belen believes that 
the bacterium was spread on mats in the school's 
fitness and wrestling rooms. The facility was 
thoroughly disinfected 40 times, and yet the fear remains.

Fears of a Pandemic

Microbiologists refer to this bacterium as 
community-acquired methicillin-resistant 
Staphylococcus aureus, or ca-MRSA. The terrifying 
thing about it is its resistance to almost all 
common antibiotics, which complicates treatment. 
And, in contrast to the highly drug-resistant 
hospital-acquired MRSA (ha-MRSA) strains, which 
primarily affect the elderly and people in 
hospitals and nursing homes, ca-MRSA affects 
healthy young people. The bacterium has become a 
serious health threat in the United States. 
Doctors have already discovered it in Germany, 
although no deaths have been attributed to it yet in the country.

The two bacteria, ha-MRSA and ca-MRSA, are only 
two strains from an entire arsenal of pathogens 
that are now resistant to almost all available 
antibiotics. Less than a century after the 
discovery of penicillin, one of the most powerful 
miracle weapons ever produced by modern medicine 
threatens to become ineffective.

The British medical journal The Lancet warns that 
the drug-resistant bacteria could spark a 
"pandemic." And, in Germany, the dangerous 
pathogens are no longer only feared "hospital 
bugs" found in intensive care units (ICUs). 
Instead, they have become ubiquitous.

About two weeks ago, consumers were alarmed by 
the results of an analysis of chicken meat by the 
environmentalist group Friends of the Earth 
Germany (BUND), which found multidrug-resistant 
bacteria on more than half of the chicken parts purchased in supermarkets.

The dangerous bacteria have even been detected on 
one of Germany's high-speed ICE trains. Likewise, 
more than 10 percent of the residents of German 
retirement homes have been colonized by MRSA 
bacteria. In their case, every open wound is 
potentially deadly. The pathogens have also been 
found on beef, pork and vegetables.

Another alarming finding is that about 3 to 5 
percent of the population carries so-called 
ESBL-forming bacteria in the intestine without 
knowing it. Even modern antibiotics are 
completely ineffective against these highly resistant bacteria.

Diminishing Defenses

When the neonatal ICU at a hospital in the 
northern German city of Bremen was infested with 
an ESBL-forming bacterium last fall, three prematurely born babies died.

Infestation with multidrug-resistant bacteria is 
normally harmless to healthy individuals because 
their immune systems can keep the pathogens under 
control. Problems arise when an individual becomes seriously ill.

"Take, for example, a person who is having 
surgery and requires artificial respiration and 
receives a venous or urinary catheter," explains 
Petra Gastmeier, director of the Institute of 
Hygiene and Environmental Medicine at Berlin's 
Charité Hospital. "In such a case, the resistant 
intestinal bacteria can enter the lungs, the bloodstream and the bladder."

This results in urinary tract infections, 
pneumonia or sepsis, which are increasingly only 
treatable with so-called reserve antibiotics, 
that is, drugs for emergencies that should only 
be administered when common antibiotics are no longer effective.

The Spread of Killer Bugs

Recently, an even greater threat has arisen. With 
the spread of ESBL-forming bacteria, reserve 
antibiotics have to be used more and more 
frequently, thereby allowing new resistances to 
develop. In fact, there are already some 
pathogens that not even the drugs of last resort 
in the medical arsenal can combat.

In India, where poor hygiene and the availability 
of over-the-counter antibiotics encourage the 
development of resistance, an estimated 100 to 
200 million people are reportedly already 
carriers of these virtually unbeatable killer 
bacteria. There is only one antibiotic left -- a 
drug that is normally not even used anymore owing 
to its potentially fatal side effects -- that is 
still effective against these killer bacteria. In 
serious cases, people who become infected with 
these types of pathogens die of urinary tract 
infections, wound infections or pneumonia.

The killer bugs have also reached England, 
presumably through medical tourists who traveled 
to India for cosmetic surgery, and they have 
reportedly already infected several hundred 
people. A few cases have also turned up in Germany.

Israel even experienced a nationwide outbreak a 
few years ago. Within a few months, about 1,300 
people were afflicted by an extremely dangerous 
bacterium that killed 40 percent of infected 
patients. Even today, the same bacterium still sickens some 300 people a year.

The Post Antibiotic Era
This rapid spread has caused many to wonder 
whether more and more people in Germany will soon 
die of infectious diseases that were supposedly 
treatable, as happened in centuries past. 
Unfortunately, there are many indications that 
this might ultimately be the case.

"We are moving toward a post-antibiotic era," 
predicts Yehuda Carmeli of the Tel Aviv Sourasky 
Medical Center. "But it won't happen on one day 
or at the same time in every part of the world. 
And that's the tragedy, because this means that 
it is not perceived as a serious problem."

The World Health Organization (WHO) recently 
warned against an impending medical catastrophe. 
And, in The Lancet, leading healthcare experts 
published an urgent appeal: "We have watched too 
passively as the treasury of drugs that has 
served us well has been stripped of its value. We 
urge our colleagues worldwide to take 
responsibility for the protection of this 
precious resource. There is no longer time for silence and complacency."

In fact, the carelessness with which doctors and 
farmers are jeopardizing the effectiveness of one 
of the most important groups of drugs borders on 
lunacy. Some 900 metric tons of antibiotics are 
administered to livestock each year in Germany 
alone. Instead of treating only those animals 
that are truly sick, farmers routinely feed the 
medications to all of their animals. Likewise, 
some 300 metric tons of antibiotics are used to 
treat humans each year, far too often for those 
merely suffering from a common cold.

A Foe We Helped Become More Flexible

This large-scale use inevitably leads to the 
spread of resistant bugs. Indeed, antibiotics 
offer ideal growth conditions to individual 
bacteria that have naturally become resistant 
through a small change in their genetic makeup. 
Simply put, they benefit from the fact that the 
antibiotics still kill off their competitors, the non-resistant bacteria.

In many cases, a genetic mutation isn't even 
necessary to allow a resistant bacterium to 
develop. Bacteria can incorporate bits of genetic 
material from other pathogens. For example, for 
millions of years, the gene for ESBL resistance 
lay dormant in the ground, where it was part of a 
complicated ecosystem of bacteria, 
penicillin-producing fungi and plant roots. Again 
and again, the gene was incorporated by human 
intestinal bacteria -- as useless ballast. It was 
only the large-scale use of antibiotics that 
provided the ESBL-forming bacteria with the opportunity to proliferate.

Recent studies show that quantities of 
antibiotics much smaller than previously thought 
can lead to the development of resistance. In 
retrospect, the uncontrolled dispensing of 
antibiotics has proven to be a huge mistake. "In 
the last 30 years, we have contaminated our 
entire environment with antibiotics and resistant 
bacteria," says Jan Kluytmans, a microbiologist 
at Amphia Hospital, in the southern Dutch city of 
Breda. "The question is whether this is even 
reversible anymore. Perhaps we can prevent only 
the worst things from happening now."

Shocking Levels of Antibiotic Abuse on Farms

Since a large share of resistant bacteria come 
from barns, it will be critical to drastically 
reduce the use of antibiotics in agriculture. 
Remarkably often, farmers, feedlot operators and 
veterinarians are themselves carriers of 
multidrug-resistant bacteria. Kluytmans has even 
demonstrated that the pathogens found in humans 
are very often genetically identical with the bacteria detected on meat.

It's virtually impossible to become infected by 
eating such meat, at least as long as it's 
well-cooked. The risk arises when raw meat comes 
into contact with small wounds. What's more, even 
vegetable crops can become contaminated when 
liquid manure is spread onto fields.

The exhaust gases emitted by giant feedlots for 
pigs and chickens could also pose a danger 
greater than previously thought. These meat 
factories blow bacteria, viruses and fungi into 
the air. The government of the western German 
state of North Rhine-Westphalia has commissioned 
a study to determine whether feedlots are 
discharging multidrug-resistant bacteria, thereby 
endangering people in the surrounding areas.

Last year, North Rhine-Westphalia was also the 
first German state to systematically investigate 
the use of antibiotics in chicken farms. The 
horrifying conclusion was that more than 96 
percent of all animals had received these drugs 
-- sometimes up to eight different agents -- in 
their short lives of only a few weeks. "That was 
the proof that the exception -- namely, treating 
disease -- had become the rule," says Johannes 
Remmel, a Green Party member and the state's consumer protection minister.

Abysmal Feedlot Conditions

As the results of the investigation suggest, 
factory farming is to blame. The bigger an 
operation, the more antibiotics are administered 
to individual animals. Investigators also noted 
that the duration of antibiotic use was usually 
very short -- shorter than specified in the 
licensing requirements. This saves money, but it 
also promotes the formation of resistance.

The fact that livestock farmers mix antibiotics 
into feed has to do with production conditions in feedlots:

    * To produce veal, animals from different 
sources that are too weak for milk and beef 
production -- and likewise more susceptible to 
infectious diseases -- are often jammed into enclosures.
    * Pigs are usually kept in very small spaces, 
making them very aggressive and causing them to 
fight. Their wounds have to be treated with antibiotics.
    * In the past, it took 80 days until a 
chicken was ready for slaughter. Today it's only 
37 days. Chicken farmers have a profit margin of 
only a few cents per animal. To minimize losses 
through disease, poultry producers and their 
veterinarian helpers use antibiotics as a preventive tool.

However, factory farming is also possible without 
the uncontrolled use of antibiotics. Dairy cows, 
for example, are usually not given these drugs 
[in Europe, but this does not hold for the U.S. - 
MC] since antibiotics would interfere with the 
production of cheese and yogurt. Nevertheless, 
there are still plenty of inexpensive milk products on supermarket shelves.

"In the Netherlands," says Kluytmans, "the use of 
antibiotics in feedlots was even reduced by about 
30 percent within two years -- partly as a result 
of stricter regulations for veterinarians. That's 
more than we administer to humans." 
Unfortunately, he adds, the use of antibiotics in 
feedlots is practically a matter of religious belief.

Efforts to Combat Antibiotics Abuse

In early January, Ilse Aigner, Germany's minister 
of food, agriculture and consumer protection, 
unveiled a package of measures aimed at curbing 
the use of antibiotics in farm animals. The 
measures include stricter controls that would 
make it more difficult to add antibiotics 
urgently needed in human medicine to animal feed. 
Germany's federal government is also considering 
suspending veterinarians' right to dispense 
medicine. In contrast to doctors practicing 
medicine on humans, who prescribe drugs to be 
purchased at pharmacies, veterinarians can even 
directly sell drugs to farmers and feedlot 
owners, which means they stand to profit 
handsomely from the large-scale use of antibiotics.

However, Remmel, the consumer protection minister 
of North Rhine-Westphalia, believes that Aigner's 
proposals are "deceptively packaged," and he is 
calling for exact specifications on the amounts 
of antibiotics that can be used.

Similarly, there is also little control over the 
use of antibiotics in human medicine. In Germany, 
in particular, doctors prescribe antibiotics as 
they see fit, whereas in the Netherlands doctors 
must first consult with a microbiologist.

"Just as in pain therapy, there really ought to 
be experts for treatment with antibiotics," says 
Gastmeier, the director of the Institute of 
Hygiene and Environmental Medicine at Berlin's 
Charité Hospital "But young doctors, in 
particular, are often relatively uninformed." 
Indeed, in medical school, they learn very little 
about the proper use of antibiotics.

Little Research into New Antibiotics

Still, even more responsible prescribing 
practices will hardly be able to stop the advance 
of resistant bacteria in the long term. What's 
more, no new antibiotics can be seen on the 
horizon. Only four pharmaceutical companies 
worldwide are still working on developing new agents.

"Antibiotics have a serious problem," says 
Wolfgang Wohlleben of the Institute of 
Microbiology at the University of Tübingen, in 
southwestern Germany: "They actually work." 
Indeed, the drugs can get the better of an 
infection within a few hours or days, and then 
they are no longer needed. By contrast, patients 
taking drugs to fight high blood pressure or 
diabetes often have to take them for the rest of 
their lives -- which translates into steady, 
reliable profits for pharmaceutical companies.

Yet another factor making antibiotic-related R&D 
unattractive is the fact that doctors can only 
prescribe a new antibiotic in the most extreme of 
emergencies lest it lose its efficacy within a short amount of time.

Given these circumstances, major pharmaceutical 
companies stopped searching for new antibiotics 
years ago. Nowadays, only small start-ups or 
university-based researchers are interested in the field.

Abandoned by Big Pharma

In reality, the search for new drugs should be 
getting easier rather than more difficult. In the 
1990s, the large pharmaceutical companies spent 
several million euros searching for weaknesses in 
the genetic makeup of bacteria. But although the 
researchers were actually successful, the 
subsequently developed drugs never made the final leap into clinical use.

"In the end, the risks of antibiotic research 
were simply too great for companies," says 
pharmacist Julia Bandow, who went into academia 
to continue studying antibiotics after working 
for the US-based pharmaceutical giant Pfizer for six years.

But without the large pharmaceutical companies, 
there can be little hope of progress. After all, 
testing a drug in human subjects takes years and 
costs millions. And, as Bandow says of her fellow 
academics, "We can't do it alone."

If pharmaceutical companies refuse to invest in 
the necessary studies, it's critical for the 
government to step in. At the least, politicians 
could make the development of antibiotics more 
attractive, for example, by extending the time 
before patents expire so as to allow companies to 
earn returns on their investments for longer. 
But, so far, these are all nothing but ideas.

"At some point in the coming years," says 
microbiologist Kluytmans, "there will be a 
disaster involving resistant pathogens with many 
casualties. Only then will something change."


Translated from the German by Christopher Sultan



Related SPIEGEL ONLINE links:

Stench: Confronting the Threat of Industrial Pig Farms (01/20/2012)
and Protection Money: German Farmers Seek their 
Fortunes in Russia (01/12/2012)

Ring the bells that still can ring,  Forget your perfect offering.
There is a crack, a crack in everything, That's how the light gets in.
~ Leonard Cohen